[{"command":"openDialog","selector":"#drupal-modal","settings":null,"data":"\u003Cdiv id=\u0022republish_modal_form\u0022\u003E\u003Cform class=\u0022modal-form-example-modal-form ecl-form\u0022 data-drupal-selector=\u0022modal-form-example-modal-form\u0022 action=\u0022\/da\/article\/modal\/9348\u0022 method=\u0022post\u0022 id=\u0022modal-form-example-modal-form\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cp\u003EHorizon articles can be republished for free under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.\u003C\/p\u003E\n      \u003Cp\u003EYou must give appropriate credit. We ask you to do this by:\u003Cbr \/\u003E\n      1) Using the original journalist\u0027s byline\u003Cbr \/\u003E\n      2) Linking back to our original story\u003Cbr \/\u003E\n      3) Using the following text in the footer: This article was originally published in \u003Ca href=\u0027#\u0027\u003EHorizon, the EU Research and Innovation magazine\u003C\/a\u003E\u003C\/p\u003E\n      \u003Cp\u003ESee our full republication guidelines \u003Ca href=\u0027\/horizon-magazine\/republish-our-stories\u0027\u003Ehere\u003C\/a\u003E\u003C\/p\u003E\n      \u003Cp\u003EHTML for this article, including the attribution and page view counter, is below:\u003C\/p\u003E\u003Cdiv class=\u0022js-form-item form-item js-form-type-textarea form-item-body-content js-form-item-body-content ecl-form-group ecl-form-group--text-area form-no-label ecl-u-mv-m\u0022\u003E\n        \n\u003Cdiv\u003E\n  \u003Ctextarea data-drupal-selector=\u0022edit-body-content\u0022 aria-describedby=\u0022edit-body-content--description\u0022 id=\u0022edit-body-content\u0022 name=\u0022body_content\u0022 rows=\u00225\u0022 cols=\u002260\u0022 class=\u0022form-textarea ecl-text-area\u0022\u003E\u003Ch2\u003ETherapeutic digital gaming and VR to level-up treatment for addiction \u003C\/h2\u003E\u003Cp\u003E\u0026nbsp;\u003C\/p\u003E\n\n\u003Cp\u003EIn a lab in Berlin, Germany, healthy older adults are immersed in a cruise trip simulation called Schiff Ahoi! (Ship Ahoy!). Armed with a tablet device, they must quickly move food items from the ship\u2019s buffet onto a plate before they disappear, while avoiding items they have been instructed not to take. Performance-related points help sail the ship to Mediterranean destinations, where players can collect virtual postcards.\u003C\/p\u003E\n\n\u003Cp\u003ESuch games may hold the key to finding innovative ways of training inhibition in people with addictions or impulsive behaviours. From alcohol and drug use to smoking, gambling and food-related disorders, these can be notoriously hard to break, and there is a significant chance of relapse even when evidence-based treatments are applied.\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003ERelapse rates\u003C\/strong\u003E\u003C\/p\u003E\n\n\u003Cp\u003E\u2018Relapse rates are really high, especially in the first year after treatment,\u2019 said Dr Leonie Ascone Michelis, a postdoctoral clinical psychologist at the University Medical Center Hamburg-Eppendorf (UKE) in Germany. \u2018It\u2019s a global burden concerning costs, the economy, and especially the lives of people who are detrimentally affected.\u2019\u003C\/p\u003E\n\n\u003Cp\u003EWhile there\u2019s no substitute for counselling, the continuing challenge in overcoming addictions suggests it is important to find supplementary and easily accessible methods to beat them. EU researchers are therefore working to create more immersive experiences via digital formats to aid self-control as part of the addiction recovery process.\u003C\/p\u003E\n\n\u003Cp\u003EIn the \u003Ca href=\u0022https:\/\/cordis.europa.eu\/project\/id\/677804\u0022 target=\u0022_blank\u0022\u003ESelf-Control\u003C\/a\u003E project in which Dr Ascone is involved, part of the ethos is that methods for overcoming addiction do not need to be dull and can be developed in a more positive and fun way. The aim is to create interactive methods using such means as video games and smartphone apps, making patients more enthusiastic to engage and thus improve their capacity for self-control.\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cblockquote class=\u0022text-center text-blue font-bold text-2xl w-full lg:w-1\/2 border-2 border-blue p-12 my-8 lg:m-12 lg:-ml-16 float-left\u0022\u003E\n  \u003Cspan class=\u0022text-5xl rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n  \u003Cp class=\u0022font-serif italic\u0022\u003EA lot of people like computer games, so if we combine them with something useful then hopefully it will help.\r\n\u003C\/p\u003E\n  \u003Cfooter\u003E\n    \u003Ccite class=\u0022not-italic font-normal text-sm text-black\u0022\u003EDr Leonie Ascone Michelis, postdoctoral clinical psychologist, University Medical Center Hamburg-Eppendorf (UKE) \u003C\/cite\u003E\n  \u003C\/footer\u003E\n\u003C\/blockquote\u003E\n\u003C\/p\u003E\n\n\u003Cp\u003EThe project is also using virtual reality (VR) to closer replicate the real-life environments in which people face temptations. \u2018We\u2019re trying to implement these gaming interventions or virtual reality interventions as part of our clinical programme,\u2019 Dr Ascone explained. \u2018A lot of people like computer games, so if we combine them with something useful then hopefully it will help.\u2019\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003EImpulse control \u003C\/strong\u003E\u003C\/p\u003E\n\n\u003Cp\u003EIt has been hotly debated whether self-control can really be trained. Such attempts have often failed, but the seeds of the project were planted in a study that produced evidence of \u003Ca href=\u0022https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1053811917304184?via%3Dihub\u0022 target=\u0022_blank\u0022\u003Esuccessful inhibition training using video game\u003C\/a\u003E\u003Ca href=\u0022https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1053811917304184?via%3Dihub\u0022 target=\u0022_blank\u0022\u003Es\u003C\/a\u003E.\u003C\/p\u003E\n\n\u003Cp\u003EIn the study, led by Simone K\u00fchn, principal investigator on Self-Control and a neuroscientist also at UKE and the Max Planck Institute for Human Development in Berlin, a group of older adults trained by playing Ship Ahoy! for around 15 minutes daily for two months.\u003C\/p\u003E\n\n\u003Cp\u003EParticipants who completed the training were found to perform better than control groups in a classical task used to test inhibition. Participants were asked to press buttons in response to the direction of an arrow, but withhold this reaction when the arrow turned red. The results of this so-called \u201cstop-signal task\u201d suggested potential for transferring self-control to other situations.\u003C\/p\u003E\n\n\u003Cp\u003EInterestingly, brain scans using magnetic resonance imaging (MRI) taken after the raining discovered a rise in thickness of a prefrontal area of the brain known as the right inferior frontal gyrus. Earlier research had shown this to be linked to inhibitory responses.\u003C\/p\u003E\n\n\u003Cp\u003E\u2018Based on these findings, it\u2019s possible to modify our inhibitory behaviour,\u2019 said Dr Ascone. \u2018The question is, to what degree?\u2019\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003EVR headsets\u003C\/strong\u003E\u003C\/p\u003E\n\n\u003Cp\u003EThe initial study showed promise for investigating this question through further development of digital and game-based approaches, something that the Self-Control team has been exploring.\u003C\/p\u003E\n\n\u003Cp\u003ESome games are based on adaptations of self-control methods that have already shown promise in earlier studies. For example, one builds on a method called approach-avoidance training (AAT), which stems from a finding that people who are dependent on alcohol have a faster tendency to approach representations of alcohol than they do to avoid them.\u003C\/p\u003E\n\n\u003Cp\u003ETraditionally played on a PC with a joystick using images of alcoholic and non-alcoholic drinks that they pull towards them or push away, such training has been linked in some studies to \u003Ca href=\u0022https:\/\/pubmed.ncbi.nlm.nih.gov\/25526597\/\u0022 target=\u0022_blank\u0022\u003Ereductions in relapse rates\u003C\/a\u003E.\u003C\/p\u003E\n\n\u003Cp\u003EIn the Self-Control project, this concept has been extended to create a \u003Ca href=\u0022https:\/\/bmcpsychiatry.biomedcentral.com\/articles\/10.1186\/s12888-020-02739-1\u0022 target=\u0022_blank\u0022\u003Egame that uses a VR headset\u003C\/a\u003E where participants train in the more real-life 3D setting of a virtual bar with virtual drinks and replicate true-to-life arm movements. The concept is being tested alongside standard treatments in inpatient alcohol rehabilitation clinics in Denmark, Germany and Poland.\u003C\/p\u003E\n\n\u003Cp\u003E\u2018In the end, we will have data from different countries and can check whether it works like we hope,\u2019 said Dr Ascone. \u2018But patients like it and we hope we can do a planned three-month follow-up in most cases, because the three months after hospital discharge are often the most vulnerable.\u2019\u003C\/p\u003E\n\n\u003Cp\u003EThe team is also working on a portable VR version that people can use at home and that Dr Ascone likens to the lightsabre-based VR game Beat Saber. \u2018I want to call that one AAAT, instead of the commonly used term AAT, as it will be some sort of anti-alcohol aggression training.\u2019\u003C\/p\u003E\n\n\u003Cp\u003EVarious other games and apps are also being evaluated with participants to see what works. One game is set in a supermarket and requires players to collect healthy snack options from shelves and avoid unhealthy ones, again using the stop-signal concept. Another app, which is based on AAT and conducted on a tablet, aims to combat smoking. \u2018We are trying out different approaches, combining gaming elements and clinical knowledge in applications that are both fun and effective,\u2019 said Dr Ascone.\u003C\/p\u003E\n\n\u003Cp\u003EHigh relapse rates suggest it is just as important to investigate the wider neuroscience behind addiction and the factors that aid recovery.\u003C\/p\u003E\n\n\u003Cp\u003E\u2018We should be very critical and think about whether we are looking even in the right directions. Should we approach this from a different angle?\u2019 said Dr Janna Cousijn, a neuroscientist at Erasmus University Rotterdam in the Netherlands.\u003C\/p\u003E\n\n\u003Cp\u003EOne way of generating new insights is to start bringing together separate strands of research, Dr Cousijn explained. \u2018We have developed more and more methods to zoom into specific mechanisms,\u2019 she said. \u2018To me, it feels like the next challenge would be to bring those together, integrating the evidence at multiple levels.\u2019\u003C\/p\u003E\n\n\u003Cp\u003EShe thinks a starting point is filling in some key research gaps, several of which she identified as the basis for a project she leads called \u003Ca href=\u0022https:\/\/cordis.europa.eu\/project\/id\/947761\u0022 target=\u0022_blank\u0022\u003EAging Matters\u003C\/a\u003E. One is that studies on addiction tend to separately look at adolescents and adults, while few compare them, meaning knowledge is limited on the impact of age on underlying mechanisms.\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003EAge of addiction\u003C\/strong\u003E\u003C\/p\u003E\n\n\u003Cp\u003EIn addition, Dr Cousijn points out, studies in adolescents usually focus on risk of addiction rather than looking at their ability to bounce back, which tends to be greater than in adults. \u2018If you know why some people can recover and do it on their own, maybe studying those processes in more detail can tell us more about the brain\u2019s natural potential to recover,\u2019 she said.\u003C\/p\u003E\n\n\u003Cp\u003ETo carry out the age comparison part of the project, Dr Cousijn plans to recruit 300 people between the ages of about 16 and 35 who use alcohol, cannabis or both for a three-year longitudinal neuroimaging study, which she hopes to begin around September. \u2018I want to go from low to severe users to capture the whole range,\u2019 she said.\u003C\/p\u003E\n\n\u003Cp\u003EDr Cousijn intends to conduct MRI tests to assess cognition and brain function at both the start and end of the period, correlating that to how people say their cannabis or alcohol use has changed. In addition, she plans to conduct interventions with computer tasks and games to further assess cognitive control-related functions.\u003C\/p\u003E\n\n\u003Cp\u003E\u2018I really hope to isolate crucial elements of similarities and differences between young people and adults who use drugs, and that this information can guide others into optimising prevention and treatment strategies targeted at specific age groups,\u2019 she said.\u003C\/p\u003E\n\n\u003Cp\u003ETo fill in further gaps through another comparative study \u2013 this time between people and animals \u2013 Dr Cousijn will study the same addictions in rats during adolescence and adulthood, for which her team has developed a protocol for testing humans and animals with the same scanner set-up.\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cblockquote class=\u0022text-center text-blue font-bold text-2xl w-full lg:w-1\/2 border-2 border-blue p-12 my-8 lg:m-12 lg:-ml-16 float-left\u0022\u003E\n  \u003Cspan class=\u0022text-5xl rotate-180\u0022\u003E\u201c\u003C\/span\u003E\n  \u003Cp class=\u0022font-serif italic\u0022\u003EI\u2019m very much invested in developing new experimental paradigms to test the processes underlying addiction.\r\n\u003C\/p\u003E\n  \u003Cfooter\u003E\n    \u003Ccite class=\u0022not-italic font-normal text-sm text-black\u0022\u003EDr Janna Cousijn, neuroscientist, Erasmus University Rotterdam\u003C\/cite\u003E\n  \u003C\/footer\u003E\n\u003C\/blockquote\u003E\n\u003C\/p\u003E\n\n\u003Cp\u003EThe advantage of this approach is that the researchers can both perform more in-depth analyses of brain function in rats and have much more control over their environment, helping eliminate the influence of external factors. \u2018This means that if you find similar associations between both, then we\u2019re more sure about causality,\u2019 explained Dr Cousijn.\u003C\/p\u003E\n\n\u003Cp\u003E\u003Cstrong\u003ERating images\u003C\/strong\u003E\u003C\/p\u003E\n\n\u003Cp\u003ETo address yet another gap, she will look at the complex role of social environment in addiction through use of a questionnaire, as well as tasks such as rating images of beers and seeing how answers are affected after people receive feedback from their peer group. This is a key part of the equation for tackling the issue of addiction, with the need to compare how the brain reacts to substances in social versus non-social situations, says Dr Cousijn.\u003C\/p\u003E\n\n\u003Cp\u003ETackling addiction, she emphasises, will ultimately need fresh approaches, whether these stem from technology or experimental methods. \u2018I\u2019m very much invested in developing new experimental paradigms to test the processes underlying addiction,\u2019 she said. \u2018Then I hope that information can be used by others to help develop treatments and for prevention.\u2019\u003C\/p\u003E\n\n\u003Ch5\u003EThe research in this article was funded by the EU. 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