Journal Article

Virtual reality cue-exposure therapy in reducing cocaine craving: the Promoting Innovative COgnitive behavioral therapy for Cocaine use disorder (PICOC) study protocol for a randomized controlled trial

Lehoux, T., Mopsus, Yann, Rollier, Sloane, Gervilla, Miguel, Melgire, Manuela, Weiner, Luisa, Capobianco, Antonio, Lecuyer, Flavien, Lacoste, Jérôme

2024

Overview

Background Cocaine craving is a central symptom of cocaine use disorders (CUD). Virtual reality cue-exposure therapy for craving (VRCET) allows more immersive, realistic, and controllable exposure than traditional non-VR cue-exposure therapy (CET), whose efficacy is limited in treating substance use disorders. The purpose of this study is to evaluate the efficacy and acceptability of VRCET, as a stand-alone and add-on intervention (i.e., combined with cognitive therapy), compared to a picture-based CET (PCET), in reducing self-reported cocaine craving in inpatients hospitalized for CUD. Methods Fifty-four inpatients hospitalized for CUD will be randomized in one of two intensive 3-week treatment arms: 10 meetings/2-week treatment of VRCET plus 5 meetings/1-week treatment of memory-focused cognitive therapy (MFCT; experimental arm), or 15 meetings/3-week treatment of PCET (active control arm). The Craving Experience Questionnaire (CEQ – F & S) will be used to assess the primary outcome, i.e., the post-treatment decrease of self-reported cocaine craving frequency (within the past 2 weeks) and intensity scores (in VR exposure to cocaine cues). Secondary endpoints include urinary, physiological, and self-reported cocaine use-related measures. Assessments are scheduled at pretreatment, after 2 weeks of treatment (i.e., VRCET vs. PCET), post-treatment (3 weeks, i.e., VRCET + MFCT vs. PCET), and at 1-month follow-up. Acceptability will be evaluated via (i) the Spatial Presence for Immersive Environments – Cybersickness along VRCET and (ii) the Client Satisfaction Questionnaires after 2 weeks of treatment and post-treatment. Discussion This study will be the first to evaluate the acceptability and efficacy of VRCET for CUD, as a psychotherapeutic add-on, to reduce both cocaine craving frequency and intensity. Additionally, this study will provide evidence about the specific interest of VRCET, compared to a non-VR-based CET, as a cue reactivity and exposure paradigm for treating substance use disorders. Trial registration NCT05833529 [clinicaltrials.gov]. Prospectively registered on April 17, 2023.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abstinence / Adult / Behavior modification / Behavioral health care / Biomedicine / Clinical trials / Cocaine / Cocaine craving / Cocaine use disorder / Cocaine-Related Disorders - psychology / Cocaine-Related Disorders - therapy / Cognitive behavioral therapy / Cognitive Behavioral Therapy - methods / Cognitive Sciences / Cognitive therapy / Craving / Cue-exposure therapy (CET) / Cues / Drug use / Female / Funding / Health Sciences / Hospital patients / Human health and pathology / Humans / Innovations / Intervention / Life Sciences / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Memory-focused cognitive therapy (MFCT) / Neurons and Cognition / Nicotine / Patients / Psychiatrics and mental health / Randomized Controlled Trials as Topic / Registration / Statistics for Life Sciences / Study Protocol / Substance abuse / Systematic review / Time Factors / Treatment Outcome / Virtual reality / Virtual reality cue-exposure therapy (VRCET) / Virtual Reality Exposure Therapy - methods