Virtual Reality Intervention Aims to Improve Social Relationships, Reduce Bullying

Researchers aim to test how virtual reality can enhance social and emotional skills to reduce bullying.

Editor's Note: Where Discovery Leads is a multimedia storytelling project that delves into key research themes at Children's Hospital of Philadelphia Research Institute. This is part three of a five-part series that focuses on the scientific studies aimed at addressing behavioral and mental health.

Complementing the series is a brief video featuring Tami Benton, MD, Psychiatrist-in-Chief, as she highlights CHOP's behavioral health lifespan research, which is moving treatment closer to personalized medicine.

Researchers from Children's Hospital of Philadelphia are expanding upon their evidence-based bullying prevention programs by incorporating a virtual reality component. This new element will allow students and their teachers to navigate potentially uncomfortable situations in a safe, controlled environment, practicing de-escalation and problem-solving skills in real time.

"Bullying is notably perpetuated by a system, so we're interested in how we can more universally improve the climate in classrooms to reduce bullying and aggression," said Tracy Waasdorp, PhD, MEd, Lead Investigator and Director of Research for School-Based Bullying and Social Emotional Learning. "If we start programming early, in first through fifth grade, we can try to stem the trajectory of extreme cases."

To achieve this, Dr. Waasdorp, along with Brooke Paskewich, PsyD and the research team, will leverage their long-standing relationship with the School District of Philadelphia to adapt curriculum from the Preventing Aggression in Schools Everyday (PRAISE) Program and the Bullying Classroom Check Up (BCCU) Program that were evaluated in Philadelphia schools. Researchers aim to trial the efficacy of enhancing the PRAISE program using a simulated experience to promote the development and retention of the social and emotional skills taught.

Building the Evidence-base for Student Strategies

From left: Brooke Paskewich, PsyD; Tracy Wassdorp, PhD, MEd; and Stephen Leff, PhD.

PRAISE began as a universal adaptation of the Friend to Friend Program (F2F), a school-based intervention designed by Stephen Leff, PhD, Co-director of the Center for Violence Prevention at CHOP. Developed in the early 2000s, F2F was the first effective relational aggression intervention for youth in urban school settings. Relational aggression is a form of non-physical behavior that involves the manipulation of social relationships through gossip and social exclusion.

The F2F program focused on teaching small groups of third- through fifth-grade girls how to reduce relational aggressive behaviors by better identifying their feelings, introducing calming strategies, and interpreting others' intentions.

PRAISE has since grown to address all forms of aggression and bullying and into two programs supported by the CHOP Research Track Faculty Pilot Program. Collectively, the program aims to reduce aggression and bullying early on by scaffolding skills over five years: PRAISE Friendship Voyagers encompasses third through fifth grade, and the newly developed PRAISE Friendship Explorers helps first and second graders develop foundational skills for making and improving friendships.

"PRAISE delves into universal programming for everybody, with a focus on all forms of aggression" Dr. Waasdorp said. "But, we're not just targeting aggressors; we're targeting the bystanders who aren't the perpetrators but who may be perpetuating bullying, and we're focusing on the victims to ensure they don't become reactive aggressors."

The study findings appeared in Prevention Science.

In Philadelphia schools where PRAISE Voyagers is being implemented, Dr. Waasdorp, together with Dr. Paskewich, who leads the implementation of the program, will work with CHOP-based school interventionists to provide training and coaching for teachers to implement the enhanced program using the virtual simulation. Children at higher risk of aggressive behaviors who could benefit from repeated practice outside of the classroom will be identified by their teachers. For the first time, these children will have the opportunity to participate in the simulated environment to continue developing their social and emotional skills.

The research team will present the child with a skill to practice, such as calming down when someone says something mean. Once in the simulator, the student will encounter virtual children who may be struggling with a situation like hostile attribution bias, which is a cognitive bias where people may interpret social cues or behaviors such as whispering or an accidental bump as intentionally hostile. The student will have the opportunity to then teach the avatars the tools they could use to diffuse the situation and calm down.

"Sometimes when you teach, you learn," Dr. Waasdorp said. "Our hope is that practicing these social and emotional skills in an environment where children are comfortable will provide them with additional supports to learn how they can use these skills themselves, without being judged by a whole classroom."

CHOP School Interventionists will provide support during the virtual experience and will have the ability to pause the simulation to point out teachable moments and to provide guidance on a particular skill that students can take with them as they return to classroom settings.

Equipping Teachers with Social, Emotional Tools

Research shows that by improving social and emotional skills in a classroom, bullying decreases and academics improve, but traditionally, teachers are not trained in this prior to their in-classroom experiences.

"Our first step is to help teachers understand that if they can navigate the social emotional worlds of their children, they more easily get the children to focus on academics," Dr. Waasdorp said.

The BCCU program, which was developed by Dr. Waasdorp and her colleagues at Johns Hopkins School of Public Health and the University of Virginia School of Education, provides teachers with coaching and guided-practice learning skills for in-the-moment bullying identification, prevention, and intervention. A key aspect of the BCCU program is guided practice for these bullying interventions in a virtual simulation. This virtual experience will be adapted for the current project so teachers can practice implementing the PRAISE Voyagers program in unpredictable environments.

First, teachers will undergo training for PRAISE Voyagers lessons before going into the simulator to navigate teaching the intervention in real time. The virtual students will be primed with phrases and topics that typically derail a bullying prevention program. Teachers will be prompted with different courses of action that, when selected, will determine how the simulation proceeds.

Each outcome is designed to help teachers learn strategies to keep a lesson on pace and manage productive classroom conversations. Dr. Waasdorp and her team continue to adapt their programming to incorporate evidence-based strategies, with the end goal of enhancing effective delivery of the PRAISE Program and improving teachers' understanding and ability when implementing social emotional learning.

Behavioral Health Lifespan Research: Moving Closer to Personalized Medicine. Access the video transcript.