Not the Right Cue for Me: Investigating VR Cue Design and Biofeedback Integration in Drug Psychotherapy

Psychotherapy is vital for identifying and managing craving-triggering cues. In this study, we paired virtual reality (VR) drug-cue scenarios with physiological sensors to capture participants’ real-time responses. Qualitative interviews with nineteen patients and six therapists showed that contextual elements resembling past drug-use experiences reliably provoked cravings, while biofeedback data confirmed that VR effectively elicits measurable physical responses. Our findings further suggest that adjusting the completeness and fidelity of VR scenarios to match a patient’s recovery stage can manage craving intensity and prevent urges from persisting beyond each session. Therapists also see opportunities to integrate virtual reality into clinical practice to address challenges from prior sessions and enhance therapeutic outcomes. This paper offers concrete recommendations for developing clinically deployable VR scenarios and outlines implications for future research and therapeutic applications in drug treatment.