Table 3.

Clinical trial on Virtual Reality (VR) treatment in addiction.

Study	Design	Population	Control conditions	VR intervention	A	Assessment	Outcomes
NICOTINE
Lee et al. (2004)	- Trial	−15 adolescent males, low to moderate ND1		- VET (20 min, 1 session) 20 min sessions	N	- Baseline, end of treatment: VAS, morning and daily smoking count, planning (min), FTND, SSQ, PQ	- No change in craving and others variables
Pericot-Valverde et al. (2014)	- Trial	−48 TS, low to moderate NDa, b		- VET: progressive individualized exposure (30 min, 5 sessions, 1/w)	Y	- Baseline, end of treatment: VAS, cig/d, air expired CO	- ↓ Craving - ↓ Cig/day and air expired CO
Pericot-Valverde et al. (2015)	- Trial	−41 TS, low to moderate NDa, b		- VET: degressive individualized exposure (30 min, 5 sessions, 1/w)	N	- Baseline: gender, age, years of education, marital status, duration of daily smoking, FTND, NDSS, MNWS, STAI, BDI-II, DD - Week 1 and 5 post-treatment: VAS	- ↓ Craving; correlated with younger age, higher Cig/day, DD, BDI-II
Park et al. (2014)	- CT	−30 TS males, moderate NDa, c	- TTT: CBT (4 sessions, 1/w)	- VET: 2 complex and 2 neutral (25 min, 4 sessions, 1/w)	N	- Baseline, end of treatment, week 12: QSU, cig/d, air expired CO, FTND, MNWS (per protocole analysis)	- No change in craving- No difference on craving - ↓ Dependence (daily smoking count, expiratory CO levels, FTND)
Pericot-Valverde et al. (2019)	- RCT	−102 TS, moderate NDa, c	- TTT: CBT (60 min, 6 sessions, 1/w)	- VET (+CBT): progressive individualized exposure (30 min, 5 sessions, 1/w)	N	- Baseline and month 1, 6, 12: VAS, abstinence, relapse rate, treatment retention (ITT analysis)	- ↓ Craving - ↑ Relapse at 12 months
Girard et al. (2009)	- RCT	−91 outpatients, moderate to high NDa	- TTT: Grasp up to 60 virtual balls (30 min, 4 sessions, 1/w)	- VBT: find and crush up to 60 virtual cigarettes (30 min, 4 sessions, 1/w)	N	- Baseline, end of treatment, week 12: cig/d, air expired CO, FTND, PQ, SSQ (ITT analysis)	- ↓ Dependence - ↑ Abstinence at week 12 - ↓ Treatment drop out - ↑ Presence and ↓ cybersickness at end of treatment
Bordnick et al. (2012)	- RCT	−46 TS, moderate to high NDa, d	- TTT: NRT	- VCBT: progressive individualized exposure and coping skill training (1 h, 10 sessions, 1/w)	Y	- Baseline, end of treatment: QSU-Brief, cig/d, SASE - 1 month post treatment: SCQ (No ITT analysis)	- ↓ Craving - ↓ cig/d - ↑ Self-efficacy and SCQ
ALCOHOL
Lee et al. (2009)	- CT	−38 inpatient males, ADd(abstinent from a week)	- TTT: CBT + education (45 min, 10 sessions, 2/w) - Group: VET in 15 healthy males	- VET: relaxation, exposure, aversive situation (25 min, 10 sessions, 2/w)	Y	- Baseline, end of treatment: VAS, EEG	- ↓ Craving - ↑ Right Frontal EEG alpha power
Son et al. (2015)	- Trial	−12 inpatient, ADd, e (abstinent from a week)	- Group: 15 healthy subjects	- VET: relaxation, exposure, aversive situation (25 min, 10 sessions, 2/w)	Y	- Baseline, end of treatment: VAS, TEP-FDG	- ↓ Craving - No correlation between change in craving and brain metabolism
Choi and Lee (2015)	- Trial	−20 male, HSDe	- Group: 20 male LDf	- VET: 2 social aversive situations (20 min, 1 session)	N	- Baseline, end of treatment: AUQ, alcohol-IAT, eye-tracking test, alcohol-Stroop test.	- ↓ Craving - ↓ Alcohol-IAT and reaction times for alcohol-related stimuli
GAMBLING DISORDER
Giroux et al. (2013)	- Trial	−10 outpatient, gamblers		- VET: progressive exposure (20 min, 1 session)	Y	- Baseline, post treatment: VAS, self-efficacy	- No change in craving and self-efficacy
Bouchard et al. (2017)	- CT	- Study 1: 28, frequent gamblersg	- TTT: in vivo exposure or neutral exposure (1 session) - Group: 36 occasional gamblersg	- VET: 2 complex (7 min each, 1 session)	Y	- Baseline, post treatment: GCS, SOGS	- ↑ Craving in VR gambling and real VLT; correlated to baseline SOGS; correlated to baseline SOGS
		- Study 2: 34 inpatient, pathological gamblersb undergoing CBT	- TTT: imaginal exposure (2 sessions)	- VET: 2 complex (20 min, 2 session)	Y	- Baseline, post treatment: GCS, SSQ	- ↓ Craving
		- Study 3: 25, pathological gamblersb undergoing CBT	- TTT: imaginal exposure (4 sessions)	- VET: 2 complex scenes (20 min, 4 session)	Y	- Baseline, post treatment: My treatment, questionnaire, effectiveness (CPGI, DIG, GRCS)	- ↓ Craving - ↑ Effectiveness
INTERNET GAMING DISORDER
Park et al. (2016)	- RCT	−24, IGDh	- TTT: CBT (2 h, 8 sessions, 2/w)	- VET: relaxation, exposure, aversive situation (2 h, 8 sessions, 2/w)	Y	- Baseline, post treatment: YIAS, fMRI	- ↓ YIAS in both conditions - ↑ Connectivity from the PCC seed to the left middle frontal and bilateral temporal after VET

^aFTND.

^bDSM-IV-TR.

^cDSM-V.

^dDSM-IV.

^eAUDIT >8.

^fAUDIT <8.

^gSOGS.

^hIYAS>50.

A, Assisted by a therapist; AUDIT, Alcohol Use Disorder Identification Test; AUQ, Alcohol Urge Questionnaire; CBT, Cognitive-Behavioral Therapy; CO, Carbone monOxyde; CPGI, Canadian Problem Gambling Index; CT, Controlled Trial; DD, Delay Discounting; DIG, Diagnostic Interview for Gambling; EEG, Electroencephalography; FDG-PET, Fluoro-Deoxy-Glucose Positron Emission Tomography; FTND, Fagerström Test for Nicotine Dependence; GCS, Gambling Craving Scale; GRCS, Gambling Related Cognition Scale; HSD, Heavy social drinkers, IAT, Implicit Association Test; ITT, Intention To Treat; LD, Light Drinkers; MNWS, Minnesota Nicotine Withdrawal Scale; NDSS, Nicotine Dependence Syndrome Scale; NTS, Non-Treatment Seeking; PCC, Posterior Cingulate Cortex; PQ, Presence Questionnaire; QSU, Questionnaire of Smoking Urge; RCT, Randomized Controlled Trial; SASE, Smoking Abstinence self-efficacy; SCQ, Smoking Confidence Questionnaire; SSQ, Simulator Sickness Questionnaire; STAI, State-Trait Anxiety Inventory; TS, Treatment Seeking; VAS, Visual analog Scale; VBT, Virtual Behavioral Therapy; VCBT, Virtual cognitive-Behavioral Therapy; VET, Virtual Exposure Therapy; VLT, Video Lottery Terminal; YIAS, Young Internet Addiction Scale; YIAS, Young Internet Addiction Scale.