Exploring the effects of Street Temptations on cognitive distortions and treatment motivation within behaviorally at-risk adolescents

Antisocial and externalizing problem behavior among adolescents is a widely
acknowledged problem, that highlights the importance of adequate and effective
treatment to help behaviorally at-risk adolescents behave more socially
adequate. Self-serving cognitive distortions (e.g., Self-Centered and Blaming
Others) play a central role in initiating and maintaining antisocial behavior.
Therefore, it seems particularly important to focus on opportunities to
challenge these distortions when it comes to treatment. Exercises regarding
social perspective-taking can provide these opportunities. In addition to
cognitive distortions, behaviorally at-risk adolescents often display a lack of
motivation regarding treatment and behavioral change. Consequently, a focus on
treatment motivation is needed as well, in order to create a treatment
environment in which behavioral change can actually be enhanced. Street
Temptations (ST) is a new training program that has the potential to foresee in
both aspects, through a primary focus on mentalization, i.e. reflective
functioning. One of the innovative aspects of ST is the use of virtual reality
(VR) to enhance the therapeutic exercises. The current research project will be
conducted to provide a first and thorough exploration into ST*s effectiveness
in enhancing cognitive distortions and treatment motivation in behaviorally
at-risk adolescents.

The primary objective is to explore whether participation in ST leads to a
change with regard to cognitive distortions and treatment motivation in
behaviorally at-risk adolescents. Secondarily, it will be analysed whether
participants show a difference in reflective functioning and social
perspective-taking. Qualitative data will be collected to analyse adolescents*
and therapists* opinions and experiences regarding working with ST and VR, as
well as to address ST*s possible long term influence on subsequent treatment
trajectories.

The effects of ST will be examined through a repeated multiple baseline
Single-Case Experimental Design (SCED). 18 participants will be randomly
assigned to one of three different baselines, equally divided over two
different settings. The course of the study will consist of three phases: phase
A - baseline, phase B - intervention and phase C - follow-up. Throughout the
different phases, daily measurements on cognitive distortions and treatment
motivation will be conducted.

All participants will undergo the ST-training program. ST is an intervention
that consists of 7 treatment sessions. Through practical and dynamic exercises
that focus on social perspective-taking, youths can practice with mentalization
skills. An additional innovative aspect of ST is the use of VR technique to
enhance the exercises. Adolescents watch a short VR-video of a street fight or
visualize a personal experience, to present a scenario and start the
conversation. The different characters in the VR-video are used during the
intervention to take different perspectives, e.g. offender, victim, bystander,
etc.

In total, the research period from the start of the baseline till the end of
the first follow-up will take up approximately eight weeks per participant.
During this period, participants will undergo 7 ST-sessions of 45-60 minutes.
Daily assessments can be performed within 5 minutes. Other data will be
collected in 4 face-to-face or telephonic assessments. These assessments will
take up +/- 45-60 minutes (interview at T1) to +/- 90 minutes (T0, T1 and Tf1).
Additionally, the executive researcher and assistants will be in touch with
participants regularly by telephone, to check how things are going. Three
months after Tf1, participants will be approached again for a second interview
(Tf2), that will take up +/- 45-60 minutes as well. Three months after Tf2,
participants will be approached for a final follow-up interview (Tf3) that will
also take up +/- 45-60 minutes. The only potential risk that is foreseen, is
the possible experience of motion sickness or eyestrain when using the
VR-glasses. Adolescents can choose to not use the VR-glasses again if this
happens. This kind of discomfort does not have lasting effects.