161 Virtual Reality Tools to Enhance Evidence Based Treatment of Substance Use Disorders
Fast Track is not allowed.
Direct to Phase II is not allowed.
Information about Phase II is provided for planning purposes only.
Number of Anticipated Awards: 2-3
Budget (total cost):
Phase I: $150,000 for 6 months.
Phase II: For planning purposes, this may be sought with an estimated award of $1,000,000 for two years to test clinical outcome of IT approaches to augment standard treatment in a patient population in comparison with stand treatment alone. Further, Phase II will include a description of the path toward clinical adoption of this VR based IT approach.
There are numerous existing evidence-based behavioral treatment approaches for substance use disorders. A significant proportion of patients who receive treatment using evidence-based behavioral therapies relapse, suggesting that additional adaptations are needed to enhance the effectiveness of these therapies. Technology driven approaches (e.g., cell phone based applications, text messaging interventions, ecological momentary assessment (EMAs)) to improving evidence-based treatments have shown some success.
Virtual reality is unique among other technological enhancements in that it can recreate some elements of the social situations and physical environments that typically trigger relapse, allowing patients to practice skills they will need when they encounter such situations in real life. The potential for VR to enhance treatment effects has been demonstrated in domains outside of substance use (e.g., Manzoni et al., 2015 1). In addition to the potential to increase the potency of interventions by allowing patients to practice skills in realistic virtual settings, VR also has the potential to extend access to treatment outside of clinical settings, this could increase the frequency of treatment for patients and could be particularly beneficial for patients who live in rural areas or who have other health or financial barriers that make it difficult for them to get to appointments on a regular basis.
The ultimate goal is to have VR-enhanced treatments facilitate improved treatment outcomes as well as make treatment more accessible.
Numerous evidence-based substance abuse treatments may lend themselves to virtual reality adaptation. Examples may include:
• Cognitive Behavioral Therapy variations
• Contingency Management
• Motivational Interviewing/Motivational Enhancement Therapy variations
• Multisystemic Therapy
• Multidimensional Family Therapy
• The Matrix Model
• 12-Step Facilitation Therapy
• Behavioral Therapy
Develop Virtual Reality (VR) IT approach to be used to improve behavioral treatment approaches for substance abuse disorders with the following elements:
• Complete initial development and proof-of-concept for VR-enhanced evidence-based substance abuse treatment that takes advantage of the unique abilities to VR. This may include, but is not limited to, presenting a variety of virtual stimuli and environments that might illicit or inhibit drug seeking behavior or relapse using widely available commercial VR platforms (e.g., Oculus Rift, PlayStation Morpheus, HTC Vive, Samsung Gear VR).
• Complete initial efficacy/effectiveness testing of the VR-enhanced treatment to demonstrate impact on meaningful clinical outcomes.
• Obtain and document feedback that may include surveys, focus groups, user testing from relevant stakeholders who would be involved in implementing VR-enhanced treatments into substance abuse clinical treatment. This includes, but is not limited to, patients who would use the VR-enhanced treatment, clinicians who might use VR-enhanced therapy as part of their practice in private practice and larger clinical settings, and payers. This feedback should identify any challenges or barriers to implementing VR-enhanced therapy in both clinical settings as well as its potential to extend treatment outside of clinical settings (e.g., HIPPA privacy requirements, obstacles to reimbursement, patient safety concerns, etc.).
Make modifications that incorporate input received from the above surveys, focus groups and user testing.
Phase I Activities and Expected Deliverables:
• Seek feedback from a panel of health care professionals who are potential end users (e.g. therapists who are using the EBT in clinical practice) on what features and functions these professionals would most like to see and most likely convince them to employ this VR-enhanced approach.
• Assemble a team of professionals to develop a proof-of-concept VR-enhanced evidence-based substance use treatment for patients with substance use disorders. The adapted intervention must be capable of implementation on an existing commercially available consumer VR system (e.g., Oculus Rift, PlayStation Morpheus, HTC Vive, Samsung Gear VR) that use head mounted displays. At a minimum, it is expected that this proof-of-concept system would yield at least 1-2 hours of interactive content. The final amount of content should be determined by the EBP that is being adapted. Furthermore, documentation accompanying the proof-of-concept should indicate how the VR-enhanced intervention would be used to modify the existing EBP across the full treatment course indicated by the existing EBP (i.e., number of sessions, length of sessions, sequence of content, etc.).
• Conduct exploratory research with relevant stakeholders to understand the implications of HIPPA standards, data security and other considerations that would be required for clinical use (e.g., insurance reimbursement, etc.).
• Ensure that the VR system balances the need for high quality graphics to enhance user engagement, while also ensuring that the intervention could be implemented via widely available commercial technologies. Widely available technologies include consumer-grade laptop or desktop computers, tablet-based computers and/or smartphones.
• Collect quantitative and qualitative data on patient reactions to VR-enhanced treatment, including, but not limited to, ratings of graphics quality, immersive qualities, engagement, functionality, usability, acceptability, physical reactions (e.g., dizziness), interactivity, etc. Diverse patient perspectives should be solicited, and specific attention paid to features that could be easily modified to enhance the tailoring of the intervention and to enhance cultural relevance of the intervention.
• Examine clinician reactions to VR-enhanced proof concept including, but not limited to potential for inclusion in existing clinical workflow, expected patient engagement, expected clinical value, etc.
• In this phase of the research, testing for complete therapeutic outcomes is premature. However, for a treatment to work, it must produce change. Therefore, potential positive impact on the patient, which can include
biological, psychological, and/or therapeutic outcomes, should be measured. These data will be critical in determining if this project will move forward.
1 Manzoni et al., VR-enhanced CBT for obesity treatment: A randomized Control Study with Year Follow-up: http://www.ncbi.nlm.nih.gov/pubmed/26430819