Personalized Virtual Reality Future Selves Elicit Introspective Brain Activation in Early Substance Use Disorder Recovery.

Introduction: Substance use disorder (SUD) recovery typically requires transformative change and prioritizing long-term healthy goals. Unfortunately, successful recovery is threatened by relapse rates that typically exceed 50% in the first year. We previously reported on an experiential virtual reality (VR) SUD recovery intervention using personalized future self-avatars that produced emotional engagement and positive behavioral change, ie, stronger connection with the future self and future rewards, and reduced craving. Here, we used fMRI to identify brain engagement to a future self experience with divergent futures. Methods: Twenty adults (14 males, 33 years old) in early SUD recovery (<1 year) interacted with age-progressed versions of themselves in two different VR future "realities": an SUD Future Self and a Recovery Future Self. Vivid lifelike visual and audio animation was augmented with a personalized narrative concerning future drug use and recovery. MRI immediately followed. Participants viewed videos of their future selves in the virtual environment and were directed to contemplate what they were seeing during MRI. Results: Viewing and contemplating the future selves elicited activation in midline default mode regions (posterior cingulate and ventromedial prefrontal cortices), visual regions including the occipital and fusiform face areas, and left middle frontal gyrus. The Recovery Future Self produced significant left occipital face area activation compared with the SUD Future Self. Midline default mode activation correlated with VR-induced increases in delayed reward preference, and also with greater trait perseverance. Discussion: Using digital selves as therapeutic agents reveals novel possible interventions and opens exciting new frontiers in behavior change methodology. Future studies targeting decision-making and future behavior could be informed by evaluating increased midline default mode engagement, with uniquely self-focused mechanisms signaled by executive network and face area coactivation. While preliminary, these data suggest promise for a range of new restorative experiences enabled by immersive digital therapeutics.