Ameliorating positive parenting skills: the added value of Virtual Reality to Parent-Child Interaction Therapy (PCIT-VR)

Disruptive behaviour is one of the most common reasons that young children are
referred to child and adolescent mental health care services worldwide.
Untreated disruptive behaviour can have long-term negative effects that carry
on into adolescence and adulthood. Addressing problem behaviour at a young age
diminishes the risk of the problems getting worse and interfering with social
and emotional development. Additionally, parents are still the factor with the
most influence in a young child's life. Research indicates that treatments for
child disruptive behaviour where parents are the primary agents of change have
the most substantive evidence. There are currently a few parent management
training (PMT) programs that are being implemented within the Netherlands; one
of which is Parent-Child Interaction Therapy (PCIT). PCIT has been well
researched pan culturally, of which in the Netherlands. To date, although
effective, a common limitation is that there is a very high dropout rate. One
of the reasons for this, is that parents seem to have difficulty grasping the
positive parenting skills being taught throughout PCIT. Therefore, it is
important to create the opportunity for parents to better grasp the parenting
skills to increase overall effectivity of PCIT.

Parent-Child Interaction Therapy (PCIT) is one of the few interventions that
has been found effective in ameliorating positive parenting skills whilst
diminishing child disruptive behavioural problems. In the Netherlands, PCIT has
shown to be effective thus far. However, there are currently high dropout
rates, in part due to parents having difficulty with grasping positive
parenting skills , which means that the program does not effectively reach a
large audience. In order to facilitate this and reduce dropout rates, this
study will be an enhanced version of PCIT by adding virtual reality (VR).
Parents will have the opportunity to practice the skills taught in the
sessions, at home, through VR scenario's created by the researchers. By
providing PCIT-VR, attrition based on lack of grasping positive parenting
skills can be prevented. Additionally, we believe that the families will need
less sessions in order to achieve mastery, due to the addition of VR, therefore
also decreasing time spent on the therapy.

In this project, the effects of PCIT-VR will be examined through an n-of-1
design (Single-Case Experimental Design, SCED). The research method will add a
multiple baseline to the SCED. Additionally, 15 participants will be randomly
assigned to the three different possibilities of receiving PCIT-VR, through the
add-in component analysis corresponding the SCED. The course of the study will
consist of multiple phases: phase A (baseline) (4-6 weeks), phase B (CDI phase
as usual) (approximately 10 weeks), phase B' (CDI phase including VR) (starting
at 0, 3, 6 weeks), phase C (PDI phase as usual) (however many sessions it takes
to achieve mastery), phase D (follow-up) (6 months later).
Throughout phases A, B, B' and C there will be weekly measurements on parental
factors, child behavioural problems and virtual reality experiences (when
included).

Parent-Child Interaction Therapy (PCIT) is a protocolled intervention program
for parents and young children. Throughout the program, parent and child are
trained together and a therapist coaches the parent through an earpiece. The
overall goal of the therapy is to improve positive parenting skills, diminish
child behavioural problems and better the parent-child relationship. There are
two phases in PCIT, the first being the child-directed interaction (CDI) phase
and the second being the parent-directed interaction (PDI) phase. The CDI phase
puts emphasis on building up the quality of the parent-child relationship. By
doing so, a foundation for effective behaviour change is created. The first
session of this phase is a teaching session with the parent alone and is used
to teach the parent skills that they will use throughout CDI. Similarly,
parents attend the first session of the PDI phase, which again is a teaching
session, alone with the therapist and they are taught PDI skills. It is
expected after the first teaching session, that parents go home and practice
these skills with their children before having a session where both parent and
child are present. However, where PCIT-VR differs from standard protocol PCIT,
is that they will also practice with VR scenario's starting from the teaching
session (dependent on their random allocation to phase B'). This gives them the
opportunity to better understand how they can apply the positive parenting
skills, without having had a session with their child present yet. As such, in
PCIT-VR, the parents will receive the opportunity to familiarise themselves
with the skills by practicing with VR. Therefore, when attending the coaching
sessions the skills will be fresher in their minds and they will be able to
apply these skills more effectively from the first coaching session onwards.
This implies that they will grasp the concept quicker and therefore that they
achieve mastery sooner.

No more risks are expected when participating in the current study than when
receiving Parent-Child Interaction Therapy with the regular protocol.
Participation in the study only requires time from the parents and children.
The research includes three assessments of 1 hour each where the researcher
visits the parents and children at their home to decrease the burden. The only
potential (short-term) risk, is that parents can potentially experience motion
sickness as a result of the use of the VR goggles. If this is the case, they
will not use the VR goggles again. This does not have lasting effects.