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

Many patients residing in forensic psychiatric centers have difficulties regulating their aggression in an adequate manner. Therefore, they are frequently involved in conflicts. Evidenced-based aggression therapies in forensic psychiatry are scarce, and due to the highly secured environment, it is hard to practice real-life provocations. We have developed a Virtual Reality aggression prevention training (VRAPT), providing safe virtual environments, in which patients can practice controlling their aggressive behaviors in an adequate way. The main objective of this study is to examine whether VRAPT is effective in reducing aggression among forensic psychiatric inpatients. Four forensic psychiatric centers in the Netherlands are participating in this study. Participants will be randomly assigned to either VRAPT or a waiting list. The two groups will be compared at several different time points: baseline (12 weeks before intervention), pre-intervention, post-intervention and at 12 weeks follow-up. After follow-up measurements are completed, participants from the waiting list will also receive VRAPT. The primary outcome is level of aggressive behavior, consisting of staff-reported and self-reported measures. Secondary outcomes are self-report questionnaires on e.g., anger, impulsivity and aggression. To the best of our knowledge this is the first study to examine the effectiveness of a VR aggression prevention training in forensic psychiatric centers. Further details on the methodological issues are discussed in this paper. Dutch Trial Register ( NTR, TC = 6340 ). Retrospectively registered 14–04-2017.

Research into the criminal behavior of women with psychopathy is scarce. The overall aim of the present study was to examine differences between the criminal behavior of women with and without psychopathy. The sample comprised 221 female forensic psychiatric patients who are or have been admitted to one of four participating forensic settings in the Netherlands between 1984 and 2012. An extensive questionnaire containing demographic, criminal, and psychiatric variables was coded, as well as the Psychopathy Checklist-Revised , several risk assessment tools, and a taxonomy of motivations (inspired by Coid, 1998). The lowered PCL-R cut-off score as applied in the Female Additional Manual was used to define women with psychopathy. It was found that women with psychopathy were younger at their first conviction and had more criminal versatility in their offense histories than women without psychopathy. With respect to the index offense it was found that women with psychopathy committed a fatal index offense less often, were more likely to have stranger victims, and committed offenses motivated by power, dominance, or personal gain (i.e., Bad motivation typology) more often than women without psychopathy. No differences were found between women with and without psychopathy with respect to type of weapon used at the index offense. Implications and suggestions for future research into psychopathy in women are discussed.

We present the collection and annotation of a multi-modal database with negative human-human interactions. The work is part of supporting behavior recognition in the context of a virtual reality aggression prevention training system. The data consist of dyadic interactions between professional aggression training actors (actors) and naive participants (students). In addition to audio and video, we have recorded motion capture data with kinect, head tracking, and physiological data: heart rate (ECG), galvanic skin response (GSR) and electromyography (EMG) of biceps, triceps and trapezius muscles. Aggression levels, fear, valence, arousal and dominance have been rated separately for actors and students. We observe higher inter-rater agreement for rating the actors than for rating the students, consistently for each annotated dimension, and a higher inter-rater agreement for speaking behavior than for listening behavior. The data can be used among others for research on affect recognition, multimodal fusion and the relation between different bodily manifestation.