Elsevier

Addictive Behaviors

Volume 41, February 2015, Pages 61-64
Addictive Behaviors

Short Communication
The effect of repeated exposure to virtual gambling cues on the urge to gamble

https://doi.org/10.1016/j.addbeh.2014.09.027Get rights and content

Highlights

  • VR casino environment was able to evoke a significant urge to gamble.

  • The participants' urge to gamble was the strongest in playing a casino game scene.

  • The urge to gamble decreased continuously as a function of repeated exposure.

  • VR-CET combined with relaxation training can reduce recreational gamblers' urges.

Abstract

Introduction

This study aimed to investigate the effectiveness of using a virtual reality (VR) casino environment in cue exposure therapy (CET) for gambling. The main objective of this study was to assess the ability of five VR casino cues to elicit subjective reactions and physiological responses that can be used within the CET paradigm. A second objective was to analyze changes in participants' urge to gamble after repeated exposure to a VR casino program and relaxation training.

Methods

Twelve recreational gamblers were exposed to five virtual environments with casino-related cues that reproduced typical gambling situations. Self-reported subjective urges and psychophysiological responses were recorded during exposure.

Results

All virtual environments with casino-related cues generated craving in recreational gamblers, whereas no increase in the psychophysiological variables was observed. In addition, urges to gamble elicited by VR casino environment reduced through repeated exposure and relaxation training.

Conclusion

These findings provide evidence of the effectiveness of VR for simulating casino environments in the treatment of gambling.

Introduction

Pathological gambling (PG) is a progressive and recurrent maladaptive pattern of gambling behavior characterized by increased preoccupation with gambling activities, loss of control over such behavior, and continued gambling despite problems in social or occupational functioning (American Psychiatric Association, 2000). It is associated with significant financial losses and disrupted interpersonal and familial relationships (Blanco, Hasin, Petry, Stinson, & Grant, 2006).

Cue exposure therapy (CET) refers to repeated exposure to drug-related cues aimed at reducing reactivity to such cues via extinction (Conklin & Tiffany, 2002). Craving and cue reactivity have been conceptualized as classically conditioned responses, and CET is based on the notion that prolonged and repeated non-reinforced presentation of cues will result in a gradual diminution of the urge through Pavlovian extinction. Several authors have reported that virtual reality (VR) is an effective approach to reducing cue reactivity related to alcohol, cannabis, and cigarettes (Bordnick et al., 2005, Bordnick et al., 2008, Bordnick et al., 2009, Choi et al., 2011).

Symes and Nicki (1997) tested the effect of repeated exposure to stimuli associated with gambling on the urge to gamble and perceived self-efficacy. During each session, two probable pathological gamblers received five exposures to relevant stimuli to provoke the urge to gamble. Data obtained during each session showed a reduction in the urge to gamble over the course of certain sessions. Another case study conducted by Tolchard, Thomas, and Battersby (2006) found a reduction in the urge to gamble during a single exposure session. However, the case-study experimental design used in these two studies restricts the generalization of their findings (Giroux et al., 2013). One study reported the effectiveness of a VR cue exposure paradigm for pathological gamblers (Giroux et al., 2013). Ten participants moved throughout a virtual bar with five video lottery terminals five times. Whereas the desire to gamble significantly increased when participants transitioned from the practice environment to the gambling environment, this study was unable to confirm the process of extinction because it consisted of only a single 20-min session.

In this preliminary study, we aimed to investigate the feasibility and viability of a VR casino environment for the use in repeated CET to treat gambling. The main objective of this study was to assess the ability of five VR casino cues used within the CET paradigm to produce subjective reactions as well as physiological responses. A second objective was to analyze changes in participants' urge to gamble after several sessions of repeated exposure and relaxation training.

Section snippets

Participants

We recruited subjects through advertisements posted at an outpatient clinic. Those eligible to participate had a basic interest in gambling for recreational purposes; score on the South Oaks Gambling Screen (SOGS; Lesieur & Blume, 1987) of 4 or less; and no history of excessive gambling. One reason for recruiting recreational gamblers was that they have reported levels of cue-elicited urges similar to those reported by pathological gamblers in response to the videotaped exciting-gambling

Results

In the first section of Table 1, Experiment 1 shows the mean subjective gambling urges reported by participants, as well as their psychophysiological responses before and after exposure to the virtual environments. According to these data, all scenes with casino cues succeeded in increasing participants' subjective urges. The results of the repeated-measures ANOVAs revealed significant differences in subjective urge across scenarios (F(3.83, 42.13) = 8.19, p = .00). Post hoc comparisons showed the

Discussion and conclusion

To our knowledge, this is the first study to evaluate the effect of CET on the urge to gamble using VR system with a design including multiple independent sessions. The main goal of Experiment 1 was to assess the feasibility and effectiveness of several virtual environments with specific casino-related cues that were developed by the researchers to elicit craving in social gamblers. In Experiment 2, the main purpose was to assess changes in urges related to casino gambling associated with

Role of funding sources

This work was supported by a grant from the Korea Healthcare Technology R&D Project of the Ministry for Health and Welfare, Republic of Korea (HI12C-0113) and by the Seoul National University Hospital Research Fund (0420110980).

Contributors

Jung-Seok Choi designed the study and wrote the grant. Jun-Young Lee, Hee Yeon Jung, and Bo Kyung Sohn provided summaries of a previous research and supervised the development of the virtual environments and the data collection. Su Mi Park and Chan-Bin Park collected and analyzed the data and wrote the first draft of the manuscript. Chan-Bin Park wrote the final version of the manuscript. All authors contributed to and have approved the final manuscript.

Conflicts of interest

All the authors declare that they have no conflicts of interest.

Acknowledgments

The authors would like to thank Duke Jung at FNI Co., Ltd. for technological support in the production of the virtual reality content.

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