Enhancing Prospection with Virtual Reality in Alcohol 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，以增加禁欲、增强未来定向和延迟 在早期戒酒中，奖励偏好、量化大脑反应和改善康复结果 精神障碍(澳元)人群。我们还打算证明，年迈的未来自我代表着另一种未来 是干预行动的“积极因素”。未来导向受损和未来结果贴现 似乎是AUD和其他成瘾的行为内表型。恢复尝试通常会失败 在治疗的6个月内，长期恢复的疗效仍有相当大的提高空间。 越来越多的证据表明，澳元的一个特点是偏好立即的享乐奖励和 有损于对未来的想象和规划。为了增强对未来的可视化，我们将先前的工作扩展到 通过虚拟体验看似合理的替代未来来断断续续地思考未来。我们的干预增加了 通过让受试者沉浸在与未来自我的现实互动中，与未来建立联系 不同的未来依赖于当前的决定。我们整合了自我差异理论，关注差距。 在“现在是什么”和“可能是什么”之间，以增强动力，我们通过最大化 体验的新颖性和情感上的突显。早期康复的澳大利亚人进入一个引人注目的虚拟 世界，被介绍给时间旅行叙事，并与两个数字时代进步的未来自我互动； 一次是在持续15年的酗酒之后，另一次是在15年的康复之后。两个未来的自我 与参与者谈论他们的康复奖励，或因重新饮酒而蒙受的损失，以及 旅途中的个人挣扎。强调机构、乐观主义和决策。 经过反复开发和可行性和安全性测试，该范例产生了有希望的初步数据 表现出更多的亲社会行为变化和大脑目标参与。与未来的自我互动 与照常治疗的对照组相比，虚拟现实显著提高了禁酒率， 增加对未来的认同感，增加行为延迟奖励，并增强大脑激活 以及执行和自省网络中的连接性。目前的提案将在一个 更大的样本，扩展了恢复未来的自我互动(每天30次)，以显示有效性 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 戒酒和饮酒在1个月和6个月的结果，未来的自我相似性，以及行为奖赏延迟。 目标2将通过展示更强大的执行和内省网络来展示大脑目标参与度 决策过程中和休息时的功能，以及与以下方面相关的高管网络连接 延迟奖励偏好。此外，大脑的激活将提供一种神经信号，可以用作 干预应答者的预测性标记。最终目标是提供强有力的恢复支持 在促进长期复苏的背景下很容易实施的干预措施。

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.