Virtual Reality-Augmented Future Orientation in Stimulant Use Disorder Recovery

项目总结/摘要 我们提出了一种新的虚拟现实干预，以测试减少兴奋剂使用和增加 禁欲，伴随着未来自我认同，未来时间观念和延迟的增加， 奖励，在早期恢复兴奋剂使用障碍（StUD）的人。未来方向感受损， 奖励似乎是物质使用障碍的行为内表型。恢复的尝试通常 如果在6个月内治疗失败，则有相当大的改善功效的空间。趋同证据 表明StUD的一个标志是对未来的视觉和计划受损，这对应于 更大的延迟奖励贬值。我们对干预的初步测试是有希望的，n=14 的n=18参与者在30天后保持禁欲;重要的是，14名禁欲者中有10名表现出阳性反应。 对干预措施的反应，表明疗效标志物。干预增加了未来的自我认同 以及从物质使用障碍中恢复过来的人的奖励延迟， 此外，VR对延迟奖励的影响与内省-执行大脑连接相关。 扩展先前关于情景未来思维的工作，我们采用了精确医学方法来设计一个 个性化的沉浸式虚拟体验，整合个人细节，最大限度地提高感官体验 订婚我们的干预通过让受试者沉浸在现实的环境中， 在不同的未来中与未来自我互动的写照。重要的是，我们将自我差异 理论，专注于“是什么”和“可能是什么”之间的差距，以提高动力，我们促进 通过最大化体验的新奇和情感突出性来参与。早期恢复StUD 人们进入一个现实的虚拟世界，被引入一个时间旅行的故事，并与两个数字互动， 年龄增长的未来自我;一个是在持续滥用兴奋剂15年后，另一个是在持续滥用兴奋剂15年后。 复苏两个未来自我都向参与者讲述了他们的恢复奖励，或者返回 习惯性吸毒，以及旅途中的个人斗争。强烈强调的是机构，乐观， and decision-making决策.经过迭代开发和可行性及安全性测试，该范例产生了一个 有希望的功效信号、行为变化和大脑目标参与。目前的提案将验证 在扩大的样本中使用相同的VR来显示功效和行为机制 范例目标1将测试对兴奋剂和药物使用结果（数量、频率、类型、复发， 和禁欲），并在1个月和6个月时进行纵向评估。目标2将通过测试确定机制 未来自我认同、未来时间观念和行为延迟折扣的变化。很长的- 该项目的长期目标是验证一种具有长期恢复效益的有效干预措施， 在治疗后护理期间或在治疗环境中容易实施。

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.