Using Virtual Reality to help adults with Alcohol Use Disorder learn and practice coping skills in realistic high-risk situations - Project Summary/Abstract Alcohol use disorders (AUDs) are the third most common mental health condition worldwide and the fourth leading cause of disability. Only about a third of those with AUD who receive treatment in the US remain abstinent a year later, suggesting that there is ample room to improve the efficacy of treatment. Helping patients learn coping skills is a key element of nearly all effective treatments for AUD and could represent a common factor of these treatments. Coping skills training is also a core component of cognitive behavior therapy (CBT) for AUD, an evidence-based approach to psychosocial AUD treatment that is commonly used in community settings. “Coping skills” refer to a broad range of cognitive and behavioral strategies to avoid drinking, including steps like controlling exposure to high-risk situations, employing various strategies to avoid drinking in high-risk moments, and assertively refusing social pressure to drink. One common way that therapists help patients learn these skills is by asking them to anticipate high-risk situations and identify how they might use specific coping skills in those situations. However, imparting these skills verbally, and in therapy rooms far removed from the real situations in which patients need to use them, has limitations. Virtual reality (VR) experiences can provide a way to immerse patients with AUD in realistic high-risk situations to help them identify important triggers, experiment with different coping strategies, and practice deploying them in realistic situations. VR has also been used as an adjunct to counseling for a variety of other mental health disorders, with notable success facilitating exposures for anxiety disorders and PTSD, supporting its feasibility as a tool to enhance psychotherapy. Meta-analyses suggest that these VR-assisted exposures are realistic and as effective as in vivo exposures. Several VR experiences that immerse users in situations that are high-risk for drinking have already been developed, but all have been used exclusively for research purposes. Using experiences like these to augment treatments that provide training in coping skills could help therapists provide more realistic contexts that help patients learn and practice these skills, ultimately improving the effectiveness of these interventions for AUD. In this project, we propose to use the Delphi method to develop consensus among experts about the most promising ways to use VR to enhance coping skills training and use these findings to develop a protocol to guide the use of VR within CBT, an evidence-based AUD treatment that involves coping skills training at its core. In a longitudinal, randomized controlled pilot trial, we will test whether a 12-week CBT treatment with VR-enhanced coping skills training is feasible, tolerable, and acceptable, relative to standard CBT in those with AUD. We will also explore preliminary efficacy across conditions and assess patient and therapist preferences relevant for future implementation. This work is the first step in a line of research that explores how VR can enhance treatments that are regularly used in community settings.
