Effects of a virtual reality-based training program for adolescents with disruptive behaviour problems on cognitive distortions and treatment motivation: Protocol for a multiple baseline Single-Case Experimental Design (Preprint)

BACKGROUND Serious disruptive behaviour among adolescents is a prevalent and often persistent problem. This highlights the importance of adequate and effective treatment to help adolescents with disruptive behaviour problems react less hostile and aggressive. In order to create a treatment environment in which behavioural change can actually be enhanced, treatment motivation plays an essential role. Regarding treatment itself, a focus on challenging self-serving cognitive distortions in order to achieve behavioural change is important. Street Temptations (ST) is a new training program that was developed to address both treatment motivation and cognitive distortions in adolescents with disruptive behaviour problems. One of the innovative aspects of ST is the use of virtual reality (VR) techniques to provide adolescents during treatment with visually presented daily social scenarios to activate emotional engagement and dysfunctional cognitions. By using the VR scenarios as an integral starting point of ST’s sessions and transferring the power of the VR experience into playful and dynamic exercises to practice social perspective-taking, adolescents are encouraged to reflect on both their own behaviour as on that of others. This focus on reflection is grounded in ST’s main treatment mechanism to influence treatment motivation and cognitive distortions, namely mentalizing (i.e., reflective functioning). OBJECTIVE Describing the research protocol to evaluate the effects of ST on treatment motivation and cognitive distortions. We take a closer look at the use of ST and the methodology used, namely the repeated Single-Case Experimental Design (SCED). METHODS The effects of ST are studied through a multiple baseline Single-Case Experimental Design, using both quantitative and qualitative data. In total, 18 adolescents from secure residential youth care and secondary special education are randomly assigned to one of three different baseline conditions. Throughout a baseline phase (1, 2, or 3 weeks), intervention phase (4 weeks) and follow-up phase (1, 2 or 3 weeks), daily measurements on treatment motivation and cognitive distortions are conducted. Secondary study parameters are assessed before baseline, after intervention and after follow-up. Qualitative data is collected after intervention, as wells as 3 and 6 months after intervention. RESULTS Data collection for this study is planned to be completed by June 2023. The results will be published in peer-reviewed journals and presented at national and international conferences. CONCLUSIONS ST aims to improve disruptive behaviour problems of adolescents. The study described in this article will be the first to gain insight into the effectiveness of ST. Strengths of this study include its thorough and individually focused design (SCED), the focus on a residential as well as a secondary special education setting, and the ecological validity. Implications for practice are discussed. CLINICALTRIAL The study is registered at the Central Committee on Research Involving Human Subjects (NL75545.029.20, 24-06-2021) and the Netherlands Trial Register NL9639; https://www.trialregister.nl/trial/9639 (11-08-2021).