JMIR Publications

ABSTRACT

Background:

Despite robust empirical support, exposure-based CBT remains one of the least utilized evidence-based practices (EBPs) for anxiety disorders in typical practice settings. Research suggests providers’ negative beliefs about the risk of negative events during exposure delivery are a major predictor of its underutilization. Studies have demonstrated that incorporating experiential learning such as role-playing into conventional didactic training can reduce therapists’ negative beliefs. However, these methods face limitations in terms of accessibility, standardization, and fidelity to real-life experiences. Emerging evidence suggests virtual reality (VR) simulations may be an effective and scalable alternative for improving skills and attitudes pertinent to mental health treatment.

Objective:

This study examines the initial efficacy of a novel VR simulation-based exposure training program (SET-VRTM) based on (1) perceptions of usability, and (2) degree of change in therapist learning targets (i.e. knowledge, self-efficacy, attitudes). Clinician participants were randomly assigned to a low-immersion desktop version or a high-immersion head-mounted display (HMD) version of the SET-VRTM program to explore the influence of immersion on key outcomes.

Methods:

Clinician participants (N=41) were recruited from a variety of practice settings. Before randomization, both groups received conventional (4-hour) didactic training for exposure therapy. Next, groups were assigned to immersion modality (desktop or HMD) and began delivering exposures to a virtually simulated patient. Participants practiced titrating exposure intensity (increase, decrease, continue) based on real-time visual and auditory cues from the virtual patient. Participants completed three rounds of exposure delivery to a simulated patient and reviewed their decisions with feedback at the end of each round. Exposure knowledge, exposure self-efficacy, and beliefs about exposures were measured at baseline, post-didactic, and post-VR. Participants also rated the acceptability, usability, and real-world authenticity of VR exposure training.

Results:

Both groups (desktop, HMD) showed significant improvement in exposure knowledge (p<.01; p<.01), self-efficacy (p<.01; p<.01), and beliefs about exposure (p<.01; p<.01) between baseline and didactic training. There were no significant differences between the low and high immersion groups on any measure at baseline or after didactics. Both groups demonstrated significant improvement in exposure self-efficacy (p<.01; p<.01) and beliefs (P<.001; p=.012) from post-didactic to post-exposure delivery. Neither showed improved knowledge from post-didactic to post-exposure delivery (p>.05; p>.05). Both groups gave highly positive ratings for the acceptability, usability, and authenticity of the simulated training experience. Taken together, results indicate that VR training significantly improved therapists’ self-efficacy and beliefs about exposures beyond gains from didactic training alone. 

Conclusions:

VR exposure therapy training is both well-received and effective in addressing clinician-level barriers to optimal exposure delivery. Supplementing conventional didactic training with experiential learning via VR sessions may be a promising next step in optimizing the standardization, scalability, and effectiveness of exposure training. Clinical Trial: Clinicaltrials.gov Identifier: NCT06706245