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Peer-reviewedCC BYPLOS One

A randomised feasibility trial of VR-enhanced cue exposure therapy versus neutral VR exposure for cocaine use disorder, with wearable monitoring and JITA-EMA: Feasibility randomised controlled trial protocol

  • Eileen Brobbin1
  • Matteo Cella2
  • Alexandre Copello3
  • Simon Coulton4
  • Hannah Darvell1
  • Jerome Di Pietro2
  • Colin Drummond1
  • Joe Duffy1
  • Amos Folarin5
  • Steven Glautier6
  • Tayler Holborn1
  • Ceyda Kiyak7
8 more authors
  • Jazmin Molai1
  • Thomas Phillips8
  • Heet Sankesara3
  • Daniel Stahl3
  • Callum Stewart3
  • Lucia Valmaggia2,9,10
  • Colin Williams1
  • Paolo Deluca1
10 affiliations
  1. 1National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
  2. 2Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
  3. 3School of Psychology, University of Birmingham, Birmingham, United Kingdom.
  4. 4Centre for Health Service Studies, University of Kent, Canterbury, United Kingdom.
  5. 5Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
  6. 6Department of Psychology, University of Southampton, Southampton, United Kingdom.
  7. 7Department of Psychology, University of Southern Denmark, Odense, Denmark.
  8. 8Centre for Addiction and Mental Health Research (CAMHR), Faculty of Health Science, University of Hull, Hull, United Kingdom.
  9. 9Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
  10. 10Digital XR Innovation Lab, Orygen, Parkville, Australia.
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Abstract

Background: Cocaine use disorder (CUD) is associated with high rates of relapse, with craving and cue reactivity playing important roles in ongoing use. Cue Exposure Therapy (CET) aims to reduce conditioned responses to drug-related cues through extinction learning, but traditional approaches may be limited by poor ecological validity. Virtual reality-enhanced Cue Exposure Therapy (VR-CET) offers a potentially more immersive and realistic method of delivering cue exposure. Concurrently, advances in wearable physiological monitoring and just-in-time adaptive ecological momentary assessment (JITA-EMA) enable the real-time assessment of craving in everyday life. Objective: To assess the feasibility of recruitment, consent, randomisation, blinding, intervention delivery and retention over 8 weeks post-randomisation. Method: This is a two-arm, parallel-group, randomised feasibility trial conducted in UK community drug treatment services. Sixty adults receiving treatment will be randomised (1:1) to either VR-CET or an active VR-Relaxation control condition. Both arms will receive six VR sessions over four weeks, alongside continuous physiological monitoring using a wearable device and smartphone-based JITA-EMA for eight weeks. Feasibility outcomes will include recruitment, retention, intervention adherence, wearable wear time, EMA completion, acceptability, and safety. Clinical outcomes will include cocaine use measured by Timeline Follow-Back, cue reactivity assessed through subjective and physiological measures, and participant-confirmed craving episodes captured via wearable-triggered JITA-EMA. Qualitative interviews with participants and service providers will explore intervention acceptability and implementation facilitators, barriers and suggestions. Results: Planned start date is July 2026, and enrolment is due to end in April 2027. Data analysis is estimated to be completed by the end of spring 2027. Conclusions: To our knowledge, this is the first feasibility RCT of VR-CET for CUD within UK drug treatment services. Results from this trial will help assess the feasibility of integrating VR-CET, continuous physiological monitoring, and real-time craving JITA within CUD treatment. This can be used to inform the design of a future definitive trial and contribute to the development of personalised, technology-enabled approaches to relapse prevention and substance treatment.

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Cite

BibTeXRIS
BibTeX
@article{brobbin2026randomised,
  title = {{A randomised feasibility trial of VR-enhanced cue exposure therapy versus neutral VR exposure for cocaine use disorder, with wearable monitoring and JITA-EMA: Feasibility randomised controlled trial protocol}},
  author = {Eileen Brobbin and Matteo Cella and Alexandre Copello and Simon Coulton and Hannah Darvell and Jerome Di Pietro and Colin Drummond and Joe Duffy and Amos Folarin and Steven Glautier and Tayler Holborn and Ceyda Kiyak and Jazmin Molai and Thomas Phillips and Heet Sankesara and Daniel Stahl and Callum Stewart and Lucia Valmaggia and Colin Williams and Paolo Deluca},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0358193},
  url = {https://doi.org/10.1371/journal.pone.0358193},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - A randomised feasibility trial of VR-enhanced cue exposure therapy versus neutral VR exposure for cocaine use disorder, with wearable monitoring and JITA-EMA: Feasibility randomised controlled trial protocol
AU  - Eileen Brobbin
AU  - Matteo Cella
AU  - Alexandre Copello
AU  - Simon Coulton
AU  - Hannah Darvell
AU  - Jerome Di Pietro
AU  - Colin Drummond
AU  - Joe Duffy
AU  - Amos Folarin
AU  - Steven Glautier
AU  - Tayler Holborn
AU  - Ceyda Kiyak
AU  - Jazmin Molai
AU  - Thomas Phillips
AU  - Heet Sankesara
AU  - Daniel Stahl
AU  - Callum Stewart
AU  - Lucia Valmaggia
AU  - Colin Williams
AU  - Paolo Deluca
PY  - 2026
DA  - 2026/10/30
JO  - PLOS One
DO  - 10.1371/journal.pone.0358193
UR  - https://doi.org/10.1371/journal.pone.0358193
AB  - Background: Cocaine use disorder (CUD) is associated with high rates of relapse, with craving and cue reactivity playing important roles in ongoing use. Cue Exposure Therapy (CET) aims to reduce conditioned responses to drug-related cues through extinction learning, but traditional approaches may be limited by poor ecological validity. Virtual reality-enhanced Cue Exposure Therapy (VR-CET) offers a potentially more immersive and realistic method of delivering cue exposure. Concurrently, advances in wearable physiological monitoring and just-in-time adaptive ecological momentary assessment (JITA-EMA) enable the real-time assessment of craving in everyday life. Objective: To assess the feasibility of recruitment, consent, randomisation, blinding, intervention delivery and retention over 8 weeks post-randomisation. Method: This is a two-arm, parallel-group, randomised feasibility trial conducted in UK community drug treatment services. Sixty adults receiving treatment will be randomised (1:1) to either VR-CET or an active VR-Relaxation control condition. Both arms will receive six VR sessions over four weeks, alongside continuous physiological monitoring using a wearable device and smartphone-based JITA-EMA for eight weeks. Feasibility outcomes will include recruitment, retention, intervention adherence, wearable wear time, EMA completion, acceptability, and safety. Clinical outcomes will include cocaine use measured by Timeline Follow-Back, cue reactivity assessed through subjective and physiological measures, and participant-confirmed craving episodes captured via wearable-triggered JITA-EMA. Qualitative interviews with participants and service providers will explore intervention acceptability and implementation facilitators, barriers and suggestions. Results: Planned start date is July 2026, and enrolment is due to end in April 2027. Data analysis is estimated to be completed by the end of spring 2027. Conclusions: To our knowledge, this is the first feasibility RCT of VR-CET for CUD within UK drug treatment services. Results from this trial will help assess the feasibility of integrating VR-CET, continuous physiological monitoring, and real-time craving JITA within CUD treatment. This can be used to inform the design of a future definitive trial and contribute to the development of personalised, technology-enabled approaches to relapse prevention and substance treatment.
SN  - 1932-6203
ER  -