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

Disruptive behavior among adolescents is a widely acknowledged problem, that highlights the importance of adequate and effective treatment to help adolescents with disruptive behavior problems behave more socially adequate. Self-serving cognitive distortions (e.g., Self-Centered and Blaming Others) play a central role in initiating and maintaining disruptive 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, adolescents with disruptive behavior 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 was developed to address 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 within adolescents with disruptive behavior problems. 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. Participants will be recruited among adolescents who are staying in a secure residential youth care facility providing (forensic) psychiatric and residential youth care, and among students from schools providing secondary special education for adolescents with severe behavioral problems. From both populations, adolescents aged 12 to 18 years can be referred to participate in the project.

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.

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, the daily assessments take place. Other data will be collected in 4 face-to-face assessments. Three months after the research period, participants will be approached again for a second interview. Three months after that, participants will be approached for a final follow-up interview.

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 or their personal experience are used during the intervention to take different perspectives, e.g. offender, victim, bystander, etc.