Virtual Reality-Augmented Future Orientation in Stimulant Use Disorder Recovery

项目摘要/摘要 我们提出了一种新的虚拟现实干预方法来测试减少兴奋剂使用和增加兴奋剂使用的有效性 节欲，伴随着未来自我认同、未来时间洞察力和延迟时间的增加 奖励，在早期康复的兴奋剂使用障碍(STOP)者。未来取向受损和延迟- 奖赏似乎是物质使用障碍的行为内表型。恢复尝试通常 在治疗6个月内失败，仍有相当大的提高疗效的空间。汇聚证据 表明种马的标志是对未来的可视化和计划受损，这对应于 延迟奖励的贬值幅度更大。我们对干预措施的初步测试是有希望的，n=14出局 在18名参与者中，30天后仍保持戒酒；重要的是，14名戒毒者中有10名显示出阳性 对干预的反应，暗示了一个疗效标记。这种干预增加了未来的自我认同 从物质使用障碍中恢复的人的奖赏延迟，并参与大脑网络管理 此外，VR对奖赏延迟的影响与内省-执行大脑的连通性有关。 扩展先前关于间歇性未来思维的工作，我们采用了精确医学的方法来设计一种 个性化身临其境的虚拟体验，集成了个人细节并最大限度地提高了感官 订婚。我们的干预通过让受试者沉浸在现实的 在不同的未来中与未来的自我互动的写照。重要的是，我们把自我差异 理论，专注于“现在是什么”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颖性和情感重要性来参与。早期恢复期研究 人们进入一个现实的虚拟世界，被介绍给一个时间旅行叙事，并与两个数字交互 年龄进步的未来自我；一个是在持续滥用兴奋剂15年后，另一个是在15年后 恢复。两个未来的自我都会与参与者谈论他们的恢复回报，或返回到 习惯性吸毒，以及旅途中的个人挣扎。重点放在代理、乐观、 和决策。经过迭代开发和可行性和安全性测试，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 这一范例在扩展的样本中显示了使用相同VR的有效性和行为机制 范例。目标1将测试兴奋剂和药物使用结果的有效性(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 关于未来自我认同、未来时间视角和行为延迟折扣的变化。长的- 该项目的长期目标是验证具有长期恢复好处的有效辅助干预，即 在治疗后的后续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.