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Background: Treating violent behavior in prisons comes with challenges, such as the inability to practice safely with triggering situations and motivational issues. A solution may be the use of Virtual Reality (VR). With VR, specific conditions or needs can be tailored for individual practice, it can enhance motivation and VR has proven to be a safe and effective tool in mental health treatment. Objective: A pilot study was conducted to test the acceptability, feasibility, and preliminary effects of VR Aggression Prevention Treatment (VRAPT) in a prison-based population. Methods: In total 17 detainees with aggressive behavior were included in this single-group pilot study. Acceptability and feasibility were assessed using qualitative measures for participants and therapists. Preliminary treatment effects were measured with self-report and observational measures on aggression, anger, emotion regulation, and impulsiveness. Results: Participants and therapists were predominantly positive about VRAPT. Participants rated the sessions with an average satisfaction score of 9.2 out of 10 (SD = 0.3). Qualitative data showed that participants reported having learned to respond more adequately to aggressive behavior and gained insights into their own and others' triggers and tension. The combination of VR and theory was experienced as a strength of the treatment, as well as the ability to trigger aggression in VR which provided insights into aggression. However, the theoretical framework was found to be too complex, and more aggressive and personal scenarios should be incorporated into the sessions. Self-reported aggression, anger, provocation, emotion regulation, and observed verbal aggression decreased and seemed to stabilize after the treatment ended, with small to medium effect sizes. Conclusion: VRAPT proved feasible and acceptable for most participants and therapists. An adapted treatment protocol called Virtual Reality Treatment for Aggression Control (VR-TrAC), will be used in a future RCT to investigate the effects of the treatment in a prison-based population.
RESUMO
BACKGROUND: 'No-show' is important in today's mental healthcare services, yet in forensic psychiatry, little is known about its relationship to general and disorder-specific patient characteristics. AIMS: The aim of this article is to determine the prevalence of no-show and any general and disorder-specific features associated with no-show in a cohort of offenders with attention deficit hyperactivity disorder registered at a specialist forensic mental health clinic. METHODS: Participants were 118 adult men with a mean age just over 32 years (SD 8.75) attending forensic mental health outpatient clinics in the Netherlands who had a primary diagnosis of attention deficit hyperactivity disorder and who had been aggressive and/or delinquent. RESULTS: Over a 1-year period, most patients (101, 86%) missed at least one appointment. The average number of appointments offered was 37.88 (SD = 27.27), and the average number of no-shows was 6.53 (SD = 5.99) per patient. Multivariate linear regressions showed a 10-fold likelihood of later no-shows if the first appointment was missed; not showing up after the intake procedure was also associated with higher rates of later no-show. None of the disorder-specific characteristics contributed to the problem. CONCLUSIONS: No-show is of particular concern in forensic mental health settings. In the current study, no-show was primarily associated with features related to the time of initial consultation. More attention should thus be paid at this stage to using a standard method of assessing a wider range of variables likely to affect attendance. Copyright © 2016 John Wiley & Sons, Ltd.