Virtual Reality Facilitation of Recovery from Opioid Use Disorder

项目摘要/摘要 该第一阶段项目是一项试验性随机临床试验，旨在展示一种新型虚拟药物的商业潜力 现实干预，为第二阶段开发做准备。我们建议对我们的辅助干预进行测试 减少阿片类药物使用增加戒断在阿片类药物使用障碍(OUD)早期康复中的作用 人们的自我报告和对未来结果的行为关注也随之增加。受损的未来 定位是OUD和其他上瘾的标志。恢复尝试通常在6个月内失败 在治疗方面，有相当大的提高疗效的空间。汇聚的证据，包括我们初步的 数据表明，增加对未来的想象应该会改善复苏结果。我们的试飞测试 干预是有希望的，N=18名参与者中有14名在30天后保持戒酒； 重要的是，14名弃权者中有10人对干预表现出积极反应，即100%的应答者 保持禁欲--这表明这是一个有效的标志。虚拟现实干预提高了未来的自我认同 物质使用障碍恢复者的奖赏延迟和参与的大脑网络管理 展望未来。此外，奖赏延迟的VR效应与内省-执行脑相关 连通性。扩展之前关于插曲未来思维的工作，我们采用了个性化的、身临其境的虚拟 融合个人细节并最大限度地增加感官投入的体验。我们的干预增加了 在分歧的未来中通过与未来自我的现实互动而与未来联系在一起 来自不同的选择。重要的是，我们整合了自我差异理论，专注于鲜明的对比 在这些未来之间，以提高影响力，我们通过最大限度地增加新颖性和 体验的情感突显。早期康复的参与者进入现实的虚拟世界，是 介绍时间旅行叙事，并与两个数字时代进步的未来自我互动；一个在15岁之后 一次是持续几年的阿片类药物滥用，另一次是在康复15年后。未来的自我与参与者对话 关于他们康复的回报，或重新习惯吸毒造成的损失，以及个人在 旅行。强调机构、乐观主义和决策。在迭代开发之后 以及可行性和安全性的测试，该范例产生了有希望的疗效信号、行为改变和 大脑目标交战。目前的提案将在更广泛的范围内验证这一范例 使用相同的虚拟现实范式展示有效性和行为机制的同质OUD样本。目标1 将测试对阿片类药物使用结果(使用和戒除天数)的疗效，纵向评估为30 几天。目标2将通过测试未来自我认同、未来取向、 和行为延迟折扣。第一阶段的成功验证将使过渡到第二阶段成为可能 商业化应用程序，目标是创建一个可销售、负担得起、用户友好的软件产品 在临床环境中促进更好的康复结果。

PROJECT SUMMARY / ABSTRACT This Phase I project is a pilot randomized clinical trial designed to show commercial potential for a novel virtual reality intervention in preparation for Phase II development. We propose testing our adjunctive intervention for efficacy on reducing opioid use and increasing abstinence in early recovering opioid use disorder (OUD) persons, with concomitant increases in self-reported and behavioral focus on future outcomes. Impaired future orientation is a hallmark of OUD and other addictions. With recovery attempts usually failing within 6 months of treatment, there is considerable room for improved efficacy. Converging evidence, including our preliminary data, indicates that increasing visualization of the future should improve recovery outcomes. Our pilot testing of the intervention was 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, i.e., 100% of responders remained abstinent—suggesting an efficacy marker. The VR intervention increased future self-identification and delay-of-reward in people recovering from substance use disorder and engaged 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 personalized, immersive virtual experience that integrates personal details and maximizes sensory engagement. Our intervention increases connectedness with one’s future through a realistic interaction with Future Selves in diverging futures resulting from different choices. Importantly, we integrate self-discrepancy theory, focusing on the stark contrast between these futures to heighten impact, and we promote engagement by maximizing the novelty and emotional salience of the experience. Participants in early recovery 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 opioid abuse, and the other after 15 years of recovery. 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 and more homogenous OUD sample to show efficacy and behavioral mechanisms using the same VR paradigm. Aim 1 will test for efficacy on opioid use outcomes (days of use and abstinence) with longitudinal assessments at 30 days. Aim 2 will determine mechanisms by testing for changes in future self-identification, future orientation, and behavioral delay discounting. Successful validation in Phase I will enable transition into a Phase II commercialization application, with the goal of creating a marketable, affordable, user-friendly software product for facilitating better recovery outcomes in clinical settings.