A patient with a substance use disorder in recovery drives down the street. They pass a liquor store and turn up the radio to distract themselves — only it’s a song that reminds them of drinking. A bottle of alcohol appears on the passenger’s seat when suddenly a call from their child pops up on the screen and an inspirational quote audio is played in the background.
This is how Holly Matto, PhD, professor in the department of social work at George Mason University’s College of Public Health in Fairfax, Va., and her multidisciplinary team of behavioral science, bioengineering and mathematics researchers tested whether personalized recovery cues can biologically and emotionally re-regulate that craving response when delivered through virtual reality.
A group of 12 participants received two four-minute virtual reality simulations with both drug-related and non-drug stressor cues followed by recovery cues. To measure progress, researchers used electroencephalography to record brain waves, a wearable to collect physiological data — with 37 data streams in total — and subjective interview prompts.
“The premise of our work is to expand on the existing and very well-researched drug cue-craving paradigm that suggests exposure to drug cues changes the brain and body in ways that increase craving and therefore increases relapse risk, to empirically examine if recovery cues might hold promise in helping regulate a craving reaction,” Dr. Matto said.
Researchers track how long it takes for the participant to reach for the substance and physical symptoms such as their heart rate increasing. Then, a recovery cue appears whether it be a motivational audio message, a picture of their pet or a call from someone close to them.
The goal is to develop real-world resilience while navigating everyday triggering environments. The results offer preliminary evidence that recovery cue exposure can help regulate an individual’s response to substance stimuli, according to the study.
Recovery cues are distinct from avoidance or exposure therapy: they are replacement stimuli that reinforce the neutral pathways of self-regulation, Dr. Matto said.
“We understand that resilience is not just about bouncing back, it’s learning how to adapt, stay connected and move forward,” Padmanabhan Seshaiyer, PhD, professor of mathematical sciences at GMU said. “That’s how we have thought about it. We’ve been checking what works and what does not work [and] creating safe spaces to fail, reflect and try again.”
During the interview portion, researchers ask subjective questions to pinpoint meaningful recovery cues including visual, auditory and verbal stimuli that the participant associates with their commitment to recovery, Dr. Seshaiyer said. Virtual reality creates opportunities, he said, to build a safe, controlled environment that allows them to build resilience in the lab before stepping into the real world.
“We have full knowledge of what’s going on, what we are presenting to the person, and we know if they are being triggered, or if they have a recovery cue that [makes them] feel better or feel worse,” Nathalia Peixoto, PhD, associate professor of electrical and computer engineering at GMU. “We’re recording their physiological response, and the idea is that eventually we can design a model that will work for them. It’s personalized medicine at the behavioral level when they are in the real world without virtual reality”
Another feature the team is working on is building a digital best self inside of the virtual reality space. This is a representation of the person when they are regulated and connected to recovery. After being exposed to triggers, they can interact with their best digital self to encourage self-reflection, Dr. Seshaiyer said.
In the future, researchers hope to take this lab prototype and scale it across clinics — even at-home versions for daily use.
