Moving Beyond Role-Play: Evaluating the Use of Virtual Reality to Teach Emotion Regulation for the Prevention of Adolescent Risk Behavior Within a Randomized Pilot Trial.

OBJECTIVE: The purpose of the current pilot study was to evaluate the acceptability and preliminary impact of using immersive virtual reality environments (IVREs) paired with a brief emotion regulation and risk reduction intervention (ER + IVRE) relative to this same intervention content paired with role-plays (ER + RP). METHODS: Eighty-five adolescents attending middle school (grades 6th-8th; ages 12-15 years) in an urban northeast city were recruited and randomized to ER + IVRE (n = 44) or ER + RP (n = 41) and had complete data. Data examining acceptability, feasibility, sexual knowledge and attitudes, and ER were collected at baseline and 3 months after intervention completion. Analyses of covariance controlling for baseline scores were used to evaluate study outcomes. Within and between intervention effect sizes were calculated with effect sizes ≥.20 considered meaningful. RESULTS: At the 3-month follow-up assessment, several within intervention condition effect sizes were found to exceed d = 0.20 across the measured sexual attitudes and ER outcomes. Between intervention analyses found that adolescents randomized to ER + IVRE attended more intervention sessions, reported less difficulty accessing ER strategies (d = 0.46), and reported higher emotional self-efficacy (d = 0.20) at the 3-month follow-up relative to adolescents randomized to the ER + RP intervention. CONCLUSIONS: This study provides preliminary evidence that using virtual reality environments to enhance ER skill building in risk situations was acceptable, feasible to deliver, and positively impacted ER abilities.

Development of and feedback on a fully automated virtual reality system for online training in weight management skills.

Virtual reality (VR) technology can provide a safe environment for observing, learning, and practicing use of behavioral weight management skills, which could be particularly useful in enhancing minimal contact online weight management programs. The Experience Success (ES) project developed a system for creating and deploying VR scenarios for online weight management skills training. Virtual environments populated with virtual actors allow users to experiment with implementing behavioral skills via a PC-based point and click interface. A culturally sensitive virtual coach guides the experience, including planning for real-world skill use. Thirty-seven overweight/obese women provided feedback on a test scenario focused on social eating situations. They reported that the scenario gave them greater skills, confidence, and commitment for controlling eating in social situations.

The feasibility and acceptability of virtual environments in the treatment of childhood social anxiety disorder.

Two significant challenges for the dissemination of social skills training programs are the need to assure generalizability and provide sufficient practice opportunities. In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This study evaluated the utility of an interactive virtual school environment for the treatment of social anxiety disorder in preadolescent children. Eleven children with a primary diagnosis of social anxiety disorder between 8 to 12 years old participated in this initial feasibility trial. All children were treated with Social Effectiveness Therapy for Children, an empirically supported treatment for children with social anxiety disorder. However, the in vivo peer generalization sessions and standard parent-assisted homework assignments were substituted by practice in a virtual environment. Overall, the virtual environment programs were acceptable, feasible, and credible treatment components. Both children and clinicians were satisfied with using the virtual environment technology, and children believed it was a high-quality program overall. In addition, parents were satisfied with the virtual environment augmented treatment and indicated that they would recommend the program to family and friends. Findings indicate that the virtual environments are viewed as acceptable and credible by potential recipients. Furthermore, they are easy to implement by even novice users and appear to be useful adjunctive elements for the treatment of childhood social anxiety disorder.

Eliciting affect via immersive virtual reality: a tool for adolescent risk reduction.

OBJECTIVE: A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. METHODS: 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. RESULTS: The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. CONCLUSIONS: This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues.

Couples therapy with gay and lesbian clients: an analysis of important clinical issues.

This article reviews and critiques couples therapy research that has focused on gay and lesbian relationships. In conducting our examination, we felt that it was imperative to address the sociopolitical climate that affects same-sex couples and that historically impeded this area of research. Upon addressing the therapist's role and comparing heterosexual relationships to same-sex relationships, this article presents the theoretical formulations and empirical findings that have informed gay and lesbian couples therapy research. We also present limitations of the current literature and suggestions for future research.