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

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. Trial registration: ISRCTN21409750, https://www.isrctn.com/ISRCTN21409750 .