# Digital Therapeutic Development of Virtual Cognitive-Affective Training for Opioid Use Disorder

> **NIH NIH R44** · BEHAVR, LLC · 2021 · $319,021

## Abstract

Project Summary: The US is experiencing an opioid crisis, with an estimated 2.5 million Americans meeting
full criteria for opioid use disorder (OUD). Medications for opioid use disorder (MOUD) like buprenorphine are
currently the most effective form of intervention for OUD. In spite of the proven efficacy of MOUD, nearly half of
people who begin a MOUD relapse within six months. As such, novel and efficacious behavioral adjuncts to
MOUD are needed to improve treatment outcomes. Mindfulness-Oriented Recovery Enhancement (MORE), a
cognitive-affective training intervention generated through a NIDA-funded treatment development process has
shown significant promise, demonstrating therapeutic effects in four randomized controlled trials (RCTs) by
reducing opioid use and misuse and modulating neurophysiological responses during drug cue-reactivity and
natural reward processing. However, the MORE intervention requires significant human interaction and is
therefore resource intensive. Further, in light of the COVID-19 pandemic, people with OUD may be reticent to
engage in face-to-face interventions due to the risk of viral spread. To overcome these implementation barriers
and increase access to treatment, the proposed project will develop and test a virtual reality version of the
MORE intervention (MORE-VR) built on BehaVR LLC's VR existing, commercially available platform, the
Dynamic eXperience Engine (DXE). The DXE uses machine learning to integrate biometrics into the VR
experience to personalize addictions treatment, boosting patient engagement and optimizing the efficacy of
clinical intervention. In Phase I, we will develop and test the MORE-VR prototype in a single arm clinical study
of OUD patients receiving buprenorphine in an opioid treatment program (OTP), focusing on patient safety and
engagement. If the prototype is perceived to have adequate usability and Net Promoter Scores, as well as to
produce improvements in proximal measures of craving and affective state, the project will progress to Phase
II. In Phase II, we will first develop the MORE-VR Minimal Viable Program using feedback from our Phase I
study to optimize the intervention, and then conduct a RCT of MORE-VR vs. MOUD treatment as usual. Our
robust and unbiased research design will triangulate clinical outcome measurement with biochemical
verification of abstinence, ecological momentary assessments (EMA), and neurophysiological assessment of
cue-reactivity. Further, we will integrate the MORE-VR Program into the OTP operational environment, building
Fast Healthcare Interoperability Resources interfaces to ingest patient data from electronic medical records
(EMRs) and to export patient utilization, assessment, and biometric data back to EMRs to create patient
records and inform clinicians of patient progress. Activities in Phase I and Phase II will help define the
regulatory pathway and establish regulatory feasibility to precede Food and Drug Administration (FDA)
approval of the M...

## Key facts

- **NIH application ID:** 10255561
- **Project number:** 1R44DA053848-01
- **Recipient organization:** BEHAVR, LLC
- **Principal Investigator:** RISA B WEISBERG
- **Activity code:** R44 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $319,021
- **Award type:** 1
- **Project period:** 2021-05-15 → 2022-08-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10255561

## Citation

> US National Institutes of Health, RePORTER application 10255561, Digital Therapeutic Development of Virtual Cognitive-Affective Training for Opioid Use Disorder (1R44DA053848-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10255561. Licensed CC0.

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