Pegasys VR: Integrating Virtual Humans in the Treatment of Child Social Anxiety

描述（由申请人提供）：焦虑症是青少年中最常见的精神疾病，其终生患病率在总人口的18-20%之间。在焦虑症中，社交焦虑症（SAD）影响了8%的青少年，导致严重的短期和长期损害，包括药物滥用的可能性增加、学业成就有限、职业功能减弱以及社会关系受损或缺失。新出现的数据表明，包括社交技能培训、正式的同伴推广会议和家庭作业在内的干预措施作为整体治疗策略的一部分，与没有这些组成部分的干预措施相比，效果更好——后两个要素旨在提高技能推广。两个关键的治疗要素（同伴推广、家庭作业）在传统的临床环境中难以实施，限制了在不同环境中（例如，在学校、门诊或社区设施）向需要这些服务的青少年进行最佳传播。在我们最近完成的第一阶段STTR中，我们开发并验证了一个交互式虚拟环境（VE），以解决对技能推广至关重要的强化行为练习机会的需求。我们的VE，被称为Pegasys-VR，允许密集的社交技能练习，而不需要正式的同伴小组活动（诊所解决方案）或密集的父母参与（家庭解决方案）。我们的研究结果表明，在SET-C项目中实施VE环境对参与试验的家长、临床医生和儿童来说是可访问的、可信的和可行的。此外，对组内变化的检查表明SAD症状有统计学意义的改善。鉴于第一阶段的成功，以及需要提高系统的自动化程度，以提高临床医生和社交焦虑青年对其的接受和采用，我们的第二阶段STTR研究将有以下目标：结合人工智能自然语言系统，为临床实践开发额外的虚拟现实，扩展家庭作业解决方案，提供额外的机会，以加强在体内环境中的技能获取和泛化实践，使用严肃的博弈论和技术，并对7至12岁的青少年进行随机对照试验，以测试Pegasys-VR”对患有社交焦虑症的青少年是否与传统行为干预一样有效，以及在3个月的随访中是否保持效果。如果Pegasys-VR在临床上是有效的，它将提供一种可持续的、具有成本效益的干预措施，可以轻松、快速地传播。

DESCRIPTION (provided by applicant): Anxiety disorders are the most common psychiatric disorders among youth, with lifetime prevalence ranging between 18-20% of the general population. Among anxiety disorders, social anxiety disorder (SAD) affects 8% of all youth, resulting in significant short and long-term impairment, including increased likelihood of substance abuse, limited academic achievement, attenuated occupational functioning, and impaired or missing social relationships. Emerging data suggest that interventions that include social skills training, formal peer generalization sessions, and homework assignments as part of an overall treatment strategy show enhanced efficacy when compared to interventions without these components - the latter two elements which are designed to enhance skill generalization. Two critical treatment elements (peer generalization, homework assignments) are difficult to implement in traditional clinical settings, limiting optimal dissemination to youth in need of thes services in different settings (e.g., at school, outpatient, or community facilities). In our recenly completed Phase I STTR, we developed and validated an interactive virtual environment (VE) to solve the need for intensive behavioral practice opportunities that are critical for skill generalization. Our VE, known as Pegasys-VR", allowed intensive practice of social skills without the need for formal peer group activities (in-clinic solution) or intensive parental involvement (at-home solution). Our results indicated that implementing a VE environment into the SET-C program was accessible, credible and feasible for the parents, clinicians and children who participated in the trial. Furthermore, examination of within group changes indicated statistically significant improvement in SAD symptoms. Given the success of the Phase I, and the need to increase the automation of the system to increase its acceptance and adoption among clinicians and socially anxiety youth, our Phase II STTR study will have the following goals: incorporate an artificial intelligence natural language system, develop additional VEs for in-clinic practice, expand the homework solution to provide additional opportunities to reinforce skills acquisition and generalization practice in in-vivo settings, using serious game theory and technology, and conduct a randomized controlled trial with youth ages 7 to 12 to test whether Pegasys-VR" is as effective as traditional behavioral interventions for youth with social anxiety disorder and if the effects are maintained at 3 month follow-up. If Pegasys-VR" is clinically efficacious, it would offer a sustainable, cost-effective intervention that can be easily and rapidy disseminated.