Using Virtual Reality to Impact Sexual Knowledge, Attitudes, and Emotion Regulation Among Youth.

Introduction: Adolescent use of substances and sexual activity are associated with marked risk outcomes. Substance use and abuse during adolescence is predictive of early mortality and problematic use in early adulthood. Young adolescents who engage in sexual risk taking continue to exhibit greater sexual risk (more sex partners, less condom use) than their peers as they grow older, resulting in more unintended pregnancies and STIs. Therefore, the prevention/reduction of risk behaviors among adolescents is key to disrupting long term risk trajectories. Methods: The AVATAR intervention is based on two previously validated emotion regulation interventions (R01 MH 61149 and R01 NR011906) and uses Social Cognitive Theory as a guiding model. The intervention emphasizes the impact of emotional arousal on decision making in risk situations and teaches adolescents to recognize and label these emotional states, initiate the use emotion regulation strategies (e.g., getting away from triggers, physical release of emotions, and cognitive reappraisal), and then utilize skills (e.g., refusal of substances or using condoms) once the intensity of the emotional arousal has decreased. Each of the four, 90 minute sessions, targets emotion regulation skills and is paired with a complimentary scene (party, HIV testing, condom purchasing, partner negotiation). A total of 89 adolescents (54% female; 77% ethnic/racial minority; Mage=12.97, SD=.85) participated in a small randomized pilot trial. All received an Emotion Regulation (ER) intervention; they were randomized to practice the ER skills learned with either immersive virtual reality environments (AVATAR) or group-based role-plays (Role-play). Both interventions were conducted in groups of 4-6 adolescents and took place after school over the course of four weeks (1 session per week). Adolescents were assessed at baseline and 3 months after the intervention. Results: Both ER intervention groups demonstrated improvement across all targeted mechanisms for which the study was powered (pre-post eta² range=.12-.67), including self-efficacy for risk prevention (.53), condom use self-efficacy (.42), and emotional self-efficacy (.30), supporting the efficacy of the ER intervention. Youth randomized to AVATAR versus Role-play reported less difficulty accessing emotion regulation strategies (M=14.91 vs 17.71, between treatments eta²=.05). In addition, adolescents randomized to AVATAR attended an average of 3.7 sessions (74% attended all 4 sessions) and those randomized to Role-play attended an average of 3.3 sessions (60% attended all 4 sessions).Conclusions: These results suggest that the inclusion of virtual reality enhanced adolescents’ abilities to use emotion regulation strategies and was more engaging for adolescents.