A single-case experimental design study on the integration of VR within TAU for patients with SUD and ID.

Background 
Patients with Intellectual Disabilities (ID) face unique challenges in substance use disorder (SUD) treatment due to their cognitive and adaptive limitations. Existing treatment approaches, such as Cognitive Behavioral Therapy (CBT), often fall short in effectively addressing SUD in patients with ID, because of their reflective and language-based approach. Even therapy specially adapted to individuals with ID (CBT+) still relies mostly on ‘thinking’ rather than ‘doing’. Virtual Reality (VR) might be a suitable tool to overcome these shortcomings, by offering an immersive environment in which patients can learn to recognize and cope with risk situations and triggers, without having to rely on memory or verbalization. However, the specific benefits and optimal timing of integrating VR into current SUD treatment programs are still unclear. Therefore, this study aims to explore the potential benefits of integrating VR into an adapted CBT+ protocol for patients with SUD and ID. Additionally, the study seeks to gain insight into the specific phase within CBT+ where VR demonstrates the greatest value. 

Methods 
A mixed-methods single-case experimental design study (SCED) will be conducted, with VR introduced either in the assessment or practice phase of CBT+ treatment. SCED’s are a relatively new and innovative way to gain insight into if, why and how an intervention works for individual patients, and only require a small number of participants. Six adults with ID and SUD undergoing treatment as usual (TAU) at Tactus Addiction Care in the Netherlands will be included. The VR application CleVR facilitates roleplaying in personalized VR scenarios related to SUD risk situations and coping strategies. Continuous measurements (on e.g. self-insight and self-efficacy) are conducted through after-session questionnaires and app-based experience sampling questionnaires over a 12-week period. Semi-structured interviews will be held with patients and their caregivers to gain insight into experienced benefits and barriers of VR, and preferences for integration in TAU.

Results 
The protocol for the mixed-methods SCED will be presented, with a specific focus on the use of experience sampling within this complex target group. Besides the protocol, initial experiences with the methodology and preliminary findings on changes in self-insight and self-efficacy, and experiences with the integration of VR in TAU will be presented.  

Discussion/conclusion 
This research addresses a critical gap in understanding how and when VR can be optimally utilized in the treatment of SUD among individuals with ID. The suitability of the SCED methodology and continuous self-monitoring via an experience sampling app for individuals with ID will be evaluated and lessons learned will be presented. To conclude, opportunities of VR in the assessment and practice phase of CBT will be highlighted and suggestions are made for further integration into therapy for individuals with ID.