In order to develop novel, game-based approaches to impact the health problem of obesity, especially contributing factors that resemble addiction, we earlier discussed Addiction Theory. Through understanding both addiction and its treatment, we are better able to design games that would support those who struggle with addictive aspects of overeating. In this blog, we look at the evidence-based psychotherapy for treating addiction, Cue Exposure Therapy.

Cue Exposure Therapy (CET) is a commonly used method in substance abuse treatment that uses repeated and controlled exposure to an addictive substance in order to change the patient’s response to it [1][2][3]. We looked at CET in order to discover potential ways this therapy might be applied to decrease food cravings. CET operates in two ways:

1. Extinction Response. The extinction response to treat addiction is evoked by exposing someone repeatedly to the substance that tempts them, so much that there response is basically tired out and they stop responding as strongly. The tempting substance in the case of obesity is high caloric, relatively unhealthy food. We theorize that conditioned responses to these unhealthy foods, often caused by the rewarding effects the food’s high fat and added sugar, might be reversed using the extinction response. The individual who is struggling with obesity would be exposed to food simulations repeatedly, which would initially evoke craving. However, being only a simulation and not real food, they would not be allowed to eat it and thus would experience no reward (which is called “response prevention”). Eventually the individual would have less reaction to the food when they encounter it in daily life [4][5]. Through repeated exposure, the individual also learns that he or she can tolerate seeing foods they are trying to avoid, for example, in a store or at a party, and not responding by eating them.
2. Counter-conditioning. In counter-conditioning, an unwanted behavior is replaced with a positive action and the new behavior is rewarded [6]. As with extinction, the individual would be repeatedly exposed to unhealthy food stimuli, but this time they would be encouraged to respond with some alternative behavior to eating the food [7][8]. The alternative response that is encouraged is often an adaptive, coping response. For instance in a game, rather than responding to an unhealthy but tempting food by eating it, the game structures could guide the player to reject the food physically by hitting it away. To further reinforce the alternative response, the player gains points and power-up privileges in the game. Another alternative response that could be presented via a game is a healthy substitute food. Choosing the alternative response of eating the healthy, alternative food would be rewarded in the game. Repeating these actions many times in a game may transfer to a real life change of making a similar alternative response when presented with the opportunity to choose foods to eat.

References

1. Paris MM, Carter BL, Traylor AC, Bordnick PS, Day SX, Armsworth MW, & Cinciripini PM. Cue reactivity in virtual reality: The role of context. Addictive Behaviors.2011; 36:696-699. http://www.ncbi.nlm.nih.gov/pubmed?term=Cue%20reactivity%20in%20virtual%20reality%3A%20The%20role%20of%20context. Accessed on: 2/5/2013.
2. Garcia-Rodriguez O, Pericot-Valverde I, Gutiérrez-Maldonado J, Ferrer-García M, & Secades-Villa R. Validation of smoking-related virtual environments for cue exposure therapy. Addictive Behaviors.2012; 37:703-708. http://www.ncbi.nlm.nih.gov/pubmed/22385732. Accessed on: 2/5/2013.
3. Bordnick PS, Traylor A, Copp HL, Graap KM, Carter B, Ferrer M, & Walton, AP. Assessing reactivity to virtual reality alcohol based cues. Addictive Behaviors. 2008; (33):743-756. http://www.ncbi.nlm.nih.gov/pubmed/18282663. Accessed on: 2/5/2013.
4. Kaplan GB, Heinrichs SC, Carey RJ. Treatment of addiction and anxiety using extinction approaches: neural mechanisms and their treatment implications. Pharmacol Biochem Behav. 2011; (97):619-25. http://www.ncbi.nlm.nih.gov/pubmed/20723558. Accessed on: 3/15/13.
5. Romano DM. Virtual Reality Therapy. Developmental Medicine & Child Neurology. 2005; (47):580. https://www.cambridge.org/core/journals/developmental-medicine-and-child-neurology/article/virtual-reality-therapy/C8AD25FBE37D67292949D34610D3855D. Accessed on: 3/15/13.
6. O’Brien CP, Childress AR, McLellan T, Ehrman R. Integrating systemic cue exposure with standard treatment in recovering drug dependent patients. Addict Behav. 1990; (15):355-65. http://www.ncbi.nlm.nih.gov/pubmed/2248109. Accessed on: 3/15/13.
7. Lee JH, Kwon H, Choi J, Yang BH. Cue-exposure therapy to decrease alcohol craving in virtual environment. Cyberpsychol Behav.2007; (5):617-23. http://www.ncbi.nlm.nih.gov/pubmed/17927528. Accessed on: 11/1/11.
8. Dinska VG, Frank B, Vansteenwegen D, Hermans D, & Beckers T. Counterconditioning reduces cue-induced craving and actual cue-elicited consumption. Journal of Psychology.2010; (10):1528-3542. http://www.academia.edu/588931/Counterconditioning_reduces_cue-induced_craving_and_actual_cue-elicited_consumption. Accessed on: 4/1/2013.