Virtual reality (VR) has been used successfully and effectively in psychotherapy for a variety of disorders. In the field of depression, there are only a few VR interventions and approaches. Although simple social interactions have been successfully modeled in VR for several mental disorders, there has been no transfer to the field of depression therapy. VR may be employed for psychodynamic psychotherapy to work on interpersonal conflict patterns. In this study, we developed and evaluated a VR intervention for the simulation of roleplay situations in the context of supportive-expressive therapy. We conducted a clinical user experience (UX) study at a psychotherapeutic clinic in Düsseldorf, Germany. Eight inpatients with depression and four therapists were included. Semi-structured interviews and qualitative content analysis were used to identify UX issues of the developed VR intervention. Usability questionnaires and technical usage data were also considered. The VR intervention consisted of two therapist-controlled roleplay scenarios designed to support work on the core conflictual relationship theme by allowing patients to interact in typical problematic social situations. Recorded VR roleplays allow for therapeutic debriefing with a change of perspective. Therapists were given the option of using the roleplay in multiple sessions. All therapists conducted one session per patient with the VR intervention. From the patient interviews, 26 UX issues were extracted, of which one technical malfunction and two unclarities in the interaction with the VR agent were rated as major problems. From the therapist interviews, 14 UX issues were extracted, of which five were rated as major problems related to the interface in the dialog control or the complex system setup. The main problem was designing a dialog structure that allows both complex conversational flows and a clear control interface. In principle, VR roleplays could be integrated well and safely into therapy. The VR intervention shows promise for providing an emotional experience of interpersonal conflict patterns in the context of psychotherapy. Additionally, other roleplay situations involving various social problem areas must be created and evaluated in terms of the fit to the patients' core conflictual relationship themes.

Zusammenfassung Fragestellung: Kulturelle Kompetenz von Ärzten sollte in der Aus-, Fort- und Weiterbildung angemessen vermittelt werden. Dabei können bestehende Curricula wie die Psychosomatische Grundversorgung um Aspekte der Kultursensibilität erweitert werden. Die vorliegende qualitative Studie untersuchte die Erfahrung von Ärzten im Umgang mit Patienten mit Migrationshintergrund, um entsprechende Weiterbildungsangebote bedarfsgerecht zu gestalten. Methode: Halbstrukturierte narrative Interviews mit zwanzig Ärzten wurden mit Methoden der linguistisch-ethnografischen Gesprächsanalyse analysiert. Ergebnisse: Häufigster Grund für Schwierigkeiten in interkulturellen Arzt-Patient-Beziehungen waren Sprachbarrieren, wobei der Einsatz professioneller Dolmetscher als kritisch bewertet wurde. Die interviewten Ärzte neigten dazu, die faktische Verantwortung für das Gelingen der Kommunikation bei den Patienten zu sehen. Der Bedarf für Trainings in kultureller Kompetenz wurde als eher gering erachtet. Diskussion: D... Summary ‘How strange is the patient to me?’ Physicians’ attitudes and expectations toward treating patients with a migration background Objectives: Undergraduate and postgraduate training in cultural competence remains a challenging issue. It might be useful to integrate culturally sensitive learning objectives in existing curricula. As part of a needs assessment, this qualitative study examined the prototypical experiences in clinical routines with patients with a migration background. Methods: Twenty physicians took part in half-structured narrative interviews, which were then analyzed by linguistic-ethnographic conversation analysis. Results: The main reasons for difficulties in patient-physician relation proved to be language barriers. Assignments of professional interpreters were rated critically. Physicians attributed the responsibility for successful communication mainly to the patient. The physicians saw little need for training in cultural competence. Conclusions: The integration of learning obje...