Aggressiveness, inhibitory control, and emotional states: A provocation paradigm.

The current study examines the effects of trait aggressiveness, inhibitory control and emotional states on aggressive behavior in a laboratory paradigm. One hundred and fifty-one adult participants took part (73 men, 71 women, and 7 nondisclosed). Event Related Potentials (ERPs) during a Go/No-Go task were utilized to capture the extent of inhibitory processing, with a laboratory provocation paradigm used to assess aggression. Contrary to the expectations, negative affective responses to provocation were negatively associated only with short-lived aggression and only among those with high past aggressiveness. Furthermore, past aggressiveness was related to a continuous increase in laboratory aggressive behavior regardless of the level of inhibitory control (P3 difference amplitude). However, feeling hostile was associated with short-lived aggressive behavior, only in those with lower levels of inhibitory control. These findings demonstrate the effect of distinct mechanisms on different patterns of aggressive behavior.

Risk and protective factors in risk assessment: Predicting inpatient aggression in adult males detained in a forensic mental health setting.

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.

Executive functioning as mediator of the association between traumatic brain injury and prison bullying.

OBJECTIVE: This study examined whether executive functioning (EF) mediated the relationship between childhood traumatic brain injury (TBI) and engaging in bullying in prison (BP). PARTICIPANTS: A sample of male adults in custody in Uruguay (N = 236), drawn from five prisons. METHODS: Inmates filled out self-report questionnaires examining TBI (Head Injury Questionnaire), EF (Behavior Rating Inventory of Executive Function Adult, BRIEF-A) and bullying in prison (Direct and Indirect Prisoner Behavior Checklist - revised, SCALED, DIPC-SCALED-r). RESULTS: Findings showed that TBI was associated with prison bullying after controlling for age, level of education, socioeconomic status, and civil status. The mediation analysis indicated that the relationship between TBI and bullying was fully mediated via executive impairment, especially through the behavioral regulation component (mainly inhibition and emotional control). CONCLUSION: These findings suggested that compensating for EF difficulties in adult inmates with brain injuries might help to decrease the bullying in prison.

Extreme Stress Events in a Forensic Hospital Setting: Prevalence, Impact, and Protective Factors in Staff.

The current research explored the prevalence of stressful events in a forensic hospital setting, and their impact on staff. A systematic review of the literature on responses following exposure to extreme stress comprised 46 articles. This was followed by a Delphi study of professionals based in a forensic hospital (n = 43) to explore views on the factors that affect responses to extreme stress. This comprised three rounds to build consensus. Finally, a study of forensic hospital staff was conducted (n = 153, 47% male) to capture current trauma symptoms. The systematic review indicated three superordinate themes: outcomes adversely impacting staff and patients; personal characteristics moderating the impact of events; and organisational and interpersonal support moderating the impact of events. The Delphi supported these themes and noted the importance of factors external to the workplace and internal factors, such as self-blame. The final study demonstrated how a fifth of the workforce showed at least some trauma symptomology. Those who experienced less burnout reported lower trauma symptoms, while staff who experienced higher levels of secondary trauma at work reported higher levels of trauma symptoms. A higher level of resilience was related to lower levels of trauma symptomology. Findings are discussed in relation to the importance of recognising trauma in staff and implementing strategies to reduce and/or buffer the impact of stress on wellbeing. In doing so, the research presents a new model for consideration and development, the Impact and Amelioration of extreme stress events Model (IA-Model).

Exploring Pathways to Gambling: Proposing the Integrated Risk and Protective Factors Model of Gambling Types.

Three linked studies, testing key aspects of the Pathways towards Problem and Pathological Gambling Model (Blaszczynski and Nower in Addiction 87(5):487-499, 2002), are presented. Study one comprised 204 students and 490 gambling forum users. It predicted differences in gambling severity, mental health and substance use across different motives for gambling. Those with a primary social motive for gambling displayed less severe gambling and anxiety than those without, with the primary coping subgroup displaying the most anxiety and depression. Those who gambled primarily to enhance positive affect reported severe gambling. Study two comprised 404 gambling forum users and 265 students. Similar groups to the Pathways Model emerged, with a behaviourally conditioned and an emotionally vulnerable group. Unexpectedly, however, those in the emotionally vulnerable group reported more severe cognitive distortions than the behaviourally conditioned group. The final study, 378 gambling forum users and 201 students, found, as predicted, that three distinct gambling groups emerged; (1) those with lower levels of psychopathology and higher levels of protective factors; (2) those with heightened pre-existing anxiety and depression, and moderate levels of protective factors; and (3) those with heightened impulsivity, psychopathology, offending behaviour and the least protective factors. Three gambling groups are consequently presented (Social Gambler; Affect-Regulation Gambler; Antisocial Gambler) alongside the proposed Integrated Risk and Protective Factors Model of Gambling Types (IRPF-MGT). Directions for future research and implications for practice are outlined.

Potential Sources of Moral Injury for Healthcare Workers in Forensic and Psychiatric Settings: A Systematic Review and Meta-ethnography.

The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A systematic literature review was conducted to identify peer-reviewed articles reporting on sources of moral injury or similar concepts (e.g., moral distress) for healthcare workers in such settings. Thirty articles were included and analyzed using a meta-ethnographic approach. Synthesis yielded three third-order factors, each reflecting a moral dichotomy: (a) "between profession and system," (b) "between relations with patients and relations with others," and (c) "between principles and practices." Findings illustrated the hierarchical relationships between dichotomies, with discordance between values of the healthcare profession and features of the healthcare system providing the conditions for PMIEs to occur. The review advances conceptual understandings of PMIEs in forensic and psychiatric settings, illustrating the multilayered dimensions within which morally injurious events are experienced. Theoretical and practical implications are offered that may support the early detection and prevention of moral injury in healthcare professionals.

Emotionally abusive behavior in young couples: exploring a role for implicit aggression.

Emotionally abusive behaviors reported across a 6-month period in intimate relationships were examined. There were 269 participants aged 18-25 years who took part (98 men, 171 women). All completed the Multidimensional Measure of Emotional Abuse (MMEA) and a measure of implicit aggression, the Puzzle Test. Implicit processing refers to subtle cognitive processing that occurs outside of conscious awareness. This study focused on aggressive implicit processing. Overall emotional victimization by a partner was associated with increased implicit aggressive levels, particularly for women. Those classified as perpetrators/victims (mutual aggressors and victims) were also predicted by increased implicit aggression. Women reported higher levels of implicit aggression than men. Results are discussed regarding future research and the value of theory in understanding the association between emotional abuse and implicit aggression.

Towards an Integrative Theory of Bullying in Residential Care for Youth.

To date, no theory of bullying in residential care for youth has been proposed. By drawing on the results of the existing research on bullying and peer violence in youth residential care and adapting the Multifactor Model of Bullying in Secure Settings (MMBSS), this paper proposes the first integrative theory of bullying in residential care-the Multifactor Model of Bullying in Residential Settings (MMB-RS). The paper first summarises the existing empirical findings on bullying and peer violence in residential care for youth and describes the MMBSS. It then moves on to proposing and describing the MMB-RS. In a nutshell, the MMB-RS assumes that bullying in residential care is shaped by a dynamic interaction between a complex set of individual and contextual factors. The model also takes into account the interaction between bullies and victims, thus explicitly considering the social interactional components of bullying and victimisation and offering possible explanations of the sizable overlap between bullying and victimisation in residential care, including the possible contributions of residential peer cultures. The paper concludes by noting the importance of empirically testing the MMB-RS and proposing a programme of research that may be helpful in testing it.

The centrality of cognition and coping styles in driving aggressive responses.

OBJECTIVE: Despite the presence of theoretical frameworks explaining aggression, they still require refinement in the form of a specification of mechanisms that facilitate such behaviour. METHOD: Study 1 recruited participants (N = 31) from the general population (N = 20) and from a forensic hospital (N = 11). It was expected that aggression supportive cognitions and stress would be positively associated with aggressive behaviour. An experimental paradigm was used to induce stress and participants were subsequently given the opportunity to aggress. Study 2 was based on self-report questionnaires in community sample (N = 462). It was expected that aggressive behaviour and traits would be associated with experienced stress, hostile attributions, coping styles, and attitudes to violence. Specifically, that criminal attitudes to violence will mediate the effect of hostile attribution on aggression, while coping styles will mediate the effect of perceived stress. RESULTS: An Implicit Theory "I am the law" was found to be associated with aggression. Furthermore, elevated skin conductance, but not changes in the heart rate, during the stress task was positively associated with aggression, and only among patients. Structural Equation Model confirmed the mediating role of criminal attitudes to violence and of maladaptive coping style for aggressive behaviour. CONCLUSION: Aggression-supportive cognitions and maladaptive coping style are specific mechanisms through which external demands or subjective perception of a situation can result in aggressive behaviour.

Understanding the sleep-aggression relationship in a forensic mental health sample.

The contribution of cognition to the sleep-aggression relationship is explored via three connected studies, involving adult male forensic patients detained in a high secure hospital. Study 1 included 31 patients, interviewed to examine their experiences of specific sleep problems. In Study 2, 42 patients completed a series of measures examining sleep dysfunction, aggression, and cognition, while Study 3 was designed to impact on sleep via a cognitive approach. In the latter, 48 patients were randomly assigned as part of a feasibility trial to one of three conditions: mindfulness (cognitive approach), sleep education, and treatment as usual. Collectively, the studies demonstrated the multifaceted nature of cognition in the sleep-aggression relationship, with a need to account fully for cognitive factors. A preliminary conceptual model is outlined - the Cognitive Sleep Model for Aggression and Self Harm (CoSMASH), as a direction for future research to consider.

International perspective on guidelines and policies for child custody and child maltreatment risk evaluations: A preliminary comparative analysis across selected countries in Europe and North America.

Little knowledge exists on how evaluators in child custody and child maltreatment cases are informed by guidelines, the kinds of qualifications required and the types of training provided in different countries. The purpose of this paper is to provide an international preliminary comparison on how child custody and child maltreatment risk assessments are conducted in selected Western countries, and how the assessments are informed by best practice guidelines. Another aim is to increase knowledge on how the guidelines and best-practice standards could be developed further to reflect recent research findings. A total number of 18 guidelines were included in the analyses: four from Canada, five from the United States, three from the United Kingdom, three from the Netherlands, two from Finland, and one from Germany. We conducted a content analysis of the included guidelines in the database, focusing on how the guidelines address the best interest of the child criteria, guidelines for conducting the assessments, considerations for evaluative criteria, and specific guidance for conducting specific assessment procedures (e.g., interviews and observations). Findings show that the qualifications of and training provided to evaluators in child custody and child maltreatment risk evaluations are largely heterogeneous across the countries represented. Guidelines differ in whether and how they highlight the importance of evidence-based practices and scientifically validated assessment measures. Implications are drawn from the review and contextualized by international expert authors in the fields of forensic psychology, and family law. After the content analysis, discussion sessions within the expert group were held. The authors provide both commentaries and suggestions to improve the development of standard methods for conducting both child custody and child maltreatment risk evaluations and to consider a more transparent and judicious use of social science research to guide methods and the recommendations offered within these assessments.

Aggression and offence motivation in prisoners: exploring the components of motivation in an adult male sample.

This study examined aggression and offending motivation. Participants were 206 adult male prisoners. All completed the Aggression Motivation Questionnaire [Ireland, 2008], the Offending Motivation Questionnaire [Gudjonsson and Sigurdsson, 2004], the Multidimensional Anger Inventory [Siegel, 1986] and the Balanced Inventory of Desirable Responding [Paulhus, 1991]. It was predicted that aggression motivation would separate into two factors, one reflecting proactive aggression and the other reactive aggression. It was predicted that aggression motives would vary by offence type. It was also predicted that the offending motives identified in previous research (i.e. Excitement, Compliance, Provocation and Financial) would be reflected in this study. Levels of anger and social desirability were also examined for their relationship with aggression and offending motives. Results indicated that aggression motivation separated into four core motives; protection, social recognition, perceived positive outcome, and pleasure. Violent and nonviolent offenders were found to differ in their underlying motives for recent acts of aggression. Anger was related to all core aggression motives, whereas social desirability was related only to some. Offending motives were similar to previous research although some differences were found. Results are discussed with reference to their theoretical and clinical implications.

The importance of coping, threat appraisal, and beliefs in understanding and responding to fear of victimization: applications to a male prisoner sample.

The current study explores conceptualizations of victimization by men, focusing on threat appraisal, coping appraisal, and beliefs, and seeking to apply protection motivation theory, the applied fear response model, and social cognition. Five hundred and sixty-six male prisoners, comprising adults and adolescents, completed a measure of victimization and perpetration (DIPC-SCALED) and of fear, appraisal, and beliefs (TAB). It was predicted that increased threat appraisal and ineffective coping appraisal would predict increased fear of victimization, particularly among the mutual perpetrator/victim group. This group was expected to select strategies for managing the threat of victimization, which carried more risk to them (e.g., such as an aggressive reaction) and to present with beliefs supporting the use of aggression as a response to victimization. Fear of victimization was predicted by threat and coping appraisal although the deficit for victims appeared in coping appraisal only. Mutual perpetrator/victims presented with a specific difficulty in appraising their ability to cope with threat. Differences in beliefs supporting an aggressive response to threat were also noted across perpetrator and/or victimization groups. The article concludes by outlining the implications for theory and clinical practice.

Understanding bullying among younger prisoners: recent research and introducing the Multifactor Model of Bullying in Secure Settings.

The current paper explores bullying among prisoners, with a focus on younger samples. It notes some key findings from the recent literature and how this can be applied to understand intra-group aggression. The paper will focus on what are felt to be key recent developments, highlighting how models of aggression can apply to prisoner samples; how juveniles are less likely to appear in victim groups than older adolescents and adults; the role played by the emotion of fear; and an increased role for attitudes. The paper will then present a revised version of a model used to explain the bullying that occurs in secure settings, one which emphasises in more detail a role for emotion and attitudes. The paper will introduce this revised model for the first time and conclude by noting the importance of developing such models to aid our understanding of prison bullying.

Personality structure among prisoners: how valid is the five-factor model, and can it offer support for Eysenck's theory of criminality?

BACKGROUND: Research with offenders has tended to use a categorical system of diagnosis or a three-factor model. There is growing evidence among non-offending groups that a five-factor model (FFM), which is more holistic and emphasises strengths as well as limitations, may be more clinically useful. AIM: The purpose of this study was to test the validity of the FFM of personality in a sample of adult male prisoners. It was predicted that they would show higher scores for extraversion (E) and lower scores for emotional stability (ES) [the equivalent of higher neuroticism (N)], that E would be predicted by prison experience and age and that the FFM would be confirmed as a better fit to the data over Eysenck's three-factor [P(psychoticism)EN] model. METHODS: Two independent samples of adult male prisoners were asked to complete the International Personality Item Pool while locked in their cells over the lunchtime period. Parallel and confirmatory factor analyses were used to test the hypotheses. RESULTS: There was a 65 and 75% response rate across the independent samples, resulting in samples of 259 and 183, respectively. Overall, more positive personality traits were evidenced across both samples. E was not predicted by prison experience or age, with increased ES related to increased age in only one sample. The best-fitting model comprised five factors, but represented a variant of the FFM. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The value of applying broad conceptualisations of personality to special samples is discussed, with the importance of accounting for positive, as well as negative, traits acknowledged. The presence of increased positive traits in comparison to negative traits is not in keeping with Eysenck's original personality theory of criminal behaviour, with the study highlighting value in accounting more for environmental factors.

Staff Beliefs Toward Self-Injurious Behavior in Patients: A Study of Secure Services.

ABSTRACT: Staff beliefs toward patient self-harm in secure forensic services are explored, capturing forensic nurses and other clinical staff from four secure units from one National Health Service trust, comprising high through low and forensic learning disability. One hundred fifty-five respondents took part (overall completion rate: 61%). The Theory-Driven Measure of Self-Injurious Behavior and the Suicide Competency Assessment Form were completed. It was predicted that higher competency and increased levels of training would associate with beliefs toward patient self-harm. Beliefs differed in accordance to location; perceiving self-injurious behavior as planned and within patient control was endorsed more in high-security settings by forensic nurses, with nurses in high security also more likely to endorse the perception that patients engaging in such behaviors were able to cope and felt valued. Competence and training experience were identified as factors of relevance. The study offers suggestions for future research, including a focus on capturing the environment, exploring "endorsed beliefs" as opposed to "negative attitudes," and proposing the concept of "professional exposure to self-harm" as an important variable.

Understanding Factors Relevant to Self-Injurious Behavior in a High-Risk Secure Psychiatric Sample: Developing the Theory-Driven Measure of Self-Injurious Behavior Engagement.

ABSTRACT: A measure for the assessment of self-injurious behavior is developed. Commencing with a Delphi composed of 33 experts: detached experts (academics), experts by exposure (staff), and experts by experience (patients), the Theory-driven Measure of Self-Injurious Behavior Engagement is outlined. This is then examined in two samples: high-secure psychiatric male patients (n = 76) and high-secure psychiatric nursing staff (n = 100; 50 men, 50 women). We predicted that all components of the Theory of Planned Behavior and the capacity, belongingness, and burdensomeness elements of the Interpersonal Psychological Theory of Suicidal Behavior would be confirmed as important inclusions. Results initially showed the importance of including intention, perceived behavioral control, affect, capacity, and burdensomeness. The role of environmental and individual factors, such as coping, was captured as additional variables of value. However, the structure of items differed between patients and staff. Being valued consistently represented a core consideration, as did capacity and affect. Directions for future research are indicated.

Do personality characteristics and beliefs predict intra-group bullying between prisoners?

This study assesses how beliefs about aggression and personality can predict engagement in intra-group bullying among prisoners. A sample of 213 adult male prisoners completed the DIPC-SCALED (bullying behavior), the EXPAGG (beliefs toward aggression), and the IPIP (a five-factor measure of personality). It was predicted that bullies would hold greater instrumental beliefs supporting the use of aggression than the other categories, with perpetrators reporting lower scores on agreeableness, conscientiousness, and openness to experience, and higher scores on neuroticism (i.e. low scores on emotional stability) than the remaining sample. Bullies and bully-victims endorsed greater instrumental aggressive beliefs than the victim category. Only one perpetrator group, bullies were predicted by reduced levels of agreeableness and increased levels of neuroticism, whereas bully/victims were predicted by decreased levels of neuroticism. Limitations of this study and directions for future research are discussed.

Psychopathy and trauma: Exploring a potential association.

This research presents a series of linked studies exploring the association between psychopathy and trauma. It comprises a systematic review (n = 58), followed by an expert Delphi (n = 19), and patient file trawl using a male forensic psychiatric patient sample (n = 66). An association between psychopathy and developmental trauma was predicted. It was further predicted that different types of trauma would be associated with different subtypes of psychopathy and that the severity of trauma would be important. The systematic review identified the following core themes: presence of Post-Traumatic Stress Disorder and/or symptoms; trauma type; trauma/abuse variables; and sex differences. The ensuing Delphi study indicated the specific variant of psychopathy to be important, with secondary psychopathy particularly relevant. The final study found that the severity of developmental trauma related differentially to primary and secondary psychopathy. Implications and directions for future research are discussed, most notably with regards to the conceptualisation of psychopathy.

Initial Validation of the Suicide Competency Assessment Form among Behavioral Health Staff in the National Health Services Trust.

The Suicide Competency Assessment Form (SCAF) provides a framework for suicide prevention skills training. This study assessed SCAF psychometric properties in a sample of behavioral health staff. A cross-sectional survey of National Health Services (NHS) staff from varying disciplines (N = 170) was conducted. The SCAF yielded a 1-factor structure with high internal consistency. Nursing assistants reported lower SCAF scores compared to other professionals. SCAF scores demonstrated positive associations with prior suicide prevention training, job enthusiasm, and several suicide/self-injury prevention outcome expectations (i.e., optimism working with self-harming patients and perceived ability to help self-harming patients). SCAF scores further demonstrated incremental validity in the form of multivariate model associations with suicide/self-injury prevention outcome expectations. Improved job satisfaction mediated the pathway from SCAF scores to perceived ability to help self-harming patients. The SCAF can be utilized in suicide prevention training and clinical supervision.