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.
Public Health Relevance Statement: PROJECT NARRATIVE This project will involve the development and testing of a virtual reality (VR) software program for training exposure therapists. We anticipate the training platform will optimize experiential learning during training and overcome barriers to the dissemination of exposure therapy in practice settings. The experimental therapeutics approach to designing and testing the training intervention will provide a framework for future development of targeted trainings to spread the use of evidence-based practices.
Project Terms: Anxiety; Anxiety Disorders; Mental disorders; Mental health disorders; Psychiatric Disease; Psychiatric Disorder; mental illness; psychiatric illness; psychological disorder; Belief; Dangerousness; Medical Education; Equilibrium; balance; balance function; Fright; Fear; Feedback; Future; Goals; Interview; Investments; Learning; Literature; Methods; NIMH; National Institute of Mental Health; On-Line Systems; online computer; web based; Online Systems; Patients; Play; Research; Study Type; study design; Research Design; social role; Role; Running; Software; Computer software; Standardization; Technology; Testing; Training Programs; Measures; base; Clinical; Phase; Evaluation; Training; Distress; Workshop; Educational workshop; Data Bases; data base; Databases; Cooperative Learning; Experiential Learning; Active Learning; uptake; Glare; Education for Intervention; Instruction Intervention; Training Intervention; instructional intervention; Educational Intervention; Exposure to; tool; programs; Hour; Pattern; System; Best Practice Analysis; Benchmarking; behavior change; Services; experience; Structure; simulation; novel; virtual reality; Intervention Strategies; interventional strategy; Intervention; Investigational Therapies; Experimental Therapies; Investigational Treatments; experimental therapeutic agents; experimental therapeutics; Effectiveness; Evidence based practice; Effectiveness of Interventions; randomisation; randomization; randomly assigned; Randomized; Research Training; Strategic Planning; Community Practice; Small Business Technology Transfer Research; STTR; Update; Process; Development; developmental; Behavioral; pilot trial; virtual; design; designing; efficacy evaluation; efficacy analysis; efficacy assessment; efficacy examination; evaluate efficacy; examine efficacy; cost effective; innovation; innovate; innovative; Impairment; clinically relevant; clinical relevance; handheld mobile device; mobile device; usability; research to practice; research into practice; community setting; anxious; practice setting; virtual reality headset; virtual reality displays; virtual reality goggles; head mounted display; head mounted device; Immersion; virtual patient
