JMIR Publications

ABSTRACT

Background:

Substance Use Disorders (SUDs) are prevalent and characterized by high relapse rates. Individuals with Mild to Borderline Intellectual Disability (MBID) are more likely to develop SUDs, highlighting the need for SUD treatment. However, people with MBID face challenges with treatment as usual. Cognitive Behavioral Therapy (CBT) is often difficult for this group due to the difficulties they experience with abstract thinking, verbal skills, and generalizing learned strategies to real-world contexts. These difficulties can reduce CBT’s effectiveness, requiring adapted interventions. Immersive Virtual Reality (IVR) may enhance CBT by simulating realistic, safe environments where patients with SUD and MBID can practice cognitive and behavioral skills that are tailored to their treatment needs with visual and practice-oriented materials.

Objective:

This study provides input for developing IVR-CBT treatment for patients with MBID and SUDs. We focus on high-risk situations and triggers inducing alcohol craving and examine coping strategies to reduce nicotine craving by using specific coping elements within the IVR.

Methods:

Two explorative studies were conducted at an inpatient clinic for patients with MBID and SUD in the Netherlands. Study 1 included ten adults with Alcohol Use Disorder and MBID who participated in interviews to determine relevant risk situations, triggers and therapeutic goals for IVR-CBT. Study 2 included ten adults with MBID and Nicotine Dependence who practiced coping strategies within an existing IVR featuring craving inducing and craving reduction scenarios. A multiple-method approach was used to gather input for developing IVR-CBT technology and protocols, as well as exploring feasibility and acceptability (user evaluation interviews, the Questionnaire of Smoking Urges and Visual Analog Scale ratings of craving) of the IVR.

Results:

In study 1 we identified important high-risk situations (e.g. at-home routines, supermarkets and social gatherings) and triggers (peer pressure, negative affect and sensory triggers). The participants expressed interest in using IVR to identify personal triggers, discuss affective states with their therapist, and repeatedly train refusal skills in response to craving inducing triggers within IVR. In study 2, multiple strategies (e.g. relaxation exercises with virtual therapists, distractions (e.g. virtual pets), and physical activities) embedded in IVR were found helpful in training coping skills. Participants described the IVR-CBT approach with risk-coping scenarios as highly acceptable, though some needed additional support because of anxiety or unfamiliarity with IVR technology.

Conclusions:

The findings of this work provide concrete design insights into triggers and coping skills that can be integrated into an IVR-CBT for persons with MBID and SUD. Future work should investigate the design of IVR for CBT through an iterative, user-center design approach based on validated CBT related techniques (e.g. functional analysis, coping skills training), and evaluation of the IVR-CBT compared to CBT as usual to understand benefits and risks for both patients and therapists.