Pilot 1.0: Creating a virtual environment for the treatment of offenders.

Providing treatment to the offender population can be difficult for many correctional agencies, especially those with restrictions on budgets and resources to fund correctional programming. However, despite the complications, virtual reality (VR) might offer a solution to this problem. The "virtual environment for the treatment of offenders," or VETO, combines VR and cognitive behavior therapy for a group of residential juvenile offenders. The pilot program revealed several strengths and some additional considerations for those interested in this type of program. While this technology may not be a good solution for everyone, it has the potential to expand treatment programming to a variety of offenders.

Correctional rehabilitation has undergone significant changes over the past two decades. Scholars have continued to research and develop treatment programs based on evidence-based practices. Most agencies accept that cognitive behavior therapy (CBT), in various forms, is one of the most effective ways to treat offenders. In corrections, staff typically use CBT during group treatment sessions, focusing on changing maladaptive thinking by using cognitive restructuring and teaching coping skills. Staff asked group participants to practice different skills by role-playing scenarios. Traditionally, group participants must imagine themselves in different situations where they can use a specific skill; however, VR can enhance these practice sessions by providing a safe, controlled atmosphere that transports the participant to a more realistic environment. The field of psychology has been using VR for decades to diagnose and treat a range of mental illnesses, such as anxiety disorder, attention deficit hyperactivity disorder and conduct disorder. (1) VR, however, has not been used yet for treatment with correctional populations. A pilot study was conducted with a group of residential juvenile offenders to see if this technology could be useful for treatment. The pilot noted several strengths, but also some limitations, that had to be addressed to explore the feasibility of using VR-CBT to treat offenders.

Challenging the "nothing works" doctrine

For decades, people considered very few treatment programs as effective in rehabilitating offenders. (2) This led to policies toward mass incarceration and away from rehabilitation. The challenge to the "nothing works" doctrine came primarily from Canadian psychologists, such as Don Andrews, James Bonta, Paul Gendreau, Mark Lipsey and Ted Palmer, in the early 1990s. (3) They used research methodology and statistics to study why some programs were successful and others failed. From this, they developed what is known as the Principles of Effective Intervention (PEr). According to these principles, any treatment intervention should target criminogenic needs and focus on behavior modification.

Additionally, rehabilitative efforts must focus on general and specific responsivity issues and be directed toward offenders who are at a higher risk for recidivism. Studies show programs adhering to the PEI are the most effective in reducing recidivism. (4)

The risk-need-responsivity (RNR) model. The RNR model, developed from the PEI, outlines three principles--risk, need and responsivity--meant to increase the effectiveness of the correctional treatment interventions. According to the "risk principle," moderate and high-risk individuals should receive more intensive treatment. According to the "need principle," those offenders with antisocial attitudes (what they believe), a history of criminal involvement, high numbers of antisocial peer associations and antisocial personalities (how they behave) are at an increased risk of offending; therefore, these criminogenic needs should be targeted during treatment. Finally, according to the "responsivity principle," treatment should be based on evidence-based interventions, such as CBT, that are shown to be effective for most individuals.

CBT. Cognitions are peoples' thoughts. This includes beliefs, attitudes and assumptions. CBT mainly focuses on changing maladaptive patterns of thinking and the underlying beliefs that prompt criminal offending. It also addresses the antisocial cognitions and the accompanying behaviors they produce. (5) Cognitive restructuring teaches an individual to recognize maladaptive thoughts and how to replace them with more positive, prosocial thinking. CBT also teaches individuals coping skills that help them deal with triggering events that might invoke criminal thinking. This might include self-talk or "thought stopping." CBT uses strategies, such as positive and negative reinforcements and punishments, for behavior modification. Many have used CBT to treat a variety of problems, including mood disorders, anxiety disorders, personality disorders, eating disorders and substance abuse.

Real-world lessons in a virtual realm

Offenders often engage in thinking errors that reinforce deviant behaviors. (6) Correctional treatment commonly uses CBT to counter criminal thinking and behavior. A typical CBT program in U.S. corrections incorporates modeling, role play, reinforcement and cognitive exercises to teach offenders how to replace maladaptive cognitions and how to deal with problematic events by using a variety of coping skills. Corrections traditionally delivers CBT in a group treatment setting, but it can also be used in individual counseling. For example, prisons across the U.S. use Thinking for a Change, a common CBT-based program. Groups usually run roughly one hour. Facilitators teach one skill during each group, then ask participants how the skill can be used in their own lives. This encourages the participants to internalize the skill and imagine how and when they can use it. Afterward, the facilitator models the skill, and then has each participant role-play a scenario to practice what they learned. CBT programs can run anywhere from 12 weeks to nine months.

Several studies have found CBT effective at treating offenders. (7) CBT programs demonstrate greater success in treating, preventing and correcting criminal and delinquent behavior when compared to other types of programming. (8) Additionally, CBT programming increases treatment fidelity and integrity, which is related to less reports of misconduct and lower recidivism rates. (9)

While effective, the traditional techniques used in CBT for offenders have not evolved much. Other fields, such as psychology, already have incorporated various technologies into traditional treatment. Specifically, psychologists have been using VR-CBT for decades. Simply put, VR is a simulated, computer-generated world that incorporates 3-D visualization and accepts user input through various transmission devices. (10) In other words, VR uses computer graphics to create a world that appears realistic. Users can interact with the environment and anyone in the virtual world. This makes it a good candidate to use with traditional CBT. Participants can learn and practice in the virtual environment without facing the "real-world" consequences of their decisions. While other disciplines have been exploring how to use VR to address human-related issues, the criminal justice system barely has scratched the surface on its usage. Seemingly, no correctional treatment has attempted to incorporate this technology into correctional treatment until the present pilot.

Partnering for the pilot study

In partnership with the Hillcrest Academy for Boys by Rite of Passage and the University of Cincinnati Corrections Institute (UCCI), the pilot began with a group of juveniles at the residential facility in Wyoming, Ohio, in June 2013. The VETO Pilot 1.0 was a feasibility study to explore if and how a virtual environment could host group facilitation and if VR could enhance traditional CBT.

Participants. As the study mainly focused on exploration, its facilitators had to limit the eligibility criteria to participate. The study required participants to be residents of the program and agree to participate in the pilot. The agency selected 10 male juveniles, ranging from ages 12-17. Each participant volunteered to join the group and could get treatment credit for their participation. Participants were given pre- and post-study surveys asking about their background, computer expertise and prior treatment. The facilitator was also surveyed to gauge her knowledge of the technology. Additionally, the post-study survey focused on the usability of the system, effectiveness of the role play in a virtual environment, feedback mechanism and engagement during group.

Setup. The pilot began with two initial meetings with the participants prior to the group sessions. The first meeting allowed the participants to meet the facilitator and the author to learn about the study and answer any questions they had. The youths filled out the pre-study survey at this time. The second meeting allowed the participants to explore parts of the VR world and build their avatars. Through this technology, participants could pick the gender, age, race and physical characteristics of their avatar. They all selected a teenage male of their own race.

The facilitator trained participants on various skills using a group format in the virtual environment. The participants met with a CBT master trainer, who volunteered as a facilitator for the study, and they learned a variety of skills, including communicating with others, giving and accepting feedback, and active listening. Participants logged onto the virtual environment via laptop computers and used headsets and microphones to communicate with the facilitator and other group members. Web cameras also provided face-to-face interaction during the group. During training, the facilitator discussed each skill, then modeled it in the virtual world. Each participant would teleport to different environments, including an alley, house and street scene, to practice each of the skills they learned. As a reward, those who participated in the group and understood the material could explore the virtual world at the end of each group. The group met for one hour, three times a week, for 10 weeks. The post-study survey was given to participants and the facilitator during in-person, private interviews after the pilot was complete.

Findings. Several important findings were discovered from this pilot study. One particularly attractive feature, discussed in the post-study survey, was that participants and the facilitator could be at different locations physically during the group. Though they conducted several groups on-site, others occurred with group members in entirely different locations. They noted that a major strength of VR-CBT was that each participant had access to the virtual simulation, so there wasn't any disruption in treatment if they couldn't physically attend the group meeting.

All the participants had been in other traditional CBT group sessions, so they could compare their previous experiences to this group. Overall, the participants agreed that discussing skills and role-playing in the virtual environment was more engaging than in the face-to-face group environment. They enjoyed teleporting to different locations to practice each skill. Several participants stated that the experience felt more realistic than traditional role-playing. Interestingly, participants also stated that they felt more open to talking and asking questions during the session with their avatar rather than face-to-face interaction with their peers. They felt less judged in the virtual simulation.

The author and the facilitator recorded each session. This provided the ability to review and provide feedback during each role play, but it also became a potential tool for future groups to reexamine the roleplay and explore decision-making. The facilitator also commented on the security features she had available to her. She could secure different parts of the world and various objects found in the virtual environment, which helped prevent participants from becoming distracted.

Participants also commented about the reward sessions at the end of the group. Those who engaged and showed an understanding of the material were able to participate in a 15-minute "reward" session at the end of each group. They unlocked several features during this time, including the ability to fly helicopters or obtain gear (i.e., clothes, jewelry, etc.) for the participants' avatars. Participants indicated that they felt like they were playing a video game with each other and enjoyed the free time.

Issues to consider. This study also yielded some specific observations relevant to future pilots of this kind.

1. The facilitator initially received training on the basic usage of the environment, but not all of the features. The juvenile participants learned some of the features very quickly that were unknown to the facilitator, such as private messaging. This presented some distractions during the initial groups until the facilitator realized what was happening. Once the facilitator was trained on the advanced security features, these problems dissipated.

2. The facilitator met with the group as a whole to provide an overview of the project. She noted an initial one-on-one meeting with each participant prior to the group would have better enabled her to establish the therapeutic relationship more quickly.

3.It became clear in the initial groups that the participants did not have enough time to develop their avatar the way they wanted it. The facilitator only gave them one session to do this. It is important for group participants to feel their avatar is an extension of themselves. As such, one session did not provide them with sufficient time for establishing an early connection. During the first week, this distracted several participants because they were focused on tweaking the physical characteristics of their avatars. Participants commented that the avatar was a representation of them in the virtual world, but only after they had finished customizing it.

4. Because there isn't a curriculum currently available for VR-CBT groups, a more traditional skill-streaming curriculum took place in this study. The facilitator didn't feel as though the virtual environment was optimized based on the standard curriculum. For example, the VR environment provided media-sharing features, but this feature was not used. Additionally, they only used predeveloped scenes, despite the technology's ability to customize the environment. These features could have made teaching the skills and role-playing more meaningful.

5. This study had to address some hardware, facility and staff considerations prior to the group. The first issue was obtaining working computers and headsets for the participants. UCCI provided a grant for this study to purchase these items to meditate this issue; however, this may present a barrier for other agencies. A company in New Jersey, In World Solutions Inc., provided the software for this pilot. Other solutions, such as Second Life, are more widely available today and could be easily used to replicate this pilot, but this is a consideration that should be addressed prior to any new pilot. Some initial connection problems with the environment also occurred, and occasionally, the virtual world would unexpectedly error and terminate. The facility addressed these issues with the assistance of an information technology specialist. To address the space problem, this facility was able to provide a designated space for the pilot and the use of one staff person to observe the participants during group meetings. The certified trainer who could run the group volunteered her time, so there were no additional costs there. There was also a need for a main technical contact to set up and manage the virtual groups. The author was able to provide this service during the pilot.

Improvements in the technology and expanded availability of VR equipment has allowed for the initial planning of a new study. The new pilot will address some of the aforementioned issues and also look at outcomes such as misconduct reports and recidivism. The next VETO project is planned tentatively for summer 2017 and will include several nationwide residential facilities. Additionally, a curriculum specifically for VR-CBT is being developed to use during this new pilot.

Several conclusions can be drawn from this exploratory study. Overall, the observations suggest that conducting VR-CBT groups can improve traditional CBT groups. For example, "in vivo exposure" (a type of exposure therapy) or experiencing a situation in the real world are often cited as the best ways to practice a new skill; however, this presents numerous logistical and safety concerns. VR provides a controlled environment where participants can practice, but it also provides a more realistic, visual representation of a situation they might encounter. This is an improvement over traditional, imagination-based therapies. Additionally, the feedback feature proved particularly useful in allowing the participants to explore their maladaptive thinking habits. The facilitator evaluated each step of the skill, and then explore how and why they made particular decisions. Finally, those unable to physically attend group meetings in person, including the facilitator at times, could still attend group meetings. This resulted in no disruption in treatment.

VR technology has improved greatly within the past two years and will continue to become more available and widely used. Currently many use the technology for gaming, but researchers and practitioners are exploring new ways to use it to address real-world problems. The criminal justice system is no exception. Law enforcement currently uses VR for weapons training and in forensics for investigative purposes. It stands to reason that this technology also can be used to increase the effectiveness of traditional correctional treatment. While there are some potential limitations to starting up this type of program, it is worth further exploration. VR can provide offenders with quality programming no matter where they are. Once a program is established, it can scale quickly, resulting in more people getting treatment. With dwindling budgets and resources, this technology can help treat offenders and reintegrate them into society effectively.

ENDNOTES

(1) Optale, G., Pastore, M., Marin, S., Bordin, D., Nasta, A., & Pianon, C. (2004). Male sexual dysfunctions: Immersive virtual reality and multimedia therapy. Studies in Health Technology and Informatics, 99, 165-178.

(2) Martinson, R. (1974). What works? Questions and answers about prison reform. The Public Interest, 35, 22-54.

(3) Cullen, F. T. & Gendreau, P. (2001). From nothing works to what works: Changing professional ideology in the 21st century. The Prison Journal, 81(3), 313-338.

(4) Andrews, D. A., Bonta, J., & Hoge, R. D. (1990). Classification for effective rehabilitation: Rediscovering psychology. Criminal Justice and Behavior, 17(1), 19-52.

(5) Van Voorhis, P., Braswell, M., & Lester, D. (2007). Correctional counseling and rehabilitation, sixth edition, Cincinnati: Anderson Press.

(6) Ibid.

(7) Andrews, D. A, et al. (1990).

(8) Andrews, D. A, & Bonta, J. (2010). The psychology of criminal conduct, fifth edition. Cincinnati: Anderson Press.

(9) Van Voorhis, P., et al. (2007).

(10) Ticknor, B., & Tillinghast, S. (2011). Virtual reality and the criminal justice system: New possibilities for research, training, and rehabilitation. Journal of Virtual Worlds Research, 4(2), 3-44.

By Bobbie Ticknor

Bobbie Ticknor is an assistant professor at Valdosta State University