Attentional Bias During a Novel Alcohol Cue Virtual Reality Paradigm

Background: Attentional bias to alcohol cues is largely investigated using pictorial cues (i.e., two-dimensional images). The addition of eye-tracking metrics has improved these investigations yet are limited by a lack of naturalistic cues. Virtual reality (VR) can theoretically improve ecological validity through three-dimensional alcohol object presentation while utilizing eye-tracking metrics. This report sought to test the construct validity of the Alcohol Cue VR paradigm in evoking subjective craving and attentional bias through measurement of eye-gaze characteristics. Methods: Participants (n = 105, 53% male, M_age = 38), with varying alcohol use histories, underwent the Alcohol Cue VR paradigm, an alcohol visual probe task, and measures of alcohol craving and VR-related assessments. The Alcohol Cue VR paradigm comprised of three active scenes with alcohol cues present, and three neutral scenes devoid of alcohol cues. Eye-gaze fixation time (index of “attentional bias”) in response to alcohol and control cues was recorded. Forward-stepwise models searched for optimal alcohol-related predictors of attentional bias, then compared against eye-tracking and response time metrics from the alcohol visual probe task. Results: Alcohol use history, age of regular use onset, recency of use, and binge episodes were significantly associated with eye-gaze fixation time to alcohol cues; how present one felt within the VR scenes did not moderate these findings. Alcohol-related predictors accounted for a larger proportion of variance in VR-based models of attentional bias (ΔR² = 0.10) than in comparable alcohol visual probe task models based on fixation time (ΔR² = 0.05) or response time (ΔR² = 0.06). Conclusions: The Alcohol Cue VR paradigm provided commensurate measures of attentional bias in the context of alcohol cues. Unique alcohol-related characteristics impacted the extent of attentional bias to alcohol-related cues, exemplifying the utility of VR-derived measurement in assessing alcohol use. Future research can understand whether VR attentional bias is modifiable through treatment and can serve as clinical endpoints.