Enhancing Prospection with Virtual Reality in Alcohol Use Disorder Recovery

通过虚拟现实增强酒精使用障碍康复的前景

• 批准号: 10687816
• 负责人: Brandon Oberlin
• 金额: $ 63.5万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-20 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10687816
• 关键词: Abstinence; Address; Aftercare; Age; Alcohol abuse; Alcohol consumption; Alcohols; Attention; Behavior; Behavioral; Biometry; Brain; Clinical Trials; Costs and Benefits; Data; Decision Making; Development; Disease; Dose; Drug usage; Effectiveness; Emotional; Event; Functional Magnetic Resonance Imaging; Future; Goals; Impairment; Impulsivity; Individual; Intervention; Investments; Laboratories; Longitudinal Studies; Measures; Motivation; Outcome; Participant; Patients; Persons; Pharmacotherapy; Placebos; Quality of life; Randomized; Recovery; Recovery Support; Relapse; Rest; Rewards; Sampling; Self Efficacy; Signal Transduction; Substance Use Disorder; Testing; Thinking; Time; Travel; Treatment Efficacy; Treatment outcome; Validation; Visualization; Work; addiction; aged; alcohol abstinence; alcohol use disorder; behavioral economics; behavioral outcome; cingulate cortex; comparative efficacy; comparison group; craving; design; digital; discounting; drinking; early alcohol use; effectiveness testing; endophenotype; experience; feasibility testing; follow-up; hedonic; improved; intervention effect; long term recovery; male; men; multidisciplinary; neurobehavioral; neuroimaging; neurotransmission; novel; novel therapeutics; open label; optimism; pilot test; predictive marker; preference; prolonged abstinence; randomized placebo controlled trial; relapse patients; relapse prevention; response; safety and feasibility; success; sustained recovery; theories; treatment as usual; treatment duration; virtual; virtual reality; virtual reality environment; virtual reality intervention; virtual world; Abstinence; Address; Aftercare; Age; Alcohol abuse; Alcohol consumption; Alcohols; Attention; Behavior; Behavioral; Biometry; Brain; Clinical Trials; Costs and Benefits; Data; Decision Making; Development; Disease; Dose; Drug usage; Effectiveness; Emotional; Event; Functional Magnetic Resonance Imaging; Future; Goals; Impairment; Impulsivity; Individual; Intervention; Investments; Laboratories; Longitudinal Studies; Measures; Motivation; Outcome; Participant; Patients; Persons; Pharmacotherapy; Placebos; Quality of life; Randomized; Recovery; Recovery Support; Relapse; Rest; Rewards; Sampling; Self Efficacy; Signal Transduction; Substance Use Disorder; Testing; Thinking; Time; Travel; Treatment Efficacy; Treatment outcome; Validation; Visualization; Work; addiction; aged; alcohol abstinence; alcohol use disorder; behavioral economics; behavioral outcome; cingulate cortex; comparative efficacy; comparison group; craving; design; digital; discounting; drinking; early alcohol use; effectiveness testing; endophenotype; experience; feasibility testing; follow-up; hedonic; improved; intervention effect; long term recovery; male; men; multidisciplinary; neurobehavioral; neuroimaging; neurotransmission; novel; novel therapeutics; open label; optimism; pilot test; predictive marker; preference; prolonged abstinence; randomized placebo controlled trial; relapse patients; relapse prevention; response; safety and feasibility; success; sustained recovery; theories; treatment as usual; treatment duration; virtual; virtual reality; virtual reality environment; virtual reality intervention; virtual world

PROJECT SUMMARY / ABSTRACT We propose a novel virtual reality intervention to increase abstinence, enhance future orientation and delayed reward preference, quantify brain responses, and improve recovery outcomes in early recovering alcohol use disorder (AUD) persons. We also intend to demonstrate that aged future selves representing alternate futures are the ‘active ingredient’ of the intervention. Impaired future orientation and discounted future outcomes appear to be a behavioral endophenotype for AUD and other addictions. With recovery attempts usually failing within 6 months of treatment, there is considerable room for improved efficacy for long-term recovery. Converging evidence indicates that a hallmark of AUD is preference for immediate hedonic rewards and impaired visualizing and planning for the future. To enhance visualization of the future, we extend prior work on episodic future thinking through virtually experiencing plausible alternate futures. Our intervention increases connectedness with one’s future by immersing subjects in a realistic interaction with their Future Selves in divergent futures that rely on present decisions. We integrate self-discrepancy theory, focusing on the gap between “what is” and “what could be” to heighten motivation, and we promote engagement by maximizing the novelty and emotional salience of the experience. Early-recovering AUD persons enter a compelling virtual world, are introduced to a time travel narrative, and interact with two digitally age-progressed Future Selves; one after 15 years of ongoing alcohol abuse, and the other after 15 years of recovery. Both Future Selves speak to the participant about their recovery rewards, or losses from returning to problem drinking, and personal struggles during the journey. Strong emphasis is placed on agency, optimism, and decision-making. After iterative development and tests of feasibility and safety, the paradigm yielded promising preliminary data showing increased prosocial behavioral change and brain target engagement. Interacting with Future Selves in virtual reality significantly increased abstinence rates compared to a treatment-as-usual comparison group, increased identification with the future, increased behavioral delay-of-reward, and enhanced brain activation and connectivity in executive and introspection networks. The current proposal will test this paradigm in a larger sample with an expansion of Recovery Future Self interactions (30 daily experiences) to show efficacy compared to a virtual reality control. Aim 1 will test the effectiveness of the virtual reality intervention on abstinence and alcohol use outcomes at 1 and 6 months, future self-similarity, and behavioral delay-of-reward. Aim 2 will demonstrate brain target engagement by showing stronger executive and introspective network function during decision-making and at rest, and executive network connectivity that correlates with increased delayed reward preference. Further, brain activation will provide a neural signal that could be used as a predictive marker for intervention responders. The ultimate goal is to deliver a potent recovery support intervention that is readily implemented in the context of promoting long-term recovery.

项目摘要 /摘要 我们提出了一种新颖的虚拟现实干预措施，以增加禁欲，增强未来的取向并延迟 奖励偏好，量化大脑反应并改善早期恢复饮酒的恢复结果 障碍（AUD）人。我们还打算证明代表替代未来的未来自我 是干预的“主动诱导”。损害未来的定向和未来的折扣 似乎是AUD和其他添加的行为内表型。恢复尝试通常失败 在治疗的6个月内，有相当大的效率空间可以提高长期恢复的效率。 汇合证据表明，AUD的标志是享受即时享乐主义奖励和 对未来的可视化和计划受损。为了增强未来的可视化，我们扩展了先前的工作 通过实际上经历合理的替代未来，情节的未来思考。我们的干预增加了 通过将主题与他们的未来自我进行现实互动，与未来的联系联系在一起 依赖当前决定的分歧未来。我们整合了自我裁员理论，重点是差距 在“什么”和“可能是什么”之间增强动力，我们通过最大化促进参与 经历的新颖性和情感上的显着性。早期恢复的aud人进入引人注目的虚拟 将世界引入时间旅行叙事，并与两个数字化的未来自我互动； 一个经过15年后的酗酒，另一个经过15年的康复。未来的自我 与参加者谈论他们的恢复奖励，或者因返回问题而造成的损失， 在旅途中进行个人斗争。非常重视代理，乐观和决策。 在迭代发展和可行性和安全性测试之后，范式产生了有希望的初步数据 表现出社会行为变化增加和大脑目标参与。与未来自我互动 与治疗态度比较组相比，虚拟现实显着提高了禁欲率 增加对未来的识别，行为延迟的增加以及大脑激活增强 和执行和内省网络中的连通性。当前的建议将在 较大的样本，扩大了恢复未来的自我互动（每天30次体验），以显示效率 与虚拟现实控制相比。 AIM 1将测试虚拟现实干预的有效性 戒酒和酒精使用结果在1和6个月时，未来的自相似性以及奖励行为延迟。 AIM 2将通过显示更强大的执行和内省网络来证明大脑目标参与 在决策和休息期间的功能，以及与增加相关的执行网络连接 延迟奖励偏好。此外，大脑的激活将提供可用作的神经信号 干预响应者的预测标记。最终目标是提供潜在的恢复支持 在促进长期恢复的背景下很容易实施的干预措施。