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Immersive Virtual Reality-Supported Cognitive-Behavioral Therapy for Patients With Mild to Borderline Intellectual

Samantha Murray1,2, Simon Langener3,4,5, Hanneke Kip1,2

  • 1Behavioural Management and Social sciences, Psychology Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands, 31 534896027.

JMIR XR and Spatial Computing
|May 28, 2026
PubMed
Summary

Immersive virtual reality (IVR) therapy shows promise for individuals with substance use disorders (SUDs) and mild to borderline intellectual disability (MBID). This approach helps identify triggers and practice coping skills in a safe, virtual environment.

Keywords:
alcohol use disorderborderline intellectual functioningcognitive behavioral therapycravingimmersive virtual realitymild intellectual disabilitynicotine dependencerelapse preventionsubstance use disorderuser-centered design

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Area of Science:

  • Mental Health
  • Neuroscience
  • Virtual Reality Applications

Background:

  • Substance use disorders (SUDs) have high relapse rates, particularly in individuals with mild to borderline intellectual disability (MBID).
  • MBID patients face treatment barriers due to difficulties with abstract thinking and generalizing skills.
  • Experiential, context-rich therapies are needed to support trigger identification and coping skill rehearsal for SUDs in MBID populations.

Purpose of the Study:

  • To gather design input for developing and integrating immersive virtual reality (IVR)-supported therapy for individuals with MBID and SUD.
  • Study 1 explored alcohol-related triggers in patients with alcohol use disorder (AUD).
  • Study 2 assessed the feasibility and acceptability of practicing nicotine-related coping strategies in patients with nicotine dependence (ND).

Main Methods:

  • Two explorative studies were conducted with adult inpatients diagnosed with MBID and SUD.
  • Study 1 involved interviews to identify risk situations and triggers for IVR-cognitive behavioral therapy (CBT) in AUD.
  • Study 2 evaluated the use of IVR for practicing coping strategies in ND, using user evaluations, craving questionnaires, and visual analog scales.

Main Results:

  • Study 1 identified high-risk situations (e.g., home routines, social gatherings) and triggers (e.g., multisensory cues, social influences, affective states).
  • Participants expressed interest in using IVR for trigger identification, discussing emotions, and refusal skills training.
  • Study 2 demonstrated that IVR elicited and managed nicotine craving, with coping strategies including relaxation, distraction, and physical activity.

Conclusions:

  • Immersive virtual reality (IVR)-CBT elements are feasible and acceptable for inpatient MBID care with support.
  • Patient-derived insights can guide the integration of trigger identification and coping rehearsal within IVR.
  • Future research should employ user-centered design and compare IVR-CBT with standard CBT.