Virtual Reality Aggression Prevention Therapy (VRAPT) versus Waiting List Control for Forensic Psychiatric Inpatients: A Multicenter Randomized Controlled Trial

Stéphanie Klein Tuente, Stefan Bogaerts, Erik Bulten, Marije Keulen-de Vos, Maarten Vos, Hein Bokern, Sarah van IJzendoorn, Chris N W Geraets, Wim Veling, Stéphanie Klein Tuente, Stefan Bogaerts, Erik Bulten, Marije Keulen-de Vos, Maarten Vos, Hein Bokern, Sarah van IJzendoorn, Chris N W Geraets, Wim Veling

Abstract

Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic psychiatric centers, 128 inpatients with aggressive behavior were randomly assigned to VRAPT (N = 64) or waiting list control group (N = 64). VRAPT consisted of 16 one-hour individual treatment sessions twice a week. Assessments were done at baseline, post-treatment and at 3-month follow-up. Primary outcome measures were aggressive behavior observed by staff and self-reported aggressive behavior. Analysis was by intention to treat. This trial was registered in the Dutch Trial Register (NTR, TC = 6340). Participants were included between 1 March 2017, and 31 December 2018. Compared to waiting list, VRAPT did not significantly decrease in self-reported or observed aggressive behavior (primary outcomes). Hostility, anger control, and non-planning impulsiveness improved significantly in the VRAPT group compared to the control group at post-treatment. Improvements were not maintained at 3-month follow-up. Results suggest that VRAPT does not decrease aggressive behavior in forensic inpatients. However, there are indications that VRAPT temporarily influences anger control skills, impulsivity and hostility.

Keywords: aggressive behavior; forensic psychiatry; randomized controlled trial; severe psychopathology; social information processing model; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
CONSORT flow diagram Virtual Reality Aggression Prevention Training (VRAPT).
Figure 2
Figure 2
Theoretical framework of VRAPT. Based on the social information processing (SIP) model of Crick and Dodge (1994).
Figure 3
Figure 3
Virtual environments: supermarket (a), shopping street (b), and café (c). Source: CleVR BV, Delft, The Netherlandd.
Figure 3
Figure 3
Virtual environments: supermarket (a), shopping street (b), and café (c). Source: CleVR BV, Delft, The Netherlandd.

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