The Development Of Virtual Reality Based Craving Assessment Tool For Amphetamine Type Stimulants Use Disorder

Objective Craving was a crucial role in amphetamine type stimulants(ATS)use disorders,however,there were limited tools of craving assessment and subjective reporting was the main method of craving assessment.This study was to develop a virtual reality(VR)tool to assess the cue-induced craving in ATS patients,by combining autonomic nervous system(ANS)and electroencephalogram(EEG),and to study the reliability and validity of the tool.Furthermore,previous studies have found that cue-reactivity is closely related to the mesocorticolimbic reward circuit and executive control circuit.This study will explore the neuroelectrophysiological mechanism of craving based on the evaluation system using VR cue exposure.Methods In this study,through semi-structured interviews,VR neutral environment and ATS cue environment were created,and cue exposure paradigm with VR display was used to induce and assess craving.60 patients with ATS use disorder were recruited and exposed to ATS-related VR cues.During cue exposure,eight objective electrophysiological indices were collected simultaneously to evaluate their desire,including ECG,skin conductance,skin conductance level(SCL)and EEG current density of cortex in mesocorticolimbic reward circuit and executive control circuit.As for this craving assessment system,the internal consistency reliability and standard validity were evaluated by Kuber-Richardson Reliability and Cohen’s kappa value.The current densities of the circuit-related regions of interest(including the left and right dorsolateral prefrontal cortex(DLPFC)and the orbital frontal cortex/medial prefrontal cortex(OFC/MPFC)were calculated by sLORETA.The changes of SCL,high frequency heart rate variability(HFHRV)and current densities before and after cue exposure were compared,and the correlation between the changes and self-report craving was analyzed.Results The main use environment for ATS patients is private residence(home and friend’s home),accounting for about 90%of the interviews,ranking first among the five common use places of home,hotel,friend’s house,KTV and bar.The strongest trigger for ATS craving is"seeing friends using".The VR cue exposure scenario was set in the living room of private residence.Four actors used ATS and interacted with each other.After exposure to ATS-related VR cue scenarios,subjective craving(VAS)was significantly increased from 1.75+1.68 to 5.58+1.87(t=16.86,DF=56,P<0.001).SCL increased from 2.98±2.4 to 3.45±3.15 uS,with significant difference(t=2.810,df=53,p=0.007).Heart rate variability analysis showed no significant change in HFHRV(t=0.055,DF=52,P=0.956).The results of sLORETA analysis showed that the current density of right DLPFC of gamma 1 and gamma 2 bands in ATS-related VR cue environment was significantly lower than that in neutral environment(p<0.05,after FDR correction).The gamma band current density of MPFC/OFC brain area decreased significantly before and after exposure to cords(p<0.05,after FDR correction).Kuder-Richardson reliability of internal consistency reliability is 0.845 and Cohen’s kappa value was-0.03 between the results of VR system and self-report craving of patients.Simple linear correlation analysis showed no correlation between SCL and HFHRV changes and craving increase.Multivariate linear regression results showed that the current density of MPFC/OFC and DLPFC in gamma 2 band could predict SCL changes(R~2=0.217,F=2.862,p=0.016 after correction).Conclusions With VR environments,this study for the first time synchronously monitored neuroelectrophysiological activities including ECG,SCL and EEG during cue-exposure.A virtual reality-based ATS craving assessment system was successfully developed to assess the cravings of ATS users.The system can effectively induce the subjective craving in patients with ATS use disorder,and the objective electrophysiological indicators in the system have good internal consistency reliability.In addition,the results of mechanism study showed that the changes of ANS activity before and after cue exposure and the changes of cortical activity in mesocorticolimbic reward circuit and executive control circuit,further confirmed that substance-related cue may induce craving by affecting these two circuits,and at the same time produce changes in ANS balance and somatic physiological response.