Enhancing Prospection with Virtual Reality in Alcohol Use Disorder Recovery

项目总结/摘要 我们提出了一种新的虚拟现实干预，以增加禁欲，增强未来的方向和延迟 奖励偏好，量化大脑反应，并改善早期恢复酒精使用的恢复结果 （AUD）人。我们还打算证明，代表交替未来的年老的未来自我 是干预的“活性成分”。未来导向受损，未来成果打折 似乎是AUD和其他成瘾的行为内表型。由于恢复尝试通常失败 在治疗的6个月内，有相当大的空间来改善长期恢复的功效。 越来越多的证据表明，AUD的一个特点是偏好即时享乐奖励， 视力受损，无法规划未来。为了增强未来的可视化，我们扩展了先前的工作， 通过虚拟体验可能的未来来思考未来的情景。我们的干预增加 通过让受试者沉浸在与未来自我的现实互动中， 不同的未来取决于当前的决策。我们整合了自我差异理论，聚焦于差距 在“是什么”和“可能是什么”之间进行选择，以提高动力，我们通过最大限度地提高 体验的新奇和情感的突出性。早期恢复的澳元人士进入一个引人注目的虚拟 世界，被引入到一个时间旅行的叙事，并与两个数字年龄进步的未来自我互动; 一个是在持续酗酒15年后，另一个是在15年后康复。两个未来的自己 与参与者谈论他们的恢复奖励，或返回问题饮酒的损失，以及 旅途中的个人奋斗强烈强调的是机构，乐观和决策。 经过反复的开发和可行性及安全性的测试，该范例产生了有希望的初步数据 显示出亲社会行为的改变和大脑目标参与度的增加。与未来的自我互动 与常规治疗对照组相比，虚拟现实显著增加了戒断率， 增加对未来的认同，增加奖励的行为延迟，增强大脑激活 以及执行和内省网络的连通性。目前的提案将在一个 更大样本，扩展恢复未来自我互动（30次日常体验），以显示疗效 与虚拟现实控制相比。目标1将测试虚拟现实干预的有效性， 1个月和6个月时的戒酒和饮酒结果，未来的自我相似性和行为延迟奖励。 目标2将通过展示更强的执行和内省网络来展示大脑目标参与 在决策过程中和休息时的功能，以及与增加的 延迟奖励偏好此外，大脑激活将提供一个神经信号，可以用作 干预反应者的预测标志物。最终目标是提供有力的恢复支持 在促进长期复苏的背景下，可以随时实施的干预措施。

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.