Effectiveness of exposure-based therapy through inhibitory learning via virtual reality in electronic gambling machines: Multiple baseline single-case experimental design

Context: Electronic gambling machines (EGMs) can harm individuals and contribute to gambling disorder (GD). Empirically supported cognitive-behavioral interventions are effective yet associated with high relapse rates. One avenue for improvement is to target the urge to gamble through exposure. In the exposure approach based on the inhibitory learning model, the perceived self-efficacy (PSE) to refrain from gambling despite the urge serves as a proximal factor for change. The goal is to create a new learning association that overrides the pre-established link between gambling stimuli, urge to gamble, and PSE to refrain from gambling. Exposure can be done in virtual reality (VR) to promote self-control and reduce gambling behaviors. VR is a relevant exposure method because it allows reproduction of ecologically valid, realistic environments. Furthermore, researchers have more control over the course of the immersion experience than during exposure in vivo. Objective: This study evaluates the effectiveness of a VR exposure-based intervention for EGM players. Method:. The single-case, multiple-baseline experimental design includes six intervention sessions with VR exposure and daily journaling to measure PSE, urges, and gambling behaviors. This approach emphasizes building PSE to resist from gambling despite the urge. Four adult males who wanted to stop their gambling behavior participated in this study. Results: Statistical analyses demonstrate a significant increase in PSE across participants and a significant reduction in the urge to gamble in three of the four participants. This study highlights the potential benefits of using of such an exposure model. It provides grounds for a large-scale randomized controlled trial where exposure and its underlying clinical rational could be included in more traditional cognitive-behavioral therapy programs.