Enhancing Prospection with Virtual Reality in Alcohol Use Disorder Recovery

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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.