Virtual Reality-Augmented Future Orientation in Stimulant Use Disorder Recovery

虚拟现实增强兴奋剂使用障碍康复的未来方向

基本信息

批准号：
10455193
负责人：
Brandon Oberlin
金额：
$ 23.78万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10455193
关键词：
Abstinence Address Aftercare Age Attention Behavior Behavior Therapy Behavioral Behavioral Mechanisms Biometry Brain Clinical Psychology Clinical Trials Communities Data Decision Making Development Drug usage Effectiveness Emotional Event Evidence based intervention Exhibits Frequencies Future Goals Immersion Impairment Individual Intervention Interview Intoxication Investments Italy Laboratories Methods Motivation Neuropsychological Tests Outcome Participant Patient Self-Report Patients Persons Pharmacotherapy Preparation Randomized Clinical Trials Randomized Controlled Trials Recovery Relapse Resistance Rewards Sampling Sensory Signal Transduction Stimulant Substance Use Disorder Substance abuse problem Testing Thinking Time Travel Treatment outcome Validation Virtual and Augmented reality Work behavior change behavior test behavioral economics craving design digital discounting disorder later incidence prevention drug abstinence drug efficacy drug testing efficacy testing efficacy trial endophenotype experience feasibility testing follow-up hedonic improved male medication-assisted treatment multidisciplinary neglect non-drug novel open label optimism personalized medicine precision medicine preference recruit relapse risk response safety and feasibility stimulant abuse stimulant use stimulant use disorder success successful intervention theories treatment as usual virtual virtual reality virtual reality environment virtual reality intervention virtual world

项目摘要

PROJECT SUMMARY / ABSTRACT We propose a novel virtual reality intervention to test for efficacy on reducing stimulant use and increasing abstinence, with concomitant increases in future self-identification, future time perspective, and delay-of- reward, in early recovering stimulant use disorder (StUD) persons. Impaired future orientation and delay-of- reward appear to be behavioral endophenotypes for substance use disorders. With recovery attempts usually failing within 6 months of treatment, there is considerable room for improved efficacy. Converging evidence indicates that a hallmark of StUD is impaired visualizing and planning for the future, which corresponds to greater devaluation of delayed rewards. Our preliminary tests of the intervention were promising, with n=14 out of n=18 participants remaining abstinent 30 days later; importantly, 10 of the 14 abstainers showed a positive response to the intervention, suggesting an efficacy marker. The intervention increases future self-identification and delay-of-reward in people recovering from substance use disorder, and engages brain networks governing prospection; further, the VR effect on delay-of-reward correlated with introspective-executive brain connectivity. Extending prior work on episodic future thinking, we employed a precision medicine approach in designing a personalized immersive virtual experience that integrates personal details and maximizes sensory engagement. Our intervention increases connectedness with one’s future by immersing subjects in a realistic portrayal of interacting with their Future Selves in divergent futures. Importantly, 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 StUD persons enter a realistic virtual world, are introduced to a time travel narrative, and interact with two digitally age-progressed Future Selves; one after 15 years of ongoing stimulant 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 habitual drug use, 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 a promising efficacy signal, behavioral change, and brain target engagement. The current proposal will validate this paradigm in an expanded sample to show efficacy and behavioral mechanisms using the same VR paradigm. Aim 1 will test for efficacy on stimulant and drug use outcomes (amount, frequency, type, relapse, and abstinence) with longitudinal assessments at 1 and 6 months. Aim 2 will determine mechanisms by testing for changes in future self-identification, future time perspective, and behavioral delay discounting. The long- term goal of the project is to validate a potent adjunctive intervention with long-term recovery benefits that is readily implemented during post-treatment aftercare or in a treatment setting.

项目概要/摘要我们提出了一种新颖的虚拟现实干预措施，以测试减少兴奋剂使用和增加兴奋剂使用的功效。禁欲，伴随着未来自我认同、未来时间洞察力和延迟的增加奖励，在早期恢复兴奋剂使用障碍（StUD）的人中受损的未来方向和延迟。奖励似乎是物质使用障碍的行为内表型，通常与恢复尝试有关。如果在治疗后 6 个月内失败，则有相当大的证据表明疗效有改善的空间。表明StUD的一个特点是对未来的可视化和规划受损，这对应于我们对干预措施的初步测试是有希望的，n=14。重要的是，n = 18 名参与者在 30 天后仍然禁欲，14 名禁欲者中有 10 人表现出阳性；对干预的反应，表明干预增加了未来的自我认同。以及从物质使用障碍中恢复的人们的延迟奖励，并参与管理大脑网络此外，VR 对延迟奖励的影响与内省执行大脑的连通性相关。扩展了之前关于情景未来思维的工作，我们采用了精准医学方法来设计融合个人细节、最大化感官的个性化沉浸式虚拟体验我们的干预通过让受试者沉浸在现实中来增加与未来的联系。在不同的未来中与未来的自己互动的描绘。重要的是，我们整合了自我差异。理论，关注“是什么”和“可能是什么”之间的差距，以提高动力，我们提倡通过最大化体验的新颖性和情感显着性来提高参与度。人们进入一个现实的虚拟世界，被引入时间旅行叙事，并与两个数字互动随着年龄的增长，未来的自己；一个是持续滥用兴奋剂 15 年之后，另一个是持续滥用兴奋剂 15 年之后两个未来的自己都会向参与者讲述他们的恢复奖励或返回的损失。习惯性吸毒以及旅途中的个人挣扎非常强调代理、乐观、经过迭代开发以及可行性和安全性测试后，该范式产生了一个有前景的功效信号、行为改变和大脑目标参与将得到验证。该范式在扩展样本中展示使用相同 VR 的功效和行为机制目标 1 将测试兴奋剂和药物使用结果的功效（数量、频率、类型、复发、和禁欲），并在 1 个月和 6 个月进行纵向评估，目标 2 将通过测试确定机制。未来自我认同、未来时间视角和行为延迟贴现的变化。该项目的长期目标是验证具有长期恢复益处的有效辅助干预措施，即可以在治疗后护理期间或在治疗环境中轻松实施。