Virtual reality-based cue exposure therapy reduces psychological craving in men with methamphetamine use disorder: a randomized controlled trial

Reducing psychological craving is critical for preventing relapse in methamphetamine use disorder (MUD). This study aimed to evaluate the efficacy of virtual reality (VR)-based cue exposure therapy (CET) and cue exposure with aversion therapy (CETA) in reducing methamphetamine craving in men with MUD. In this randomized controlled trial, 89 men with MUD were assigned to three groups: VR-based cue exposure therapy (CET, n = 30), VR-based cue exposure combined with aversion therapy (CETA, n = 29), and neutral scenes (NS, n = 30). The intervention comprised 16 sessions over 8 weeks. Primary outcomes were tonic craving and cue-induced craving. Secondary outcomes included attentional bias, rehabilitation confidence, drug refusal self-efficacy, anxiety, and depression. Both CET and CETA groups demonstrated significant reductions in tonic craving post-intervention (CET: p = 0.001; CETA: p = 0.010), while the NS group showed no change (p = 0.217). The CET group demonstrated significantly lower post-intervention tonic craving compared to the NS group (p = 0.047). All groups showed decreased cue-induced craving in drug use scenes (p < 0.05). The CETA group showed significantly improved drug refusal self-efficacy compared to baseline (p = 0.001) and the NS group (p = 0.018). The CET group demonstrated reduced anxiety compared to the NS group (p = 0.014). No serious adverse events were reported during VR exposure. VR-based cue exposure therapy, particularly when combined with aversion therapy, effectively reduces psychological craving and improves drug refusal self-efficacy in MUD patients. This study provides evidence supporting VR-based interventions as a safe and promising tool for MUD treatment, though larger-scale trials are needed to confirm long-term efficacy. Clinical trial number: This randomized controlled trial was registered with the Chinese Clinical Trial Registry (Code: ChiCTR1800020014).