Wendy S. Hadley, Ph.D. - US grants

DESCRIPTION (provided by applicant): The proposed project will examine the use of immersive virtual reality technology as an intervention tool for HIV Prevention with adolescents. Adolescents are at risk for contracting HIV. Affect dysregulation is common among adolescents. Research has demonstrated connections between poor affect management abilities and risky sexual behavior among adolescents. This research suggests that the ability to regulate one's emotions is key to avoiding risk behaviors and that adolescents are at greater risk for poor affect management skills. Fortunately, these skills can be taught via teaching and modeling, making them an excellent target for intervention, which has previously been approached through role-playing. Immersive virtual reality offers many advantages over group based role-plays, used in HIV prevention interventions for adolescents, in its ability to simulate real-world environments and extend the impact of HIV prevention interventions. Similar to its use in PTSD, immersive virtual reality is a promising technology for giving teens the opportunity to practice using effective affect regulation skills in a highly realistic environment. Additional benefits of this technology will likely be increased engagement and retention in HIV prevention interventions among young adolescents. The overall aims of Phase I and Phase II of this proposed STTR project are to develop and refine a virtual reality environment for adolescents targeting affect management. In Phase I, the research team will develop and refine an immersive virtual environment that will elicit affect in a high-risk situation. The final immersive virtual reality environments (completed in Phase II) can be used by health promotion interventionists in conjunction with an HIV prevention intervention manual as a means to elicit affect and provide adolescents with a "real world" environment in which to practice emotion regulation skills related to substance use and HIV prevention. These aims will be achieved through the collaboration of researchers at Rhode Island Hospital/Brown and Virtually Better, a small business that specializes in creating immersive virtual reality environments for clinical use. This tool will represent a significant advance in the way in which affect regulation skills are practiced and honed, currently achieved via role plays or imaginal exposure, by increasing the salience of cues used to elicit affect, thus making it highly marketable to interventionists, schools, and mental health clinicians. Public Health Significance: (1) Examine whether immersive virtual reality technology provides an enhanced environment for adolescents to practice emotion regulation skills and negotiate safer sexual behavior. (2) Provide adolescent HIV prevention interventions with an additional tool to target sexual risk reduction. PUBLIC HEALTH RELEVANCE: This project would design and develop an immersive virtual reality environment for adolescents with mental health problems to provide realistic scenarios with which adolescents can practice managing affect associated with cues to engage in risk behaviors.

DESCRIPTION (provided by applicant): The proposed project, titled Reduce the Risk: An Affect Management Program for HIV Prevention, will examine the use of immersive virtual reality technology as an intervention tool for HIV Prevention with adolescents. Adolescents are at risk for contracting HIV. Affect dysregulation is common among adolescents. Research has demonstrated connections between poor affect management abilities and risky sexual behavior among adolescents. This research suggests that the ability to regulate one's emotions is key to avoiding risk behaviors and that adolescents are at greater risk for poor affect management skills. Fortunately, these skills can be taught via teaching and modeling, making them an excellent target for intervention, which has previously been approached through role-playing. Immersive virtual reality offers many advantages over group based role-plays, used in HIV prevention interventions for adolescents, in its ability to simulate real-world environments and enhance the impact of HIV prevention interventions. Immersive virtual reality is a promising technology for giving teens the opportunity to experientially practice using effective affect regulation skills in a highly realistic, context specific virtual environment. Additional benefits f this technology will likely be increased engagement and retention in HIV prevention interventions among young adolescents. The overall aims of Phase I and Phase II of this proposed STTR project are to develop, refine, and evaluate virtual reality environments for adolescents targeting affect management. In Phase I, the research team developed and refined an immersive virtual environment that elicited affect in a high-risk situation. The final immersive virtual reality environments (completed in Phase II) can be used by health promotion interventionists in conjunction with an HIV prevention intervention manual as a means to elicit affect and provide adolescents with a real world environment in which to practice emotion regulation skills related to substance use and HIV prevention. These aims will be achieved through the collaboration of researchers at Rhode Island Hospital/Brown and Virtually Better, Inc. a small business that specializes in creating immersive virtual reality environments for treatment, education, and training purposes. This tool will represent a significant advance in the way in which affect regulation skills are practiced and honed, currently achieved via role plays or imaginal exposure, by increasing the salience of cues used to elicit affect, thus making it highly marketable to interventionists, schools, and mental health clinicians.

PROJECT SUMMARY/ABSTRACT The prevalence of adolescents struggling with excess weight is remarkably high, with 38.7% of 12-15 year-olds and 41.5% of 16-19 year-olds meeting criteria for overweight or obesity. While considerable attention has been given to comprehensive behavioral interventions to address obesity in children, there is less empirical evidence demonstrating efficacy of interventions with adolescents. Additionally, there is great variability in outcomes. Limited impact of adolescent weight control treatment may be attributable to the failure of these interventions to explicitly address key mechanisms that are necessary for successful weight loss. Notably, adolescents with poorer emotion regulation have been found to consume foods of lower diet quality and report greater time spent in sedentary behavior than their peers. Poor emotion regulation among adolescents has also been associated with more rapid weight gain and higher BMI. Data from adolescents with overweight/obesity from an outpatient weight management program at Hasbro Children's Hospital (N=124) indicate that 82% of these youth report emotion regulation scores that are comparable to youth with significant mental health problems; furthermore, there is a positive association between emotional dysregulation and BMI within this same treatment-seeking sample. Despite these established relationships, interventions targeting emotion regulation in adolescents with obesity are lacking. To fill this gap, our laboratory developed and piloted an adolescent weight control intervention (HealthTRAC) that combines two efficacious interventions, one targeting emotion regulation skill building, the other focused on behavioral weight control. Preliminary findings from the small pilot trial are promising and indicate that the developed HealthTRAC intervention is acceptable, feasible to deliver, and results in significant reduction in BMI (d=.58) and improvement in emotion regulation skills (d=.20-.35) relative to a standard behavioral weight control (SBWC) condition. The proposed multi-site trial builds on these previous findings and will evaluate the efficacy of the developed HealthTRAC intervention on improving emotion regulation skills and reducing adolescent BMI. We propose to enroll 200 adolescents (100 per site) between the ages of 13-17 years of age to receive either HealthTRAC or SBWC. Adolescents will be randomly assigned to treatment condition within site. Intervention components will be delivered in 27.5 hours of direct contact time across 12 months. All adolescents will be assessed prior to randomization (baseline), immediately following the intervention (4 months), upon completion of maintenance sessions (12 months) and 18 months after the start of intervention. The information gained in this project will extend our understanding of how improving emotion regulation abilities can enhance adolescent weight control interventions.