Practice Experiences for School Reintegration (PrESR): A Pilot Multiphase Optimization Trial of a Virtual Reality Intervention for Adolescents Hospitalized for Suicide-Related Thoughts and Behaviors.

Background: Adolescent hospitalization for suicide-related thoughts and behaviors has increased over the past decade, with few interventions shown to improve outcomes post-discharge. Given the majority of adolescents return to school following a suicide-related crisis, we developed and pilot-tested Practice Experiences for School Reintegration (PrESR)^™, a virtual reality (VR) intervention designed to teach therapeutic skills to hospitalized adolescents and allowing them to practice using these skills in stressful situations set in school settings that they would be expected to experience following discharge.

Objective: This pilot optimization trial examined the feasibility, acceptability, and safety of PrESR for augmenting standard inpatient care with adolescents hospitalized for suicide-related crises.

Method: Using a Multiphase Optimization Strategy (MOST) framework, we recruited adolescents hospitalized for suicide-related thoughts and behaviors (n=42) to be randomized into one of eight conditions testing three different VR-enhanced skill lessons and practice sessions: affect regulation, cognitive restructuring, and problem-solving.

Results: Research clinicians delivered individual sessions of PrESR with a high degree of fidelity (93-100%), but patients were often discharged before completing more than one skill. Of the participants who participated in the intervention, the majority agreed or strongly agreed with statements endorsing PrESR and its components as important, appropriate, and easy to use, largely supporting acceptability. Participants also provided feedback for improvement, informing slight changes to the next version of the intervention. More generally, PrESR did not appear to result in significant safety concerns based self-reported ratings of subjective distress and pre/post measures of physical symptoms related to cybersickness.

Conclusion: Findings support the feasibility of delivering a brief version of PrESR and preliminary acceptability for the intervention. VR technology and content show promising potential for adolescent suicide prevention and mental health support. Future research should examine PrESR for improving patient outcomes and preventing suicide.