Interview with Dr. Oliver Scheibenbogen

What are your focal points and where do you use VR?

At the Anton Proksch Institute, Europe’s largest addiction clinic, we use VR in cue exposure therapy (VR-CET) for alcohol-dependent patients. Through the presentation of complex alcohol-related stimuli with simultaneous reaction prevention (no consumption), there is a gradual extinction of the association between stimulus and reaction and thus a reduction in craving and the risk of relapse.

What is your experience of VR?

Not only a simple visual or olfactory stimulus, but also complex social situations can be used in VR-CET. The patient is not forced into the role of a pure observer, but rather interacts with avatars in typical everyday situations, such as a bartender visiting a pub, party guests or shopping at the supermarket. The social pressure increases through toasts and drinking requests (bar, private party). Newly learned coping strategies can be actively trained in a situation very similar to the usual consumption environment and not in a craving-reducing treatment environment (addiction clinic).

What role does immersivity play and which factors are particularly important?

In order to be therapeutically effective in the long term, an intensive experience is needed in the therapy in which the patient can intensively perceive his/her own feelings. Only in this experience lies the chance for change. VR technology provides an intense feeling of involvement so patients actually have the feeling of being spatially present in the virtual environment. Flooding, i.e. exposing oneself to the stimulus in full intensity, is the “golden standard” in behavioural therapy with the greatest effectiveness, which, however, is often not feasible in treatment due to resistance phenomena of the affected people. VR technology helps us clinical psychologists and psychotherapists to get much closer to the intensive experience in therapy.

You once said that the VR Coach smart system was better than Tomb Raider – what exactly do you mean by that?

We gave a questionnaire that quantifies the degree of immersion in virtual reality. The results are impressive: in two out of three scales (involvement and experienced realism of the Igroup Presence Questionnaire), the patients scored higher than in the norm sample of Tomb raider gamers. This is a clear sign that immersion in the addiction-specific scenes is very successful and that those affected really “feel there”. Users of the VR headsets also show an increased skin conductance (a measure of increased general activation) and a stronger tremor due to sympathicotonic overexcitation when exposed to stimuli. Both the results of the questionnaire and the clinical behavioural observation underline the high degree of immersion.

How do you see the future and trends of VR?

I see a very high potential in VR technology. Patients find this type of therapy very attractive, which also increases adherence, because therapy often fails because those affected do not trust themselves to live without alcohol. VR-CET increases the belief in one’s own abilities not to have to resort to the “old (problem) solvent” alcohol even in risky situations and thus increases the addiction-specific self-efficacy expectation.

In addition to stimulus exposure, I also see possible uses for VR technology in learning imaginative processes. The immersion in other worlds can be seen as an intermediate step, as a kind of technology-supported visualisation exercise. There is a group of patients who, for example, find it very difficult to imagine a “safe place” or a “place of peace and strength” and find it hard to access emotionally. Here, the presentation of e.g. lonely sea bays can help to initiate this process.

When using new technologies in general, it is important to me that they are developed in close cooperation with clinical experts. A simple “digitalisation” of existing therapy procedures is usually not goal-oriented and doomed to failure. Rather, new developments are needed in which research, clinical testing and technical implementation go hand in hand.