Understanding aggression and treating forensic psychiatric inpatients with Virtual Reality

Many forensic psychiatric inpatients (in Dutch: TBS-patients) have difficulty controlling their aggression. For example, aggression can be aimed at fellow patients, staff, and / or objects. This not only has negative consequences for emotional and physical well-being, but also influences the progress of the treatment and the living environment in a TBS-clinic. The aim of the research in this dissertation was to investigate the effectiveness of a new treatment, but also to improve knowledge about aggressive behavior. TBS-patients relatively often have poor impulse control, and easily misinterpret social situations as hostile. Our systematic literature review showed that this tendency to interpret ambiguous social situations as hostile also occurs in non-aggressive TBS-patients and individuals in the general population. We also found that physical aggression from TBS-patients to staff or belongings is often preceded by non-physical aggression, so that structured monitoring of aggression can contribute to the reduction of incidents. Currently, there are few effective treatments for aggression problems. That is why we have developed a Virtual Reality aggression prevention therapy (VRAPT). This dissertation shows that the assessment, framing, monitoring and treatment of aggressive behavior in TBS-patients is a challenge, even with an innovative VR treatment. Unfortunately, the number of aggressive incidents did not decrease after VRAPT. However, the intervention studied was an important first step in the development of VR-treatments in forensic psychiatry. This dissertation shows that further steps are needed, fortunately the assessment of patients and therapists shows that there is support for this.