The digital transformation is in full swing. Intensive research is being conducted into new applications for virtual reality. Psychiatry in particular could benefit from the new technology. Addictive disorders and ADHD, which is often comorbid, present with limited diagnostic and therapeutic options. Can new, digital paths be taken here?
Virtual lifestyles are becoming increasingly important. Computer-based immersion and virtual presence have long since left the pure game world. Science, too, is increasingly making use of this world of experience. Virtual reality (VR) can be used to investigate self- and body perception, social situations, and the experience of spaces or contexts. Kornelius Kammler-Sücker, Mannheim (D), pointed out that the possibilities are manifold. In this way, experiments can be standardized, motivation can be increased with the help of the game character, imagination techniques can be applied in a protected setting, and impossible situations can be made possible. In the future, the digitalization of society will lead to people moving more and more into virtual living environments. However, this can also pose dangers, especially in the psychiatric context. After all, the digitally generated environment must not be a substitute for the real physical-social living environment. Moreover, science is still in its infancy in this regard, so results are often not easy to interpret. Critical interdisciplinarity is needed here to exploit the advantages of the new treatment pathways without giving room to the disadvantages. But it is worth it, the expert is sure.
Addiction treatment interdisciplinary
Tobacco use is undoubtedly one of the most common addictions. It causes the deaths of eight million people worldwide every year. Even after smoking cessation, sustained abstinence is rare. In other words, the recidivism rate is high. However, therapeutic measures to increase abstinence rates are severely limited. This is because the psychological and biological mechanisms underlying smoking behavior in the context of divergent environmental factors are not yet well understood. Study results suggest that smokers are more likely to reach for a cigarette when they are in the presence of others who smoke. Non-smoking attendants, on the other hand, reduce the likelihood of smoking. Implicit craving for a cigarette, approach behavior to and an attentional bias toward cigarette stimuli, as well as explicit craving and hormonal processes might mediate these associations, stated Katharina Eidenmüller, Mannheim (D).
Specifically, possible mediators include hypersensitization to motivational incentive effects. The increased wanting of the substance is due to changes in motivationally relevant dopamine systems. In addition, attentional bias also plays a role. Automatic selective attentional bias toward substance-associated stimuli is an important predictor of the outcome of targeted smoking abstinence. Approach bias represents the third aspect. It defines the automatic approach tendency toward substance-associated stimuli and is measurable with the Approach Avoidance Task. In addition, especially in the context of stress and social interactions, relevant hormones exist that serve as mediators between environmental factors and behavior. These include, for example, cortisol, arginine vasopressin and oxytocin.
What can VR do that normal life can’t?
There are tools to examine all of these mediators. Why would VR come into play? One reason is the high ecological validity with simultaneous high standardizability, according to the expert. Moreover, craving for cigarettes can be generated in the simulation and does not have to be completed in real life. This is because the VR environment with smoking cues generates thoughts and smoking and heightened attention to cigarette-associated stimuli. For example, it was found that interactions with smoking avatars in VR rooms elicited stronger craving than in smoking cues without avatars. A recently launched study is looking into this in more detail. Under investigation are the hypotheses that the presence of a smoking avatar triggers more implicit wanting for cigarettes, a stronger approach tendency to cigarette stimuli, a stronger attentional bias, and a stronger craving for a cigarette in smokers. After smoking a cigarette, these same mediators are expected to decrease. Similarly, arginine vasopression is expected to decrease, whereas cortisol and oxytocin increase.
Help with diagnostics and therapy of adult ADHD
Virtual reality can also assist in the diagnostic and treatment management of adult ADHD. Because although ADHD is defined by inattention, hyperactivity, and impulsivity, these symptoms often cannot be detected or treated by common neuropsychological methods, explained Niclas Braun, MD, Bonn (D). The reason for this paradox is probably the low ecological validity of currently existing neuropsychological procedures. VR makes it possible to create a realistic and symptom-relevant testing environment that remains highly standardizable at the same time. Inspired by virtual classroom environments for children with ADHD, a virtual seminar room environment for adults with ADHD, among others, can be used for a multimodal characterization of inattention and impulsivity. In a feasibility study with 26 healthy subjects, test performance, experience sampling, EEG theta-beta ratios, EEG P300 amplitudes, and head movements/rotations, among others, were examined. Subjects performed a Continuous Performance Task directly in the virtual seminar room while various distracting events were played simultaneously. It was shown that simultaneous study of behavioral performance, EEG, and actigraphy in VR is possible. In addition, the healthy controls tolerated this setup well and were compliant. In a next step, the test of the paradigm must now be performed on patients with ADHD.
Source: “Virtual reality technologies in addiction and ADHD therapy (research),” 11/27/2021.
Congress: dgppn 2021
InFo NEUROLOGY & PSYCHIATRY 2022; 20(1): 30-31.
