Fresh Start: A pilot, randomized controlled trial of a virtual reality (VR) experience to develop discrepancy and elicit change talk in brief motivational interventions for hazardous drinking among young adults

Background Alcohol use is the leading risk factor for premature death among young adults globally. Brief motivational interventions (BMIs) inspired by Motivational Interviewing (MI) are effective but produce modest and short-lived effects, prompting interest in ways of enhancing the effects of these interventions. Developing self-discrepancy, the perception that one's current behavior conflicts with important values or life goals, is a key mechanism in MI. Virtual Reality (VR) has the potential to help elicit self-discrepancy by immersing users in vivid, interactive experiences that encourage deep reflection. We designed Fresh Start, a VR experience that could be used in MI sessions to help develop discrepancy and elicit change talk. This paper describes the protocol for a pilot randomized controlled trial to evaluate the tolerability, acceptability, and preliminary efficacy of Fresh Start when integrated into BMIs on hazardous drinking among young adults. Methods Hazardous drinking young adults (N=120; ages 18-34) referred to the University of Alabama's Collegiate Recovery and Intervention Services will be randomized 1:1 to: (1) BMI with VR (Fresh Start) or (2) time-matched BMI only (control). Tolerability, acceptability, and feasibility of the VR experience will be assessed in a post-session survey. Alcohol use and problems will be assessed at 1, 2, 3, and 6 months post-intervention. Discussion This study will produce one of the first rigorous evaluations of a VR experience designed to help build motivation to change drinking by eliciting self-discrepancy. Results will provide important data on tolerability and acceptability outcomes of VR-enhanced BMI, as well as its preliminary efficacy, which are necessary for planning a larger effectiveness trial. Strengths and limitations of this study: · Strength: Rigorous randomized-controlled design with a meaningful follow-up period · Strength: Explores whether integrating VR within an existing, evidence-based counseling approach confers benefit · Strength: Tests preliminary efficacy and feasibility in an especially relevant population: College students who have been mandated receive counseling due to their drinking · Weakness: Trial will be conducted at a single site (the University of Alabama), and thus, generalizability to other populations and locations may be limited · Weakness: Study is a pilot study, so it will not be large enough to be certain that any between-group effects can be detected if they are present Trial registration [TBD]