Pilot Study of Parent Training With Role-plays in Virtual Reality for Parents of Children With Behavior Problems

BACKGROUND:

Parent training programs based on cognitive behavioral therapy (CBT) have shown positive effects for reducing child behavior problems, such as oppositional defiant and aggressive behaviors, and are often recommended as a first intervention. The focus of CBT-based parenting programs are e.g. to reduce negative parent-child interactions and increase positive communication.

Recently, studies have evaluated CBT with the addition of exercises and role-playing in virtual reality (VR), for instance for adults with anxiety or anger. VR can provide a safe and gradual platform to practice in environments and situations. The present project evaluates a CBT-based parenting program, which includes practicing of skills in VR.

PURPOSE AND RESEARCH QUESTIONS:

The aim of this project is to evaluate preliminary effects and feasibility of a CBT-VR parent training program. The specific research questions are as follows:

1. What are the preliminary effect of the CBT-VR parent training program on children's behavioral problems, well-being, parents' emotion regulation, parenting strategies, and family conflicts? 2. What is the level of parent engagement in the CBT-VR parent training program (e.g., the number of sessions, exercises, homework completion and dropout rates)? 3. What are the experiences of parents and therapists of the CBT-VR parent training program (e.g., its effectiveness, acceptability, usefulness as well as relevance of the strategies taught)?

METHODS:

This project consists of a small pilot study of a CBT-VR parent training program for parents with children aged 8-16 years (n=10 families). The design is based on a mixed-methods approach. Evaluation of the intervention is conducted using within-group design (repeated measurements before, during, and after the intervention).

Parents will be recruited through clinics and advertisements. They are directed to a webpage with information about the study and contact information to the researchers. Parents give written informed consent to participate. When parents are interested in participating, a member of the research team will contact the participant for screening of inclusion and exclusion criteria. Clinicians at the respective clinics will be invited to answer questions regarding experiences of delivering the program.

The treatments are evaluated quantitatively by the parents using validated assessment forms/single questions before, during, and after interventions. Additionally, qualitative interviews will be conducted with parents and clinicians who provide consent to participating in an interview.

In another, separate study we evaluate CBT and role-plays in VR for children: "Pilot study of cognitive behavior therapy with role-plays in virtual reality for children with anger problems".

POWER CALCULATION:

The quantitative and qualitative data that will be collected with ten families is considered sufficient to provide understanding and preliminary insight into acceptability, usability, relevance, and effectiveness.

ANALYSES:

The plan is to compare changes during the intervention using paired t-tests, descriptive statistics, description of reliable and clinical change, and calculation of effect sizes. If appropriate, non-parametric alternatives will be employed. The qualitative analyses will be conducted using content analysis or thematic analysis.

• Parent: Mean change from baseline in parent-ratings of child wellbeing on the KIDSCREEN-10 [Time frame: Pre- and post-intervention (10 weeks after the initiation of the intervention)]
• Parent: Mean change from baseline in parent-ratings of child wellbeing on the Strengths and Difficulties Questionnaire (SDQ) [Time frame: Pre- and post-intervention (10 weeks after the initiation of the intervention)]
• Parent: Mean change from baseline in parent-ratings of emotion regulation on the Difficulties in Emotion Regulation Scale-16 [Time frame: Pre- and post-intervention (10 weeks after the initiation of the intervention)]
• Parent: Mean change from baseline in parent-ratings of parental emotion regulation on the Parent Emotion Regulation Scale [Time frame: Pre- and post-intervention (10 weeks after the initiation of the intervention)]
• Parent: Mean change in parent-ratings of family warmth [Time frame: Pre- and post-intervention (10 weeks after the initiation of the intervention)]
• Parent: Mean change in parent-ratings of family conflicts [Time frame: Pre- and post-intervention (10 weeks after the initiation of the intervention)]
• Parent: Mean change in parent-ratings of parental satisfaction with the week [Time frame: From baseline to post-intervention (during 6-10 weeks). Completed once a week at each session.]
• Parent: Parental experiences of each session [Time frame: From baseline to post-intervention (during 6-10 weeks). Completed once a week at each session.]
• Parent: Closing questions about the intervention [Time frame: Post-intervention (measured 6 to 10 weeks after the initiation of the intervention)]
• Use of the parent program: number of sessions, homework tasks, exercises [Time frame: From pre- to post-intervention (10 weeks after the initiation of the intervention)]
• Use of the parent program: drop out rate [Time frame: From pre- to post-intervention (10 weeks after the initiation of the intervention)]
• Clinicians: Clinician perception of implementation [Time frame: From pre- to post-intervention (during 6-10 weeks).]