Understanding the Risk of Sexual Reoffending in Adult Men: A Network-Based Model.

The predominant approach to understand dynamic risk factors of sexual reoffending has been referred to as the Propensities Model (Thornton, 2016). According to this model, dynamic risk factors can be conceptualized as latent constructs whose change alters the risk of sexual reoffending. Despite its strengths and contributions to research, this model does not offer answers to the question of how dynamic risk factors contribute to the risk of sexual reoffending, or of how sustained change in risk might take place. In this paper we introduce the Network-Based Model of Risk of Sexual Reoffending (NBM-RSR), which addresses several limitations and constraints of the Propensities Model and offers empirically testable propositions regarding the nature and development of the risk of sexual reoffending. The NBM-RSR considers risk of sexual reoffending to involve a self-sustaining network of causally connected dynamic risk factors. Consistent with this, an increased risk of sexual reoffending is characterized through a network that contains more and stronger interconnected dynamic risk factors with a higher strength. Sustained change in risk of sexual reoffending occurs when activity in the network exceeds a critical point resulting in a new self-sustaining network. Propositions based on the NBM-RSR are introduced and translated into testable hypotheses. These propositions revolve around (a) risk of sexual reoffending resulting from the construction of a network of causally connected dynamic risk factors, (b) network stability, sudden changes, and critical transitions, and (c) dynamic risk factors' relative influence on risk of sexual reoffending.

Sensory processing and alcohol use in adults with autism spectrum disorder.

The association between substance use and autism spectrum disorder (ASD) is complex. Although sensory processing difficulties are highly prevalent in individuals with ASD, data on the association between sensory processing and substance use in ASD are limited. This study aimed to investigate the association between sensory processing patterns and alcohol use in adults with ASD. Kruskal-Wallis tests were performed on questionnaire data (Adolescent/Adult Sensory Profile and Alcohol Use Disorders Identification Test - Consumption) of 101 adults with ASD. Sensory processing difficulties are associated with alcohol use in adults with ASD. Differences in sensory processing between alcohol-based subgroups vary per specific sensory processing pattern: drinkers reported 6.5 to 8 points higher levels of low registration [χ2(2) = 12.408, p = .002, 99 % CI (.002.002)], non-hazardous drinkers reported 9 points higher levels of sensory sensitivity [χ2(2) = 6.868, p = .031, 99 % CI (.031, .032)], and hazardous drinkers reported 7.5 points higher levels of sensory seeking [χ2(2) = 6.698, p = .034, 99 % CI (.034, .035)], all in comparison with non-drinkers on scales ranging from 15 to 75. Our proof-of-concept study indicates that vulnerability in some individuals with ASD for substance use disorders might be explained by sensory processing difficulties. Whether alcohol is used as 'self-medication' or is associated with other neurobiological vulnerabilities needs further investigation in larger follow-up studies.

Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study.

Background: Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare. Methods: This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison. Results: The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP. Conclusion: With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings.

BACKGROUND: Virtual reality (VR) is increasingly used in healthcare settings as recent technological advancements create possibilities for diagnosis and treatment. VR is a technology that uses a headset to simulate a reality in which the user is immersed in a virtual environment, creating the impression that the user is physically present in this virtual space. Despite the potential added value of virtual reality technology in healthcare, its uptake in clinical practice is still in its infancy and challenges arise in the implementation of VR. Effective implementation could improve the adoption, uptake, and impact of VR. However, these implementation procedures still seem to be understudied in practice. This scoping review aimed to examine the current state of affairs in the implementation of VR technology in healthcare settings and to provide an overview of factors related to the implementation of VR. METHODS: To give an overview of relevant literature, a scoping review was undertaken of articles published up until February 2022, guided by the methodological framework of Arksey and O'Malley (2005). The databases Scopus, PsycINFO, and Web of Science were systematically searched to identify records that highlighted the current state of affairs regarding the implementation of VR in healthcare settings. Information about each study was extracted using a structured data extraction form. RESULTS: Of the 5523 records identified, 29 were included in this study. Most studies focused on barriers and facilitators to implementation, highlighting similar factors related to the behavior of adopters of VR and the practical resources the organization should arrange for. However, few studies focus on systematic implementation and on using a theoretical framework to guide implementation. Despite the recommendation of using a structured, multi-level implementation intervention to support the needs of all involved stakeholders, there was no link between the identified barriers and facilitators, and specific implementation objectives or suitable strategies to overcome these barriers in the included articles. CONCLUSION: To take the implementation of VR in healthcare to the next level, it is important to ensure that implementation is not studied in separate studies focusing on one element, e.g., healthcare provider-related barriers, as is common in current literature. Based on the results of this study, we recommend that the implementation of VR entails the entire process, from identifying barriers to developing and employing a coherent, multi-level implementation intervention with suitable strategies. This implementation process could be supported by implementation frameworks and ideally focus on behavior change of stakeholders such as healthcare providers, patients, and managers. This in turn might result in increased uptake and use of VR technologies that are of added value for healthcare practice.

A Mobile Self-control Training App to Improve Self-control and Physical Activity in People With Severe Mental Illness: Protocol for 2 Single-Case Experimental Designs.

BACKGROUND: Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice. OBJECTIVE: This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels. METHODS: A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. RESULTS: The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023. CONCLUSIONS: The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37727.

How are you coping? Stress, coping, burnout, and aggression in forensic mental healthcare workers.

Introduction: Perceived stress at work has been linked to several adverse outcomes in workers, including increased risk of burnout and aggression (e.g., anger and irritability). However, much remains unknown about factors that might mitigate the negative influences of perceived stress on workers' well-being. This study focusses on coping as a possible protective factor against perceived stress and its consequences in forensic mental healthcare workers. We aimed to identify which higher-order coping factors were present in this worker sample and to investigate whether these coping factors modify the associations between perceived stress and burnout or aggression. Methods: For this observational survey study, 116 forensic mental healthcare workers completed questionnaires assessing changes in work situation since the start of COVID-19, perceived stress, coping, burnout symptoms, and aggression. Results: Results from principal component analysis indicated that four higher-order coping factors could be distinguished: social support and emotional coping, positive cognitive restructuring, problem-focused coping, and passive coping. Higher perceived stress levels were associated with higher levels of both burnout and aggression in workers. Problem-focused coping was associated with less burnout symptoms in workers. Furthermore, positive cognitive restructuring was associated with less aggression in workers. Discussion: In conclusion, problem-focused coping and positive cognitive restructuring may protect workers against burnout symptoms and aggression and these results may inform future studies on preventive interventions aimed at promoting worker's well-being.

Sensory processing difficulties in psychiatric disorders: A meta-analysis.

In clinical practice, many individuals with psychiatric disorders report difficulties in sensory processing, including increased awareness or sensitivity to external stimuli. In this meta-analysis, we examined the sensory processing patterns of adolescent and adult individuals with a broad spectrum of different psychiatric conditions. A systematic search in various databases resulted in the inclusion of 33 studies (N=2008), all using the Adolescent/Adult Sensory Profile (AASP). By comparing diagnostic subgroups to the corresponding reference group of the AASP, we detected a general pattern of sensory processing, indicating elevated levels of low registration, sensory sensitivity and sensory avoiding and lowered sensory seeking behavior in patients with different types of psychiatric disorders. The majority of effect sizes were large to very large. In conclusion, sensory processing difficulties can be considered as a non-specific transdiagnostic phenotype associated with a broad spectrum of psychiatric conditions. Further research into the relevance and role of sensory processing difficulties in psychiatric disorders may improve long-term prognosis and treatment.

Sensory Processing, Perceived Stress and Burnout Symptoms in a Working Population during the COVID-19 Crisis.

Although previous research suggests an association between sensory processing and perceived stress in a broad spectrum of mental health conditions, it remains unclear whether this phenomenon occurs independently from psychopathology. The present study investigated the association between sensory processing patterns, perceived stress and occupational burnout as a stress-related condition in a working population. We focused on different aspects of sensory processing and used the momentum of a particularly stressful period: during the first months of the global COVID-19 crisis. A total of 116 workers at a mental healthcare institution in The Netherlands completed the Adolescent/Adult Sensory Profile (AASP), the Perceived Stress Scale (PSS-10) and the Burnout Assessment Tool (BAT). Our results demonstrated that higher scores on sensory sensitivity and low registration were associated with higher scores on perceived stress and core burnout symptoms. Sensory hypersensitivity was also associated with more secondary burnout symptoms. Associations were not driven by underlying sensory-related disorders (e.g., ASD or ADHD). In conclusion, sensory processing difficulties are relevant predictors of stress and occupational burnout, also in healthy employees. This phenomenon warrants further attention, as relatively simple adjustments in working environment may possess important preventive effects.

A Perspective on the Integration of eHealth in Treatment of Offenders: Combining Technology and the Risk-Need-Responsivity Model.

While there are multiple ways in which eHealth interventions such as online modules, apps and virtual reality can improve forensic psychiatry, uptake in practice is low. To overcome this problem, better integration of eHealth in treatment is necessary. In this perspective paper, we describe how the possibilities of eHealth can be connected to the risk-need-responsivity (RNR) model. To account for the risk-principle, stand-alone eHealth interventions might be used to offer more intensive treatment to high-risk offenders. The need-principle can be addressed by connecting novel experience-based interventions such as VR and apps to stable and acute dynamic risk factors. Finally, using and combining personalized interventions is in line with the responsivity-principle. Based on research inside and outside of forensic psychiatry, we conclude that there are many possibilities for eHealth to improve treatment-not just based on RNR, but also on other models. However, there is a pressing need for more development, implementation and evaluation research.

A self-control training app to increase self-control and reduce aggression - A full factorial design.

BACKGROUND: Research has shown that self-control training (SCT) is an effective intervention to increase self-control and behaviour driven by self-control, such as reactive aggression. We developed an app that offers SCT by asking users to use their non-dominant hand for daily tasks, and aimed to examine whether participants that received SCT via app or e-mail, and received either one daily task or five tasks at once, improved more in self-control and decreased in aggression compared to each other and a control group. METHODS: The design of this study was based on a pilot study in which a first version of the SCT app was developed and tested with students via a pretest-posttest design. Based on the outcomes of the pilot study, a 2 × 2 full factorial design (N = 204) with control group (n = 69) was used, with delivery via e-mail versus app and receiving one daily task versus five at once as factors. During four measuring points, self-control was assessed via the Brief Self-Control Scale (BSCS) and the Go/No-Go task, aggression was assessed using the Brief Aggression Questionnaire (BAQ). In the final questionnaire, open-ended questions were asked to gain insight into the app's points of improvement. Quantitative data were analysed using repeated measures linear mixed models, qualitative data were analysed via inductive coding. RESULTS: While no interaction effects were found, analyses showed that only the BSCS-scores of participants that used the app significantly improved over time (F[3, 196.315] = 4.090, p = .008), no improvements were observed in the e-mail and control condition. No meaningful differences in aggression, the Go/No-Go task, and between the one- and five-task conditions and control groups were found. Qualitative data showed that while the opinions on SCT-tasks differed, participants were overall satisfied with the intervention, but wanted more reminders. CONCLUSIONS: The results of this study showed that an SCT app has the potential to bolster self-control. No convincing effects on aggression were found in this student sample, which might be explained by the relatively low levels of aggression in this target group. Consequently, the app should also be investigated in populations with aggression regulation problems. Future research might also focus on the use of SCT to improve other types of behaviour driven by self-control, such as physical activity or smoking. Finally, a more personalized version of the app, in which users can select the number and types of SCT-tasks, should be developed and evaluated.

Sensory Processing and Aggressive Behavior in Adults with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) may be accompanied by aggressive behavior and is associated with sensory processing difficulties. The present study aims to investigate the direct association between sensory processing and aggressive behavior in adults with ASD. A total of 101 Dutch adult participants with ASD, treated in outpatient or inpatient facilities, completed the Adult/Adolescent Sensory Profile (AASP), the Reactive-Proactive Aggression Questionnaire (RPQ), and the Aggression Questionnaire-Short Form (AQ-SF). Results revealed that sensory processing difficulties are associated with more aggressive behavior (f2=0.25), more proactive (f2=0.19) and reactive aggression (f2=0.27), more physical (f2=0.08) and verbal aggression (f2=0.13), and more anger (f2=0.20) and hostility (f2=0.12). Evidence was found for an interaction of the neurological threshold and behavioral response on total aggression and hostility. Participants with higher scores in comparison to the norm group in sensory sensitivity had the highest risk of aggressive behavior. In conclusion, clinical practice may benefit from applying detailed diagnostics on sensory processing difficulties when treating aggressive behavior in adults with ASD.

Integrating People, Context, and Technology in the Implementation of a Web-Based Intervention in Forensic Mental Health Care: Mixed-Methods Study.

BACKGROUND: While eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and processes should be studied holistically, paying attention to factors related to context, technology, and people. OBJECTIVE: The main objective of this mixed-method study was to holistically evaluate the implementation strategies and outcomes of an eMental health intervention in an organization for forensic mental health care. METHODS: First, desk research was performed on 18 documents on the implementation process. Second, the intervention's use by 721 patients and 172 therapists was analyzed via log data. Third, semistructured interviews were conducted with all 18 therapists of one outpatient clinic to identify broad factors that influence implementation outcomes. The interviews were analyzed via a combination of deductive analysis using the nonadoption, abandonment, scale-up, spread, and sustainability framework and inductive, open coding. RESULTS: The timeline generated via desk research showed that implementation strategies focused on technical skills training of therapists. Log data analyses demonstrated that 1019 modules were started, and 18.65% (721/3865) of patients of the forensic hospital started at least one module. Of these patients, 18.0% (130/721) completed at least one module. Of the therapists using the module, 54.1% (93/172 sent at least one feedback message to a patient. The median number of feedback messages sent per therapist was 1, with a minimum of 0 and a maximum of 460. Interviews showed that therapists did not always introduce the intervention to patients and using the intervention was not part of their daily routine. Also, therapists indicated patients often did not have the required conscientiousness and literacy levels. Furthermore, they had mixed opinions about the design of the intervention. Important organization-related factors were the need for more support and better integration in organizational structures. Finally, therapists stated that despite its current low use, the intervention had the potential to improve the quality of treatment. CONCLUSIONS: Synthesis of different types of data showed that implementation outcomes were mostly disappointing. Implementation strategies focused on technical training of therapists, while little attention was paid to changes in the organization, design of the technology, and patient awareness. A more holistic approach toward implementation strategies-with more attention to the organization, patients, technology, and training therapists-might have resulted in better implementation outcomes. Overall, adaptivity appears to be an important concept in eHealth implementation: a technology should be easily adaptable to an individual patient, therapists should be trained to deal flexibly with an eMental health intervention in their treatment, and organizations should adapt their implementation strategies and structures to embed a new eHealth intervention.

Intimate Partner Violence: Variations in Perpetrators and Treatment Allocation.

The division of batterers into subtypes is hardly ever used, neither to describe the type of perpetrator nor to indicate in the clinical decision-making process what treatment should be offered. In this study, a sample of male perpetrators of intimate partner violence (IPV) who had been advised to seek treatment at a community-based Dutch forensic psychiatric facility (N = 110), either voluntarily or mandatorily, have been divided into four subtypes based on a model reported by Holtzworth-Munroe and Stuart (1994). The four subtypes are Family-Only (FO), Borderline-Dysphoric (BD), Generally Violent Antisocial (GVA), and Low-Level Antisocial (LLA). The aim of the study was to identify the subtypes and to compare the different groups on descriptive dimensions and treatment allocation. In the first part of the study, aside from identifying the batterer subtypes, important differences between the subtypes were encountered in the nature of the violence (structural vs. incidental). The characteristics of the BD subtype were found to be similar to the model except for the psychopathological dimension. Differences in allocation of treatment types between batterer subtypes were not substantial raising questions about the correspondence between typological subtypes and the judgment of clinicians. These results do suggest that more attention should be paid to the heterogeneity of the batterer population, which could improve treatment and advance our understanding of IPV.

The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care.

BACKGROUND: The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them. OBJECTIVE: The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap). METHODS: In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method. RESULTS: Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal. CONCLUSIONS: Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model's underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed.

Identifying the Added Value of Virtual Reality for Treatment in Forensic Mental Health: A Scenario-Based, Qualitative Approach.

Background: Although literature and practice underline the potential of virtual reality (VR) for forensic mental healthcare, studies that explore why and in what way VR can be of added value for treatment of forensic psychiatric patients is lacking. Goals: This study aimed to identify (1) points of improvements in existing forensic mental health treatment of in- and outpatients, (2) possible ways of using VR that can improve current treatment, and (3) positive and negative aspects of the use of VR for the current treatment according to patients and therapists. Methods: Two scenario-based methods were used. First, semi-structured interviews were conducted with eight therapists and three patients to elicit scenarios from them. Based on these results, six scenarios about possibilities for using VR in treatment were created and presented to 89 therapists and 19 patients in an online questionnaire. The qualitative data from both methods were coded independently by two researchers, using the method of constant comparison. Results: In the interviews, six main codes with accompanying sub codes emerged. Ideas for improvement of treatment were grouped around the unique characteristics of the forensic setting, characteristics of the complex patient population, and characteristics of the type of treatment. For possibilities of VR, main codes were skills training with interaction, observation of situations or stimuli without interaction, and creating insight for others into the patient. The questionnaire resulted in a broad range of insights into potential positive and negative aspects of VR related to the current treatment, the patient, the content of a VR application, and practical matters. Conclusion: VR offers a broad range of possibilities for forensic mental health. Examples are offering training of behavioral and cognitive skills in a realistic context to bridge the gap between a therapy room and the real world, increasing treatment motivation, being able to adapt a VR application to individual patients, and providing therapists with new insights into a patient. These findings can be used to ground the development of new VR applications. Nevertheless, we should remain critical of when in the treatment process and for whom VR could be of added value.

eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State.

BACKGROUND: Treatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients. OBJECTIVE: To examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness. METHODS: A systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients. RESULTS: The search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of. DISCUSSION: To overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth's potential, further research on development, implementation, and evaluation should be conducted.

Visual attention in violent offenders: Susceptibility to distraction.

Impairments in executive functioning give rise to reduced control of behavior and impulses, and are therefore a risk factor for violence and criminal behavior. However, the contribution of specific underlying processes remains unclear. A crucial element of executive functioning, and essential for cognitive control and goal-directed behavior, is visual attention. To further elucidate the importance of attentional functioning in the general offender population, we employed an attentional capture task to measure visual attention. We expected offenders to have impaired visual attention, as revealed by increased attentional capture, compared to healthy controls. When comparing the performance of 62 offenders to 69 healthy community controls, we found our hypothesis to be partly confirmed. Offenders were more accurate overall, more accurate in the absence of distracting information, suggesting superior attention. In the presence of distracting information offenders were significantly less accurate compared to when no distracting information was present. Together, these findings indicate that violent offenders may have superior attention, yet worse control over attention. As such, violent offenders may have trouble adjusting to unexpected, irrelevant stimuli, which may relate to failures in self-regulation and inhibitory control.

Psychometric properties of the forensic inpatient quality of life questionnaire: quality of life assessment for long-term forensic psychiatric care.

A substantial group of forensic psychiatric patients require (life)long forensic psychiatric care. Instead of aiming at re-entry into society, treatment in long-term forensic psychiatric care (LFPC) is principally aimed at medical and psychiatric care and optimising quality of life (QoL). To assess QoL in LFPC, the influence of both the mental disorder and the restrictive context should be considered. Therefore, a new instrument was developed: the Forensic inpatient QoL questionnaire (FQL). The FQL is based on the results of concept-mapping with patients and staff within LFPC. The main purpose of this study is to evaluate the psychometric properties of the FQL. One hundred and sixty-three FQLs, filled out by 98 male long-term forensic psychiatric patients, were included for testing reliability and content validity. For testing construct validity, 53 patients additionally completed the World Health Organisation Quality of Life-Brief version and 50 of them the Affect Balance Scale. Outcomes indicate that the FQL has good psychometric properties. Fifteen of the 16 FQL domains showed adequate to good reliability (Cronbach's α range .69-.91) and 9 domains met the criteria for homogeneity. Content validity was demonstrated by exploratory factor analysis, which revealed a three-factor structure: social well-being, physical well-being and leave. Construct validity was supported by 59% correctly hypothesised inter- and intrascale Pearson's correlation coefficients. Good psychometric properties and its clinical-based development make the FQL a valid and useful instrument for QoL assessment in LFPC. The FQL could therefore contribute to evidence-based and more advanced treatment programmes in LFPC.

Recent life events and subjective well-being of personality disordered forensic outpatients.

PURPOSE: The majority of patients treated at forensic psychiatric outpatient facilities suffer from personality disorders, especially Cluster B disorders. Life events have been shown to influence subjective well-being, severity of psychopathology and delinquent behaviour of patients with different personality disorders. However, the influence of life events on subjective well-being of patients suffering from Cluster B personality disorders has rarely been studied. Following General Strain Theory and the dynamic equilibrium model, we hypothesised that negative life events would negatively influence subjective well-being, and that subjective well-being would change when an instability of life events occurs. METHODS: Fifty-six adult male forensic psychiatric outpatients were interviewed on their subjective well-being and filled out a self-report life event questionnaire, at three time-points, with an interval of three months. Life events were categorized along two dimensions: positive / negative and controllable / uncontrollable. RESULTS: Patients had a stable pattern of positive, negative controllable and uncontrollable life events. Positive controllable events did not have a stable pattern. Results indicated that only negative controllable events correlated negatively with subjective well-being. Furthermore, positive and positive controllable events correlated with a positive change in subjective well-being and uncontrollable events correlated negatively with this change. CONCLUSIONS: Forensic psychiatric outpatients seem to experience a relatively stable 'load' of stressful life events, that does not influence change in subjective well-being. We did not find unequivocal support for General Strain Theory. In line with the dynamic equilibrium model, forensic outpatients seemed less used to positive controllable life events, which influenced positive change in subjective well-being. In outpatient forensic treatment, attempts to limit negative life events together with enhancing behaviour which results in positive events should be targeted. This might result in better lives for patients and in reduced criminal behaviour.

Quality of life of male outpatients with personality disorders or psychotic disorders: a comparison.

BACKGROUND: Quality of life (QoL) has become increasingly important as an outcome measure in community-based psychiatry. QoL refers to an individual's sense of well-being and satisfaction with his current life conditions. It is measured both through objective social indicators and life domain-specific subjective indicators. People with a personality disorder (PD) or a major mental disorder (MMD) tend to show poor social adjustment, but their relative subjective QoL is not known. AIM: To compare the QoL of male outpatients in treatment for PD or MMD overall and by means of specific social and subjective indicators. METHODS: A sample of 135 men under treatment for PD in Dutch forensic outpatient facilities were compared with 79 men with MMD using the extended Dutch version of the Lancashire Quality of Life Profile (LQoLP). RESULTS: Almost all of the objective indicators of QoL were significantly poorer among men with MMD than those with PD, but the groups did not differ on domain-specific subjective ratings of QoL. Indeed, global subjective QoL was lower in the PD than in the MMD patient group. PD outpatients seemed to have a more complex concept of QoL than the MMD outpatients for whom almost half of the variance in subjective QoL rating was related to their everyday activities and their objective sense of safety. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Further study of QoL among PD patients would be warranted to test the extent to which subjective dissatisfaction is intrinsic to PD and to explore the possibility of improving it with targeted treatments.