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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Psychology students and psychotherapy trainees (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200987) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Design recommendations emphasize pre-briefings and enhancing VP authenticity to use VP simulations as a scalable, engaging complementary method in psychotherapy training.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-09917-x","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T08:55:32Z","timestamp":1784105732000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The effect of AI-enabled virtual patient simulation on training outcomes and insecurities in psychotherapy education"],"prefix":"10.1186","volume":"26","author":[{"given":"Julia","family":"Cecil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eesha","family":"Kokje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Kathrin","family":"Kleine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Insa","family":"Schaffernak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Vogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selina","family":"Angerer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Lermer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Gaube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"9917_CR1","unstructured":"WHO. 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