Sedentary behavior, physical activity, and health-related quality of life in adults with multiple sclerosis.

Substance use disorders (SUD) among the veteran population represent a significant and costly public health concern. In response, Transcending Self Therapy (TST), an evidence-informed integrative Cognitive Behavioral Therapy (CBT) was developed and has demonstrated efficacy for SUD. However, the onset of the COVID-19 pandemic exacerbated existing mental health issues and substance misuse while straining clinical workforce capacity. This necessitated innovative solutions to support growing patient needs and limited provider availability, such as the implementation of psychotherapy services via telehealth, which has been shown to be efficacious. For example, TST was provided via a remote, on-screen therapist during COVID-19 social distancing, and veteran groups who received this remote therapy showed similar improvements in quality of life from pre- to posttreatment as those who were seen by an in-person therapist. One potential solution currently under increasing investigation for improving delivery of TST and CBT is virtual reality (VR). VR can be used as a mode for delivery of supplemental psychoeducation lessons or reinforcement of CBT and other therapeutic concepts that are typically presented in standard group or individual therapy. With the use of VR gear, patients could view immersive videos of providers addressing important problem solving or emotion regulation concepts and even complete virtual homework (). With these capabilities, VR could provide a colorful and immersive adjunct to standard therapy that may improve engagement with therapeutic materials and could also improve rates of retention in treatment. This is a critical deliverable considering the strong linkage between homework completion and successful SUD treatment outcomes, as well as the higher rate of relapse in persons with against medical advice (AMA) discharges or other irregular discharges from SUD treatment. Images of the Transcending Self Therapy Virtual Reality (TST-VR) retreat platform.