Developing a Virtual Reality Training Tool for Exposure Therapy: Simulated Exposure Trainer (SET)

Not Applicable

Completed

• Conditions: Low-immersion (Mobile Device); High-immersion (Head Mounted Display)

• Registration Number: NCT06706245
• Lead Sponsor: Bradley Hospital

Brief Summary

The goal of this study is to develop a targeted virtual training program (Simulated Exposure Trainer; SET) for exposure therapy. Two platforms with differing levels of immersion (low - mobile device; high - head mounted display) will be evaluated based on their usability and engagement of an empirically-derived training target (i.e., therapist negative beliefs). Target engagement will be evaluated by applying an experimental therapeutics framework during a brief training trial.

Detailed Description

Despite the existence of numerous, well-established evidence-based practices (EBPs) for mental disorders, it has been difficult to disseminate these practices in community settings. Exposure therapy for anxiety disorders represents one of the most glaring examples of this research-to-practice gap. Just as patients are anxious about approaching their fears, therapists are often reluctant to use exposure therapy due to their own anxious beliefs that it may be dangerous and/or intolerable for patients, even after receiving specialized exposure training. Emerging training research suggests the inclusion of targeted behavioral strategies (i.e., role play, self-exposure) can reduce anxious beliefs above and beyond standard didactic training sessions. By leveraging the same behavior change principles that reduce patient anxiety (i.e., exposure), behavioral strategies can be tailored to target therapists' anxious beliefs about the treatment (i.e., conduct training as "exposure to exposure"). Unfortunately, current experiential training tasks have failed to closely replicate commonly feared clinical contexts, and as a result lack the necessary potency to potentially overcome therapist-level barriers for uptake and quality treatment delivery following training. Virtual reality (VR) has demonstrated utility as a potent and cost-effective approach for delivering exposure. We plan to investigate the application of VR as a tailored training tool (i.e., virtual "exposure to exposure" for therapists) capable of enhancing the quantity and quality of experiential learning that is lacking in current exposure training initiatives. This study will test the implementation of a VR training program on both a low-immersion (i.e., mobile device) and high-immersion (i.e., head mounted display) platform to assess which platform provides the ideal balance of immersion, usability, target engagement, and scalability. The study involves a clinical training trial to establish target engagement. Usability and target engagement information from this pilot trial will support a Phase II project aimed at building out and broadly disseminating the VR-enhanced training approach.

Study Timeline

• Study Start: 2023-12-01
• Primary Completion: 2024-05-30
• Study Completion: 2024-07-03
• Status Verified: 2024-11
• Study First Submitted: 2024-11-19
• Study First Submitted QC: 2024-11-22
• Last Update Submitted: 2024-11-22
• Study First Posted: 2024-11-26
• Last Update Posted: 2024-11-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 42

Inclusion Criteria

• Bachelor's level of education (or higher)
• Able to come to study site in-person for experiential training
• Has the ability to provide some sort of clinical care to patients

Exclusion Criteria

• Found study procedures to be unacceptable during the consent process

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Therapist Negative Beliefs about Exposure Scale (TBES)	Before workshop starts (Baseline); immediately after 4-hour didactic portion of training (Post-didactic), immediately after remaining workshop activities (End of workshop), one month after workshop (Follow-up)	The TBES assesses the extent to which therapists agree with 21 negative beliefs about exposure therapy (e.g., "most clients have difficulty tolerating the distress exposure therapy evokes"). Items are rated on a 5-point scale from 0 ("disagree strongly") to 4 ( "agree strongly").

Secondary Outcome Measures

Name	Time	Method
Exposure Self-Efficacy	Before workshop starts (Baseline); immediately after 4-hour didactic portion of training (Post-didactic), immediately after remaining workshop activities (End of workshop), one month after workshop (Follow-up)	This is a 27-item measure of therapists' confidence in delivering exposure therapy. The first 8 items are about the therapist's ability to help patients learn skills related to exposure (e.g., "I feel confident in my ability to help my clients identify how avoidance is maintaining their fear"), and the remaining 19 items assess the therapist's confidence with implementing exposure various aspects of exposure (e.g., "I feel confident in my ability to conduct imaginal exposure"). Items are rated scale ranging from 1 ("not confident") to 5 ("very confident"). This measure has demonstrated high internal consistency and predictive validity in determining the frequency of self-reported clinical use of exposure therapy.
Exposure Knowledge	Before workshop starts (Baseline); immediately after 4-hour didactic portion of training (Post-didactic), immediately after remaining workshop activities (End of workshop), one month after workshop (Follow-up)	We condensed the original 49-item measure into 12 multiple-choice items that best fit the didactic content of the training (e.g., "Why is it important to block avoidance during exposure tasks?")
Beliefs about Exposure Scale-Training (BES-T)	Therapists complete three experiential activities during the workshop training. The BES-T is administered immediately after all three activities	This 6-item measure examines belief change during the experiential portion of training activities. The first five items are rated on a scale from 0 ("Completely Disagree") to 100 ("Completely Agree") and assess therapists' perceptions of safety and tolerability of exposure - both for their patients and themselves. The sixth item asks therapists to indicate their agreement with the statement "I feel very confident in my ability to deliver exposure therapy and I am committed to using it with my anxious clients" by selecting either "Not Yet" or "No more practice - I am ready." The item was intended to gauge self-perceptions of whether therapists felt ready and able to use exposure therapy patients with anxiety.
Training Acceptability Rating Scale (TARS)	After all workshop activities are complete (Post-workshop)	The TARS is a measure of therapists' satisfaction. The first six items, rated on a scale of 1 ("strongly disagree") to 6 ("strongly agree"), assess the acceptability of the training program, and the following 9 items ask therapists to rate the training's perceived utility on a 4-point Likert scale. Total scores range from 6 to 63. This measure has good psychometric properties.

Trial Locations

Locations (1)

Pediatric Anxiety Research Center at Bradley Hospital; 🇺🇸 Providence, Rhode Island, United States