Moving Beyond Role-Play: Evaluating the Use of Virtual Reality to Teach Emotion Regulation for the Prevention of Adolescent Risk Behavior Within a Randomized Pilot Trial.

OBJECTIVE: The purpose of the current pilot study was to evaluate the acceptability and preliminary impact of using immersive virtual reality environments (IVREs) paired with a brief emotion regulation and risk reduction intervention (ER + IVRE) relative to this same intervention content paired with role-plays (ER + RP). METHODS: Eighty-five adolescents attending middle school (grades 6th-8th; ages 12-15 years) in an urban northeast city were recruited and randomized to ER + IVRE (n = 44) or ER + RP (n = 41) and had complete data. Data examining acceptability, feasibility, sexual knowledge and attitudes, and ER were collected at baseline and 3 months after intervention completion. Analyses of covariance controlling for baseline scores were used to evaluate study outcomes. Within and between intervention effect sizes were calculated with effect sizes ≥.20 considered meaningful. RESULTS: At the 3-month follow-up assessment, several within intervention condition effect sizes were found to exceed d = 0.20 across the measured sexual attitudes and ER outcomes. Between intervention analyses found that adolescents randomized to ER + IVRE attended more intervention sessions, reported less difficulty accessing ER strategies (d = 0.46), and reported higher emotional self-efficacy (d = 0.20) at the 3-month follow-up relative to adolescents randomized to the ER + RP intervention. CONCLUSIONS: This study provides preliminary evidence that using virtual reality environments to enhance ER skill building in risk situations was acceptable, feasible to deliver, and positively impacted ER abilities.

Reactivity to cannabis cues in virtual reality environments.

Virtual reality (VR) cue environments have been developed and successfully tested in nicotine, cocaine, and alcohol abusers. Aims in the current article include the development and testing of a novel VR cannabis cue reactivity assessment system. It was hypothesized that subjective craving levels and attention to cannabis cues would be higher in VR environments with cannabis cues compared to VR neutral environments. Twenty nontreatment-seeking current cannabis smokers participated in the VR cue trial. During the VR cue trial, participants were exposed to four virtual environments that contained audio, visual, olfactory, and vibrotactile sensory stimuli. Two VR environments contained cannabis cues that consisted of a party room in which people were smoking cannabis and a room containing cannabis paraphernalia without people. Two VR neutral rooms without cannabis cues consisted of a digital art gallery with nature videos. Subjective craving and attention to cues were significantly higher in the VR cannabis environments compared to the VR neutral environments. These findings indicate that VR cannabis cue reactivity may offer a new technology-based method to advance addiction research and treatment.

Assessing reactivity to virtual reality alcohol based cues.

The use of virtual reality (VR) programs in behavioral science research has been gaining prominence over the past several years. In the field of substance abuse, VR cue reactivity programs have been successfully tested for feasibility in nicotine and cocaine dependent samples. Seeking to expand VR applications in alcohol cue research, a novel VR alcohol cue reactivity assessment system incorporating visual, auditory, and olfactory stimuli was developed and tested. In a controlled trial, 40 non-treatment-seeking drinkers with alcohol use disorders were exposed to VR alcohol cue environments. Subjective craving, attention to alcohol cues, and level of presence (realism of experience) in VR were assessed across the environments. Overall, subjective craving for alcohol increased across the VR alcohol-related cue environments versus VR neutral cue environments. Participants reported high levels of presence in VR, indicating that the environments were perceived as realistic and compelling. These initial findings support the use of VR based cue reactivity environments for use in alcohol cue-based treatment and research.

Frequency of stuttering during challenging and supportive virtual reality job interviews.

UNLABELLED: This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals' time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants' subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to-(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.

Virtual reality cue reactivity assessment in cigarette smokers.

Drug craving has purportedly been linked to relapse and to substance use. For over two decades, cue reactivity has been a viable method to assess craving and physiological reactions to drug stimuli. However, traditional cue reactivity has faced the following limitations: austere situations or stimuli, lack of complex cues, lack of standardization, and limited generalization outside of the lab setting. In order to improve cue methodologies, a virtual reality (VR) nicotine cue reactivity assessment system (VR-NCRAS) was developed and tested in a controlled experimental trial. Ten nicotine dependent smokers were exposed to VR smoking cues and VR neutral cues in a standardized, timed, computer controlled experiment. Subjective craving and physiological responses were recorded and compared across VR-NCRAS stimuli. Subjective cigarette craving increased significantly and corresponding physiological reactivity was observed in response to VR smoking cues. VR neutral cues did not result in subjective or physiological changes consistent with craving. Implications of these findings on substance abuse research and treatment are discussed.

Utilizing virtual reality to standardize nicotine craving research: a pilot study.

Traditional cue reactivity provides a methodology for examining drug triggers and stimuli in laboratory and clinical settings. However, current techniques lack standardization and generalization across research settings. Improved methodologies using virtual reality (VR) cue reactivity extend previous research standardizing exposure to stimuli and exploring reactions to drug cues in a controlled VR setting. In a controlled pilot trial, 13 nicotine-dependent participants were allowed to smoke ad libitum then exposed to VR smoking and VR neutral cues and compared on craving intensity. VR smoking cues significantly increased craving compared to VR neutral cues. On average, craving intensity increased 118% during exposure to VR smoking cues. Implications for substance abuse research and treatment using VR to assess cessation and anticraving medications are discussed.