The effect of AI-enabled virtual patient simulation on training outcomes and insecurities in psychotherapy education.

BACKGROUND: Preparing psychotherapy trainees for clinical complexity is a persistent educational challenge. Virtual patient (VP) simulations enabled by artificial intelligence (AI) may enhance training by offering practical, hands-on experience. This study examined their effectiveness in improving training outcomes and reducing insecurity in future psychotherapists. METHODS: Psychology students and psychotherapy trainees (N = 87) were randomly assigned to four online 2D-VP sessions with automated feedback or pre-recorded role-play videos. Pre- and post-assessments measured perceived psychotherapeutic competence, self-efficacy, knowledge, and insecurity. RESULTS: VP training significantly improved competence and self-efficacy while reducing insecurity, but did not enhance knowledge, though effects did not surpass video training. Greater clinical experience predicted higher competence and lower insecurity, but not training-related gains. Insecurity decreased earlier with video than with VP training. Simulation-related factors did not affect training outcomes. CONCLUSION: Design recommendations emphasize pre-briefings and enhancing VP authenticity to use VP simulations as a scalable, engaging complementary method in psychotherapy training.