Using Interactive Virtual Reality Exposure to Understand Social Information Processing (SIP) and Aggressive Behavior Problems in Youth.

Aggressive behavior problems are among the most common psychological problems
in children (Romeo, Knapp & Scott, 2006) Aggressive behavior of children has a
negative impact on the child, environment, and society at large (Dodge, Coie, &
Lynam, 2006). Furthermore aggressive behavior in childhood is predictive of a
broad range of problems later in life, such as school drop-out, unemployment,
delinquency, and various forms of psychopathology (Coie & Dodge, 1998; Curry,
Stabile, Manivong & Roos, 2010). Therefore it seems important to acquire more
insight into the underlying mechanisms of aggressive behavior in childhood.
More insight in underlying mechanisms of aggression provides the opportunity to
improve current therapies for aggressive children and thereby prevent negative
developmental outcomes. One underlying mechanism that plays a role in the
development of aggression is social information processing (SIP). SIP-models
propose that between a social stimulus and a behavioral response several social
information processing steps take place; (1) the encoding of cues, (2) the
interpretation and mental representation of cues, (3) establishing
interactional goals, (4) the generation of responses, (5) the evaluation of
responses, (6) the enactment of a response (Crick & Dodge, 1990; Crick & Dodge,
1994). SIP-models state that biases in SIP are related to aggressive behaviors
and empirical research supports this. Aggressive children attribute more
hostile intentions to others, establish non-relational interactional goals,
generate more aggressive responses and evaluate aggressive responses and their
outcomes more positively than healthy controls (Crick & Dodge, 1996; Dodge,
Lochman, Harnish, Bates, & Pettit, 1997; Lochman & Dodge, 1998; Orobio de
Castro, Merk, Koops, Veerman & Bosch, 2005; Orobio de Castro, Veerman, Koops,
Bosch, & Monshouwer, 2002; Erdley & Ascher, 1996; Orobio de Castro, Verhulp &
Runions, 2012; Van Nieuwenhuijzen, De Castro, Van Aken & Matthys, 2009). A
limitation of prior studies into SIP biases underlying aggressive behaviors of
children seems to be the methodology applied to measure SIP. Studies so far
mostly presented hypothetical vignettes where an ambiguous social situation is
being described (e.g. auditorial, video, scripts). Participants are asked to
imagine this situation would happen to them and to describe how they would
behave, think and feel. An important limitation of this methodology is that
measures SIP are based on hypothetical social situations and not on actual
real-time social situations. However, in real life, aggressive behaviors are
often characterized by strong emotions and empirical research demonstrates that
strong emotions result in more deviant SIP (Reijntjes et al., 2011; Dodge &
Somberg, 1987; De Castro, Slot, Bosch & Koops, 2003). Based on the prior it
could be questioned whether SIP measured through the traditional methodology
(vignettes) is similar to SIP underlying real-time aggressive behaviors. To
acquire more insight in SIP underlying aggressive behaviors it seems therefore
necessary to measure SIP during real-time social situations, where emotional
involvement is high. A method to SIP underlying real-time behaviors could be
Virtual Reality Exposure (VRE). In VRE participants encounter specific
situations that are problematic in real-life. VRE is already used with various
phobias and psychotic disorders (Kampmann et al., 2016; Pot-Kolder, Veling,
Geraets & Van der Gaag, 2016; Parsons & Rizzo, 2008). In the current study
participants will encounter daily social situations through VRE that elicit
variance in (aggressive) behaviors and SIP. Theory and empirical findings
suggest that behavior and SIP are being steered by an interplay between other
factors as schemata, executive functioning and temperament (e.g. Anderson,
Bushman, 2002; Hobson, Scott, & Rubia, 2011, Blair, Peschardt, Budhani,
Mitchell, & Pine, 2006; de Castro et al., 2005; Calvete & Orue, 2010). The goal
of the current study is to validate behavior and SIP in VR, in a sample
differing in aggressive behavioral problems, to aggressive behavioral problems,
daily aggressive behavior and various factors that based on the literature
correlate with different forms of aggressive behavior. In this way, this study
aims to distinguish specific groups in VR based on behavior, SIP, emotions,
schemata, executive functions, temperament and contextual factors (parenting).
In addition, this study will examine whether SIP and behavior measured in VR is
more predictive of real-life aggressive behavior than SIP and behavior as
measured through hypothethical vignettes.

The research questions are:
1. Is SIP and behavior measured in VR more predictive of aggression in
real-life than SIP and behavior as measured through hypothetical vignettes?

It is expected that SIP and behavior as measured in VR is more predictive of
aggression in real-life than SIP and behavior as measured through hypothetical
vignettes.

2. Is it possible to distinguish meaningful groups based on SIP, emotions,
behavior, schemata, executive functioning, temperament and parenting?

We expect that based on the above mentioned factors (behavior, SIP,
temperament, schemata, executive functioning, parenting) three specific
profiles can be distinguished:

We expect that there will be a group of non-aggressive children where
non-agressive behaviors and non-deviant SIP correlate with a lack of the
tendency to experience strong or cold emotions, no hostile- and instrumental
schemata, intact executive functioning en positive parenting.
In addition to the expectation that we will distinguish a non-aggressive group
without deviant SIP en aggressive behavior, it is expected that:

There will be a group of agressieve children where aggressive behaviors and SIP
correlate with deficits in cool executive functions, the tendency to experience
strong emotions, hostile schemata and harsh parenting.

There will be a group of aggressive children where aggressive behaviors and SIP
correlate with no deficits in cool executive functons, deficits in hot
executive functions, callous and emotional temperament, sensation seeking
tendencies, instrumental schemata and a lack of parental supervision.

To test the hypotheses children from regular (n=50) and special education (n =
100) will be recruited. SIP will be measured in Virtual Reality and through
vignettes (hypothetical stories). In addition, several questionnaires and tasks
will be assessed.

The assessment for children will consist of three assessment-days of 30-45
minutes each. On the first assessment-day for children, questionnaires and
executive functioning tasks will be assessed. This to measure temperament
(Callous & Unemotional Traits, Sensation Seeking), schemata and executive
functioning (working memory, inhibition, reward- and punishment
sensitivity/insensitivity). On the second- and third assessment-day for
children SIP in VR and through vignettes will be assessed. For half of the
participants SIP measurements through vignettes will be a week before the SIP
measurements in VR, for the other half of the participants SIP measurements
through vignettes will be a week after the SIP measurements in VR. In addition,
parents and teachers will be asked to fill in several questionnaires. Parents
will fill in questionnaires about the presence of aggressive behavior,
temperament (negative emotionality) and parenting style. This will take up to
15 minutes maximum. Also teachers will be asked to fill in several
questionnaires. This to measure the presence of different forms of aggressive
behavior. This will take approximately 5-10 minutes.

Virtual Reality-environments will consist of common social situations.
Therefore Virtual Reality-environments will elicit frustrations or mild
aggression that is similar to frustrations and mild aggression in real-life.
Previous research demonstrated that real-time mild provocations and social
dilemma's elicit mild aggressive behaviors without ethical boundaries are being
violated (Matthys et al., 1995; Matthys et al., 1995; Van Nieuwenhuijzen et
al., 2005; Kempes, de Vries, Matthys, van Engeland, & van Hooff, 2008). In
these studies and our VR-pilot study, participants stated they really enjoyed
participating (and spontaneously mentioned they were eager to participate in
again). Experimenters will be vigilant for any form of excessive aggression and
take action when this is required. This will be done through an aggressive
behaviors protocol that was accepted by the METC in 2005 (05-191 titled:
**Conflict management in 6-8 year old aggressive Dutch boys: do they
reconcile?*). Virtual Reality-environments could elicit "cyber sickness". Cyber
sickness consists of symptoms of nausea, drowsiness, impaired visual perception
and concentration deficits and is caused by a discrepancy between sensory
perception and the vestibular system / (LaViola Jr., 2000). It is important to
note that approximately 30% of participants exhibit any symptom of cyber
sickness (Chen et al., 2011). However, research shows that participants build a
tolerance against cyber sickness and that the quality and adjustment of the
Virtual Reality-hardware and software could reduce symptoms of cyber sickness.
(Kennedy, Stanney & Dunlap, 2002; Rebenitsch & Owen, 2016; Kennedy & Fowlkes,
2000). In addition, since participants are able to freely move in the Virtual
Reality-environments and quality of the used hard- and software is high, the
discrepancies between sensory perception and the vestibular system will be
minimal. . Experimenters will be monitor symptoms of cyber sickness and if it
is required temporarily pause the session. The session will be proceeded only
when symptoms are almost not present and participants are willing to. Children
with motion sickess will not participate in our study. The presence of motion
sickness will be assessed prior to the study. In our previous VR-pilot study
using the same VR-scenario's, none of the children exhibited cyber sickness. In
addition, in the VR pilot-study it was never required to interrupt ot intervene
as a result of extreme aggressive behavior or escalating situations.