A recent pilot study led by Timothy E. Wilens, MD, chief of the Division of Child and Adolescent Psychiatry, Co-Director of the Center for Addiction Medicine, and Director of Substance Abuse Services in Pediatric Psychopharmacology at Massachusetts General Hospital, found promising evidence that a virtual reality (VR)-based intervention could help patients successfully complete treatment for medically assisted opioid withdrawal.
Here are five things to know about the study, which is a collaboration between the research team and 3D Therapy, the company that is developing the VR intervention:
1. The Challenge
While impatient withdrawal management/acute stabilization can improve outcomes for individuals with opioid use disorder (OUD), patients often leave treatment early due to the mood, tensions and cravings associated with opioid withdrawal.
Individuals who complete opioid withdrawal management and transition into further care have significantly lower risk of death from opioid overdose, so there's a crucial need for new strategies to improve patient retention during the early stages of treatment.
2. The Intervention
In behavioral health, virtual reality (VR) has been shown to help with anxiety, acrophobia (fear of heights), and aerophobia (fear of flying), as well as acute and chronic pain.
VR interventions are believed to work by helping individuals focus on compelling stimuli and experiences that can helcounteract negative thoughts and feelings.
The 3D Therapy Thrive (3DTT) intervention is a 20-minute per session VR therapy that includes activities such as interactive 3D art, first-person challenges and problem solving.
The four-part intervention is guided by “Aimee,” a comforting presence that provides voice instruction and therapy.
• The first module, Guidance and Relaxation, teaches the patient to relax and control breathing.
• The second module, Immersive Creativity, provides a vivid, creative environment where participants can paint in multiple dimensions.
• The third module, Immersive Coping Skills, provides patients with skills to manage cravings while developing problem-solving skills.
• The fourth and final module, Confidence Building, is an exploratory experience designed to improve self-image, optimism and confidence.
The overall goal of the intervention is to help participants distinguish thoughts from statements of fact and become aware of the present moment.
A Closer Look at the 3D Therapy Thrive Intervention
3. The Trial
The research team recruited 32 patients undergoing opioid withdrawal treatment into the trial group and compared them to the outcomes of 29 patients who received treatment as usual (TAU).
All patients in the VR group were receiving medication for opioid use disorder (MOUD) as part of treatment.
Researchers took baseline measures of mood, tension and cravings from each participant upon enrolling them in the study. Participants were then asked to complete one 20-minute VR session of 3D Therapy Thrive.
Following the session, the patients completed questions regarding changes to their mood, tension and cravings.
Twenty-four to 48 hours later, participants were asked to undergo a second 20-minute VR session and complete a questionnaire about their experience.
4. The Results
The researchers found that participants who completed at least one VR session were more likely to complete their treatment protocol for medication-assisted opioid withdrawal in comparison to patients in the treatment as usual group (64% completed vs 45%).
The patients in the VR group also reported clinically and statistically significant improvements in symptoms of depression and tension, as well as diminished cravings for opioids.
“The high tolerability of 3DTT in this group coupled with the preliminary evidence of its effectiveness suggests this method may be a promising addition to existing treatments,” the team writes.
5. What's Next
A major limitation of the study is that the researchers did not collect comparison data on mood, anxiety and cravings from the treatment as usual (TAU) group.
A larger randomized controlled trial is needed to explore whether the improvements in symptoms shown in the VR group are attributable to the VR intervention or if there are other factors at play, the team writes.
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