The effects of autonomy-supportive versus controlling therapeutic approaches on treatment resistance in adolescents with disruptive behavior problems – A virtual reality experiment

This project is a within-person experiment in virtual reality (VR) to identify how therapists may cause or prevent treatment resistance in youth with disruptive behavior problems. Adolescents (N = 100; ages 14-19) will participate in two consecutive 15-minute therapy sessions in VR, manipulated as controlling or autonomy-supportive (order counterbalanced, using different therapists). We will control the VR therapist to manipulate 9 specific therapist behaviors covering the three main facets of autonomy support: 1) providing meaningful rationales; 2) acknowledging negative feelings; and 3) supporting choice. All opposing controlling behaviors are realistically used by therapists, drawn from an evidence-based intervention protocol and therapist observations. We will assess adolescents’ resistance using behavioral observation and assess their concomitant arousal using skin conductance. To test if autonomy-supportive approaches enhance the quality of therapy, we will assess the meaningfulness of adolescents’ responses to the therapist. This design will help identify the effects of controlling and autonomy supportive therapist behavior on adolescents’ resistance, and will reveal how therapists can approach therapy in autonomy-supportive ways that may prevent treatment resistance.