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

描述(申请人提供)：焦虑症是年轻人中最常见的精神障碍，终生患病率在普通人群中从18%到20%不等。在焦虑症中，社交焦虑症(SAD)影响了8%的青年，导致严重的短期和长期损害，包括药物滥用可能性增加、学习成绩有限、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，作为整体治疗战略的一部分，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，与没有这些组成部分的干预措施相比，显示出更高的疗效--后两个因素旨在加强技能推广。有两个关键的治疗要素(同伴泛化、家庭作业)很难在传统的临床环境中实施，限制了对不同环境(例如，学校、门诊或社区设施)需要这些服务的青年的最佳传播。在我们最近完成的第一阶段STTR中，我们开发并验证了交互式虚拟环境(VE)，以解决对技能推广至关重要的密集行为练习机会的需求。我们的VE，称为Pegasys-VR“，允许密集练习社交技能，而不需要正式的同龄人小组活动(诊所解决方案)或父母的密集参与(在家解决方案)。我们的结果表明，对于参与试验的父母、临床医生和儿童来说，在SET-C计划中实施VE环境是可接受的、可信的和可行的。此外，对组内变化的检查表明SAD症状在统计学上有显著改善。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少年的接受度和采用率，我们的第二阶段STTR研究将有以下目标：整合人工智能自然语言系统，开发额外的临床实践VES，利用严肃的游戏理论和技术，扩展作业解决方案以提供更多机会来加强体内环境中的技能获得和泛化实践，并对7至12岁的青少年进行随机对照试验，以测试Pegasys-VR“是否与传统行为干预方法对患有社交焦虑障碍的青少年同样有效，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，可以容易和快速地传播。

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.