Aggressive and psychopathic traits are linked to the acquisition of stable but imprecise hostile expectations.

Individuals with hostile expectations (HEX) anticipate harm from seemingly neutral or ambiguous stimuli. However, it is unclear how HEX are acquired, and whether specific components of HEX learning can predict antisocial thought, conduct, and personality. In an online sample of healthy young individuals (n = 256, 69% women), we administered a virtual shooting task and applied computational modelling of behaviour to investigate HEX learning and its constellation of correlates. HEX acquisition was best explained by a hierarchical reinforcement learning mechanism. Crucially, we found that individuals with relatively higher self-reported aggressiveness and psychopathy developed stronger and less accurate hostile beliefs as well as larger prediction errors. Moreover, aggressive and psychopathic traits were associated with more temporally stable hostility representations. Our study thus shows that aggressiveness and psychopathy are linked with the acquisition of robust yet imprecise hostile beliefs through reinforcement learning.

Testing the Effects of a Virtual Reality Game for Aggressive Impulse Management: A Preliminary Randomized Controlled Trial among Forensic Psychiatric Outpatients.

Prior laboratory experiments among healthy samples found that training avoidance movements to angry faces may lower anger and aggression, especially people high in trait anger. To enrich this training and make it more suitable for clinical applications, the present researchers developed it into a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME). The current study examined the effects of this training in a randomized controlled trial among forensic psychiatric outpatients with aggression regulation problems (N = 30). In addition to the aggression replacement training, patients played either the VR-GAIME or a control game. Aggressive behavior was measured pre-, half-way, and post-treatment via self-report and clinicians ratings. No difference was found between the VR-GAIME and the control game. However, the participants reported gaining more insight into their own behavior and that of others. Future VR intervention tools in clinical settings may capitalize more on their benefits for self-reflection within interpersonal settings.

Validity and reliability of the Dutch version of the displaced aggression questionnaire.

BACKGROUND: Displaced aggression occurs when a person encounters a provoking situation, is unable or unwilling to retaliate against the original provocateur, and subsequently aggresses against a target that is not the source of the initial provocation. The displaced aggression questionnaire (DAQ) was developed to measure individual differences in the tendency to displace aggression. AIM: To develop a Dutch version of the DAQ and examine relationships between the DAQ and novel individual differences. METHODS: The Dutch version of the DAQ was created using a back-translation procedure. Undergraduate students (n = 413) participated in the current study. The questionnaires were administered online. RESULTS: The results confirmed the original three-factor structure and showed good reliability and validity. We also found differential relationships between trait displaced aggression, social anxiety and cognitive distortions. CONCLUSION: The results may indicate that distinct patterns exist in the development of the different dimensions of trait displaced aggression. This study adds to the growing cross-cultural literature showing the robustness of trait displaced aggression in several different cultures.

Associations of multiple trauma types and MAOA with severe aggressive behavior and MAOA effects on training outcome.

Previous research showed that the disposition to react with disproportionate aggression in adults is influenced by an interaction between a variant in the X-chromosomal monoamine oxidase A gene (MAOA) and early traumatic events. Such studies have often focused on a single type of trauma, whereas we know that experiencing multiple trauma types is associated with more detrimental consequences. The differential susceptibility hypothesis suggests that individuals who are most susceptible to adversity, are also most likely to benefit from supportive experiences in childhood. Differences in susceptibility are thought to be partly genetically driven. In the present study we explored whether a genotype of MAOA linked to lower expression of the gene (MAOA-L) modified the effect of multiple types of trauma on aggression and/or altered responsiveness to treatment among adults with severe aggression. Forensic psychiatric outpatients (FPOs) (N=150) receiving treatment for aggression regulation problems were recruited. Traumatic events and aggression were measured using self-report. FPOs with multiple trauma types and those with the MAOA-L allele reported more severe levels of aggression. No interaction effects between MAOA genotype and trauma emerged. There were no differences in response to the intervention between FPOs with and without the MAOA-L variant, whereas FPOs with a single type of trauma showed the slowest reduction of aggression. FPOs with multiple types of trauma reported the highest levels of aggression over the course of treatment. Future research is needed to elucidate this association in further detail. The current study emphasized the importance of early recognition of early traumatic events.

The Computations of hostile biases (CHB) model: Grounding hostility biases in a unified cognitive framework.

Our behavior is partly a product of our perception of the world, and aggressive individuals have been found to have 'hostility biases' in their perception and interpretation of social information. Four types of hostility biases can be distinguished: the hostile attribution, interpretation, expectation, and perception bias. Such low-level biases are believed to have a profound influence on decision-making, and possibly also increase the likelihood of engaging in aggressive acts. The current review systematically examined extant research on the four types of hostility bias, with a particular focus on the associations between each type of hostility bias and aggressive behavior. The results confirmed the robust association between hostility biases and aggressive behavior. However, it is still unknown how exactly hostility biases are acquired. This is also caused by a tendency to study hostility biases separately, as if they are non-interacting phenomena. Another issue is that current approaches cannot directly quantify the latent cognitive processes pertaining to the hostility biases, thus creating an explanatory gap. To fill this gap, we embedded the results of the systematic review in a state-of-the-art computational framework, which provides a novel mechanistic account with testable predictions.

Testing the Effects of a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME): Study Protocol.

Background: Prior laboratory findings indicate that training avoidance movements to angry faces may lower anger and aggression among healthy participants, especially those high in trait anger. To enrich this training and make it more suitable for clinical applications, it has been developed into a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME). Methods: The proposed study will examine the effects of this training in a randomized controlled trial among forensic psychiatric outpatients with aggression regulation problems (N = 60). In addition to the aggression replacement training, participants will play either the VR-GAIME or a control game. Anger will be assessed using self-report. Aggressive impulses will be measured via self-report, a validated laboratory paradigm, and rated by clinicians. Discussion: The authors hypothesize that the combination of the VR-GAIME and regular aggression treatment will be more successful in reducing aggressive behavior. One of the strengths of the proposed study is that it is the first to examine the effects of a motivational intervention in a clinical sample characterized by problems in regulating anger and aggression. Another strength of the proposed study is that the VR-GAIME will be implemented as a multi-session intervention. Additionally, the VR-GAIME applies, for the first time, serious gaming and virtual reality on an avoidance motivation intervention. If positive results are found, the VR-GAIME may be systematically deployed in forensic psychiatric settings. Trial registration: The trial is registered with The Netherlands National Trial Register, number: NTR6986.

Lack of correspondence between the reactive proactive questionnaire and the impulsive premeditated aggression scale among forensic psychiatric outpatients.

The most studied bimodal classifications of aggressive behavior are the impulsive/premeditated distinction measured with the Impulsive Premeditated Aggression Scale and the reactive/proactive distinction measured with the Reactive Proactive Questionnaire. The terms of these classifications are often used interchangeably, assuming that reactive aggression is equivalent to impulsive aggression and that proactive aggressive behavior is the same as premeditated aggression. The correspondence or discrepancy between both aggression classifications/questionnaires, however, is understudied. Therefore, the current study investigated the correspondence between the RPQ and IPAS in a sample of 161 forensic psychiatric outpatients (FPOs) with severe aggressive behavior. Correlation analysis revealed a limited correspondence between the RPQ and IPAS. Cluster analyses derived three clusters from the RPQ as well as the IPAS: these clusters did not match in 60.3% of the cases. Furthermore, the notion that the RPQ measures trait aggression whereas the IPAS assesses state aggression could not be verified. The present study indicates that aggression subtypes as measured by use of the RPQ and IPAS correspond only partially and should not be used interchangeably. Furthermore, it was suggested that RPQ focuses more on actual aggressive behavior and the IPAS more on emotions and their regulation. Future research is needed to elucidate the applicability of both questionnaires in further detail.

Associations Between Neurocognitive Characteristics, Treatment Outcome, and Dropout Among Aggressive Forensic Psychiatric Outpatients.

Aggression Replacement Training (ART) is widely used to reduce aggression and is considered to be effective although there are also inconsistent results. Studies investigating the effectiveness of ART do not focus on neurocognitive characteristics. Focusing on these aspects would result in enhanced understanding of underlying mechanisms of ART. The current open uncontrolled treatment study assessed whether neurocognitive characteristics were associated with change in aggression during the social skills and anger control modules of ART among forensic psychiatric outpatients. Furthermore, differences between treatment dropouts and completers and change in these characteristics during ART were examined. A reduction of trait aggression, cognitive distortions, and social anxiety was observed. Neurocognitive characteristics were not associated with change in aggression, could not distinguish treatment completers from dropouts, and did not change after ART. It is suggested that new paradigms should be developed which take into account the social context in which these impairments appear.

Treatment Responsivity of Aggressive Forensic Psychiatric Outpatients.

Aggression replacement training (ART) is widely used to reduce aggression. Results regarding its effectiveness, however, are inconclusive regarding adults and specific populations displaying severe aggression. The current open uncontrolled treatment study aimed at assessing the social skills and anger control modules of the ART to reduce aggression in forensic psychiatric outpatients (FPOs). Furthermore, characteristics associated with treatment outcome and dropout were examined. The results suggested that aggression changed during the ART. In addition, higher baseline levels of trait aggression were associated with greater reductions of aggression, whereas more cognitive distortions were associated with less reduction. Treatment dropouts were characterized by higher levels of psychopathic traits, proactive aggression, and more weekly substance use. As there was a considerable amount of dropout; it is important to assess risk of dropping out of treatment and, subsequently, improve treatment motivation. This might enhance treatment adherence which may lead to a more successful reduction of aggression.

Generalized hostile interpretation bias regarding facial expressions: Characteristic of pathological aggressive behavior.

Individuals with aggression regulation disorders tend to attribute hostility to others in socially ambiguous situations. Previous research suggests that this "hostile attribution bias" is a powerful cause of aggression. Facial expressions form important cues in the appreciation of others' intentions. Furthermore, accurate processing of facial expressions is fundamental to normal socialization. However, research on interpretation biases in facial affect is limited. It is asserted that a hostile interpretation bias (HIB) is likely to be displayed by individuals with an antisocial (ASPD) and borderline personality disorder (BPD) and probably also with an intermittent explosive disorder (IED). However, there is little knowledge to what extent this bias is displayed by each of these patient groups. The present study investigated whether a HIB regarding emotional facial expressions was displayed by forensic psychiatric outpatients (FPOs) and whether it was associated with ASPD and BPD in general or, more specifically, with a disposition to react with pathological aggression. Participants of five different groups were recruited: FPOs with ASPD, BPD, or IED, non-forensic patients with BPD (nFPOs-BPD), and healthy, non-aggressive controls (HCs). Results suggest that solely FPOs with ASPD, BPD, or IED exhibit a HIB regarding emotional facial expressions. Moreover, this bias was associated with type and severity of aggression, trait aggression, and cognitive distortions. The results suggest that a HIB regarding facial expressions is an important characteristic of pathological aggressive behavior. Interventions that modify the HIB might help to reduce the recurrence of aggression. Aggr. Behav. 43:386-397, 2017. © 2017 Wiley Periodicals, Inc.

Examining the reactive proactive questionnaire in adults in forensic and non-forensic settings: A variable- and person-based approach.

The Reactive Proactive Questionnaire (RPQ) was originally developed to assess reactive and proactive aggressive behavior in children. Nevertheless, some studies have used the RPQ in adults. This study examines the reliability of the RPQ within an adult sample by investigating whether reactive and proactive aggression can be distinguished at a variable- and person-based level. Male adults from forensic samples (N = 237) and from the general population (N = 278) completed the RPQ questionnaire. Variable-based approaches, including factor analyses, were conducted to verify the two-factor model of the RPQ and to examine alternative factor solutions of the 23 items. Subsequently, a person-based approach, i.e., Latent Class Analysis (LCA), was executed to identify homogeneous classes of subjects with similar profiles of aggression in the observed data. The RPQ proved to have sufficient internal consistency. Multiple-factor models were examined, but the original two-factor model was statistically and theoretically considered as most solid and in line with previous research. The multi-level LCA identified three different classes of aggression severity (class 1 showed low aggressive behavior; class 2 subjects displayed modest aggression levels; and class 3 exhibited the highest level of aggressive behavior). In addition, class 1 and 2 showed more reactive than proactive aggression, whereas class 3 displayed comparable levels of reactive/proactive aggression. The RPQ appears to have clinical relevance for adult populations in the way that it can distinguish severity levels of aggression. Before the RPQ is implemented in adult populations, norm scores need to be developed. Aggr. Behav. 43:155-162, 2017. © 2016 Wiley Periodicals, Inc.

Implicit and explicit self-esteem in remitted depressed patients.

BACKGROUND AND OBJECTIVES: Low self-esteem is a symptom of depression and depression vulnerability. Prior research on self-esteem has largely focused on implicit (ISE) and explicit self-esteem (ESE) as two separate constructs, missing their interaction. Therefore, the current study investigated the interaction between ISE and ESE in a depression-vulnerable group (remitted depressed patients; RDs), compared to never-depressed controls (ND). METHODS: Seventy-five RDs and 75 NDs participated in the study. To measure ESE, the Rosenberg Self-Esteem Scale (RSES) was used. The Implicit Association Test (IAT) and the Name Letter Preference Task (NLPT) were used to assess ISE. RESULTS: RDs reported lower ESE than NDs. However, the two groups did not differ on ISE. RDs exhibited a damaged self-esteem or a low-congruent self-esteem, similar to what has been found in currently depressed patients. Moreover, damaged self-esteem was associated with residual depressive symptoms. LIMITATIONS: The results need to be interpreted with care because the IAT and NLPT did not reveal the same associations with the clinical measures. CONCLUSIONS: Implicit and explicit self-esteem may be different constructs in depression and studying the combination is important. The present study provides evidence indicating that damaged self-esteem may be more detrimental than low congruent self-esteem.

Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care.

BACKGROUND: Burnout is highly prevalent in GPs and can have a negative influence on their wellbeing, performance, and patient care. Mindfulness-based stress reduction (MBSR) may be an effective intervention to decrease burnout symptoms and increase wellbeing. AIM: To gain insight into the feasibility and effectiveness of MBSR on burnout, empathy, and (work-related) wellbeing in GPs. DESIGN AND SETTING: A mixed methods pilot study, including a waiting list-controlled pre-/post-study and a qualitative study of the experiences of participating GPs in the Netherlands. METHOD: Participants were sent questionnaires assessing burnout, work engagement, empathy, and mindfulness skills, before and at the end of the MBSR training/waiting period. Qualitative data on how GPs experienced the training were collected during a plenary session and with evaluation forms at the end of the course. RESULTS: Fifty Dutch GPs participated in this study. The MBSR group reported a greater decrease in depersonalisation than the control group (adjusted difference -1.42, 95% confidence interval [CI] = -2.72 to -0.21, P = 0.03). Dedication increased more significantly in the MBSR group than in the control group (adjusted difference 2.17, 95% CI = 0.51 to 3.83, P = 0.01). Mindfulness skills increased significantly in the MBSR group compared with the control group (adjusted difference 6.90, 95% CI = 1.42 to 12.37, P = 0.01). There was no significant change in empathy. The qualitative data indicated that the MBSR course increased their wellbeing and compassion towards themselves and others, including their patients. CONCLUSION: The study shows that MBSR for GPs is feasible and might result in fewer burnout symptoms and increased work engagement and wellbeing. However, an adequately powered randomised controlled trial is needed to confirm the study's findings.