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Neurobiological changes caused by addiction impair behavioral control and increase relapse risk, substantiating the need for long-term care coordination and recovery engagement for individuals with Substance Use Disorders (SUD). New recovery support systems that detect implicit cue-induced neurophysiological dysregulation and restore real-time regulatory capacity to decrease relapse risk are of clinical significance. Virtual Reality (VR) may be useful for developing technology-based interventions by creating learning scenarios that promote skill transfer to community contexts, to help individuals in recovery prepare for such transitions. Expanding equity in care that incorporates recovery support options using empowered participant-centered design, with menus of customized options for clients transitioning out of institutions, is clinically significant and timely.
Methods
Our feasibility STTR Phase I study used customized VR simulations to measure the impact of recovery cues (e.g., sensory reminders of recovery) on neurophysiological response, captured in-session using wearable sensors (Empatica E4 and Open BCI Ultracortex “Mark IV” EEG), as studies show increased Heart Rate Variability (HRV) and decreased Heart Rate (HR) are clinical indicators of improved mental health and correspond with increased emotional regulation. We hypothesized that participants would show increased Autonomic Nervous System (ANS) activity, as indicated by lower HRV, during substance cue exposure, and enhanced physiological regulation, as indicated by increased HRV, when recovery cues were presented. For this study, 27 variations and combinations of cues and VR environments (a park, apartment, car) were developed, with cues presented every 30 seconds during each simulation.
Results
The sample consisted of individuals in recovery (N = 12) who each participated in two VR simulations (N=24 simulations). Overall summary of results showed heartrate (BPM averaged over the previous 10 seconds) was lowered during the recovery cue exposure that followed the substance stimuli; and BPM variance was higher during recovery cue presentation as compared to substance stimuli, suggesting a more relaxed physiological state when recovery cues were presented. During substance cue exposure, data showed relatively high-power spectral density (activity) in the low beta range (13-16 Hz); and during recovery cue exposure, data showed higher power in the alpha range (8-13 Hz), with the most efficient EEG data streaming from the sensors over the forehead (FP1 and FP2).
Conclusions and Implications
Results from the study show preliminary support of the hypothesis that recovery cue exposure will help regulate neurophysiological response to substance stimuli. For our Phase II study, we are looking to increase the customized participant recovery-cue intervention experience (expanding personalized content options), providing real-time neurophysiological feedback to participants so they can learn about their regulation capacity associated with specific recovery-cue engagement patterns. In doing so, these learned strategies could be transferred to real-world contexts through the development of mobile applications. Intervention technologies that incorporate client-centered design, designed by and for individuals in recovery, may increase receptivity and engagement with treatment in ways that minimize stigma and that may be particularly beneficial when individuals transition out of institutions (e.g., jails, detox/rehab facilities, hospitals) and return to their home communities. Funding: NIH STTR Grant 1 R41 DA 50225-01