Simulated Exposure Trainer (SET-VR): Implementing Targeted Experiential Training with a Virtual Patient

PROJECT SUMMARY/ABSTRACT 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. The proposed 20-month Phase I STTR study will test the implementation of a VR training program delivered on two platforms (i.e., VR headset and web-based) to assess which platform provides the ideal balance of immersion, usability, target engagement, and scalability. The study takes place in three stages: 1) initial development, 2) iterative evaluation and development to optimize usability, 3) clinical training trial to establish target engagement. Usability and target engagement information from this pilot trial will support a Phase II STTR project aimed at building out and broadly disseminating the VR- enhanced training approach.