Effect of a Novel Somatic Avatar Training on Distress Tolerance Among Unhoused Men Recovering from Substance use Disorders: A Pilot Study

Unhoused individuals with substance use disorders (SUDs) and in recovery, who face environment-specific stress and challenges in tolerating negative affect, will likely benefit from brief, accessible interventions that target somatic awareness of emotions. This pilot study aimed to test the feasibility of somatic avatar (SA), a novel, movement-based interoceptive training, in improving distress tolerance among unhoused individuals with SUDs. Twenty-four males residing in a substance treatment facility were assigned to two conditions: SA (n = 12) and education control (EC; n = 12). The SA condition consisted of 1) two-hour emotion-focused yoga training, 2) each participant creating an avatar that visually represented their bodily/emotional states, which was then animated with their pre-recorded yoga movements, and 3) participants watching the animated avatar video. EC participants viewed emotion regulation educational videos of equivalent duration. Participants’ responses to the Distress Tolerance Scale and embodiment questions were collected at baseline and post-intervention. A mixed-model ANCOVA controlling for age, primary drug of choice, and negative feelings in the past week revealed a significant effect of SA in improving overall distress tolerance compared to EC, F(1,18) = 6.87, p = 0.017, partial \({\eta }^{2}\) ${\eta }^2$ = 0.28, with more improvements in the lower alexithymia subgroup. Exploratory analyses suggested avatar embodiment as a potential mechanism of SA. The current study provided preliminary evidence for the effect of SA in improving distress tolerance among individuals recovering from SUDs. Future studies with a larger, more diverse sample and more follow-ups are needed to extend the current findings.