Virtual Reality Therapy Assistants for Adjunctive Cue Exposure Training in the Treatment of Alcohol Use Disorder (VITAACue-AUD): Protocol for a Technical Feasibility Study.

Background: Alcohol use disorder (AUD) is associated with a substantial individual and societal burden. Cue exposure approaches can support treatment by targeting conditioned cue reactivity and high-risk contextual associations. However, routine implementation is limited by therapist time, scalability constraints, and the difficulty of reproducing ecologically valid drinking situations in standard care settings. Virtual reality (VR) and AI have been proposed as promising tools to support scalable and contextually rich interventions in mental health care. Objective: This study aims to develop and technically evaluate a prototype virtual reality-based therapy assistant (VRTA) for narratively guided alcohol cue exposure in immersive VR. Methods: This is a single-site technical feasibility study conducted at the Central Institute of Mental Health in Mannheim, Germany. It builds on a participatory development process, including multistakeholder workshops with developers, researchers, clinicians, and patient and public involvement contributors. The study began with workshops to refine implementation priorities. A VRTA prototype will be developed to guide alcohol cue exposure scenarios through speech-based interaction with a computer-generated character in immersive VR, informed by established exposure manuals (development ongoing, currently with a text-based chatbot prototype and a separate VR environment). An iterative qualitative expert appraisal will be conducted during development (ongoing). In addition, 20 adult patients with AUD will participate in an observer-based evaluation in which therapeutic staff demonstrate the prototype and patients provide qualitative feedback. Results: Results are expected on the technical feasibility of the VRTA prototype, including interaction quality and integration into therapeutic workflows. Qualitative findings from expert appraisal and patient feedback (observed from a third-person perspective) will provide insights into usability, manual conformity, acceptability, and perceived therapeutic relevance (audio transcript coding and qualitative evaluation are ongoing). Funding for this study has been approved by the Hetzler Foundation from November 2025 to October 2027. Initial workshops were conducted in January 2026 and May 2026. Prototype testing by expert participants with patient observers is planned to start in November 2026 and continue until April 2027. Conclusions: This study is intended to generate design specifications and feasibility data to inform subsequent prototype refinement and future clinical evaluation studies.