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

项目总结/摘要 尽管存在许多针对精神障碍的成熟循证实践（EBP）， 很难在社区环境中传播这些做法。焦虑症的暴露疗法 代表了这种研究与实践差距的最明显的例子之一。就像病人担心 在接近他们的恐惧时，治疗师往往不愿意使用暴露疗法，因为他们自己的焦虑信念 即使在接受专门的暴露培训后，对患者来说也可能是危险的和/或无法忍受的。 新兴的培训研究表明，包括有针对性的行为策略（即，角色扮演，自我暴露） 可以减少焦虑的信念超过标准的教学培训课程。通过利用相同的 减少患者焦虑的行为改变原则（即，暴露），行为策略可以量身定制， 目标治疗师关于治疗的焦虑信念（即，进行“暴露于暴露”的培训）。 不幸的是，目前的经验培训任务未能密切复制普遍担心的临床 背景下，因此缺乏必要的潜力，可能克服治疗师水平的吸收障碍 并在培训后提供高质量的治疗。虚拟现实（VR）已被证明是一种有效的和成本- 提供曝光的有效方法。我们计划调查VR作为定制培训工具的应用 (i.e.,虚拟“暴露暴露”的治疗师）能够提高数量和质量的经验 这是目前培训计划所缺乏的。拟议的20个月I期STTR研究将 测试在两个平台上交付的VR培训计划的实施情况（即，VR头显和基于网络的） 评估哪种平台能够在沉浸感、可用性、目标参与度和可扩展性之间实现理想的平衡。 研究分为三个阶段：1）初始开发，2）迭代评估和开发优化 可用性，3）临床培训试验，以建立目标参与度。可用性和目标参与信息 将支持第二阶段STTR项目，旨在建立和广泛传播VR- 强化培训方式。

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.