Miloff Alexander, Carlbring Per, Hamilton William, Andersson Gerhard, Reuterskiöld Lena, Lindner Philip
Department of Psychology, Stockholm University, Stockholm, Sweden.
Mimerse AB, Stockholm, Sweden.
J Med Internet Res. 2020 Mar 24;22(3):e16660. doi: 10.2196/16660.
Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome.
In this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format-the Virtual Therapist Alliance Scale (VTAS)-by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome.
A psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures.
The VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up.
These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.
自动化虚拟现实暴露疗法（VRET）是一种自助治疗方法，由患者自行进行，并由具有视觉呈现和/或音频反馈的虚拟治疗师提供支持。这模拟了面对面治疗中存在的许多非特定关系要素和共同因素，可能是提高自我指导治疗的依从性和疗效的一种手段。然而，尽管治疗联盟是治疗结果的重要预测指标，但对于与虚拟治疗师的治疗联盟了解甚少。
在本研究中，我们旨在评估首个为自动化治疗形式中具身虚拟治疗师开发的治疗联盟工具——虚拟治疗师联盟量表（VTAS），方法包括：（1）评估其心理测量特性；（2）验证量表的维度；（3）确定量表对治疗结果的预测能力。
使用来自两组蜘蛛恐惧症患者样本的数据，在具身的、基于语音的虚拟治疗师的帮助下（n = 70），对VTAS进行心理测量评估和探索性因素分析。根据自我报告的恐惧程度以及与临场感和用户友好性过程测量的一致性，使用多元回归模型和双变量相关性来评估VTAS与治疗结果的关系。
VTAS显示出一个合理的双因素解决方案，主要因素涵盖任务、目标和共同在场；具有足够的内部一致性；以及良好的收敛效度，包括与随访结果的中度相关性（r = 0.310，P = 0.01）。
这些初步结果表明，与虚拟治疗师的治疗联盟是治疗结果的重要预测指标，支持任务 - 目标因素比关系因素更重要的观点，并且应该在更大样本量的研究以及其他具身形式中进行探索。
