Treatment of aggression in Swedish prisoners with the support of virtual reality
| ISRCTN | ISRCTN14916410 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN14916410 |
- Submission date
- 01/11/2022
- Registration date
- 15/12/2022
- Last edited
- 06/12/2023
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Mental and Behavioural Disorders
Plain English Summary
Background and study aims
Individuals who are cared for and incarcerated in forensic institutions are a group with a variety of problems in addition to crime, such as substance abuse in combination with various psychological and psychiatric difficulties. For instance, it is common that violent offenders lack social problem-solving skills and the ability to regulate negative feelings and impulsivity. These problems are associated with aggressive behavior. Even though treatment programs for offenders are effective in decreasing recidivism (reoffending) in crime, the results are often modest at best. In addition, complex needs in the target group place high demands on individually adapted treatment. Key features of effective treatment for violent offenders are behavioral and skills training through role-plays based on social problem-solving. In other words, treatment needs to address concrete and specific situations that have a risk for violent crime and seek to find sounder and non-destructive solutions to these situations. A recurring challenge in interventions provided within prisons is the difficulty to create individually tailored practice situations, for both practical and safety reasons. The prison context is for obvious reasons different from other contexts that humans find themselves in. Learning to generalize skills from treatment in prisons into everyday life outside the walls is hampered within forensic institutions, probably affecting the offenders’ rehabilitation back to society. There is an urgent need for the development of clinical practice in forensic settings where, for example, new technology in the form of virtual reality (VR) can provide opportunities to respond to this need. The study is a part of a doctoral thesis where the overarching aim is to increase the knowledge of VR as a method in the development and quality of interventions that aim at reducing the risk of recidivism in criminal behavior for offenders in forensic settings.
Who can participate?
Prisoners sentenced for a violent crime in need of treatment for aggression
What does the study involve?
The study involves the program Virtual Reality Aggression Prevention Training (VRAPT) and all participants will take part in VRAPT. VRAPT is a treatment program targeting aggression through skills training in emotion recognition, aggression management and social problem-solving. Participants are followed from the start of treatment to follow up at 3 months after treatment has ended. The measurements used in the study are self-assessments of aggression, emotion regulation difficulties and anger, as well as factors that might impact treatment outcome, childhood trauma, pro-criminal attitudes, externalizing behavior and mental health problems.
What are the possible benefits and risks of participating?
The benefits of participating are a reduction in expressed aggression, as well as an increase in emotion regulation and balance in anger and other negative emotions. This impact could then reduce the risk of relapse in crime, and this is measured in this study. There is a risk of experiencing nausea or dizziness, called cybersickness. This is not harmful but can be uncomfortable and distressing. The VR exposure can be ended at any time if needed and participants can always choose to end their participation in the study at any time, should this be too distressing. There is a risk that the treatment (VRAPT) is not helpful and therefore in theory hinders other potentially effective treatments to be given to the participant. This is a risk that is hard to get rid off when trying out new forms of treatment in order to develop an effective treatment.
Where is the study run from?
The study is run by the Swedish Prison and Probation Services (SPPS) in collaboration with Lund University and the regional forensic mental health clinic in Växjö in Kronoberg region. Participants are recruited from the SPPS prisons in the cities Borås and Kumla (Sweden).
When is the study starting and how long is it expected to run for?
September 2019 to April 2022
Who is funding the study?
1. Swedish Prison and Probation Services (Sweden)
2. Region Kronoberg (Sweden)
Who is the main contact?
David Ivarsson, david.ivarsson@med.lu.se, david.ivarsson@kriminalvarden.se
Contact information
Public
Slottsgatan 78
Norrköping
60180
Sweden
 ORCID ID |
0000-0002-4004-939X |
|---|---|
| Phone | +46 (0)705833700 |
| david.ivarsson@med.lu.se |
Principal Investigator
Rättspsykiatriska regionkliniken
Johan Allgulins väg 1
Växjö
35257
Sweden
| ORCID ID |
0000-0003-0530-9560 |
|---|---|
| Phone | +46 (0)470 589933 |
| marta.wallinus@med.lu.se |
Scientific
Slottsgatan 78
Norrköping
60180
Sweden
| ORCID ID |
0000-0002-4004-939X |
|---|---|
| Phone | +46 (0)705833700 |
| david.ivarsson@med.lu.se |
Study information
| Study design | Interventional pilot study |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Non randomised study |
| Study setting(s) | Prison/detention |
| Study type | Treatment |
| Participant information sheet | Not available in web format |
| Scientific title | Pinpointing change in virtual reality assisted treatment for violent offenders: a pilot study of Virtual Reality Aggression Prevention Training (VRAPT) |
| Study hypothesis | Virtual Reality Aggression Prevention Training (VRAPT) will increase emotion regulation abilities and strategies and decrease aggression in imprisoned, violent offenders. |
| Ethics approval(s) | Approved 20/01/2020, Swedish Ethical Review Authority (Box 2110, 750 02 Uppsala, Sweden; +46 (0)010-475 08 00; registrator@etikprovning.se), ref: 2019-02337 |
| Condition | Treatment of aggression in violent offenders |
| Intervention | The study will describe and evaluate the treatment program VRAPT in an interventional pilot study within the Swedish prison and probation service (SPPS) - prison setting - targeting violent offenders (n ~ 15). The design is a multicenter within-group case series design where the impact of VRAPT is measured through pre- (T1), post- (T2), and follow-up (T3). Measures focus on relevant criminogenic needs such as emotion dysregulation, aggression and, hostility affecting aggressive behaviors and potential confounders. The study will provide information on the impact of VR-assisted aggression training within a prison context, as one of the first studies on the subject ever. Data will be analyzed with descriptive statistical analysis, using measures of frequency, central tendency, and dispersion of variation, effect sizes and graphical illustrations of change. The participants will undergo the manualized VRAPT treatment, where documentation of all interventions is made in a treatment protocol. The treatment includes 16 treatment sessions and is given by specially trained program facilitators at relevant institutions who have access to methodological support from a designated VRAPT supervisor. The VRAPT program constitutes of modules targeting getting to know virtual reality (VR), emotion recognition and differentiation, aggression management skills training and social problem-solving and skills training. |
| Intervention type | Behavioural |
| Primary outcome measure | 1. Aggression is measured using Aggression Questionnaire-Revised Swedish Version (AQ-R): self-assessment of aggression and hostile behavior, at pre-, (T1), post-, (T2) and follow-up (T3) 2. Emotion dysregulation is measured using the Difficulties in Emotion Regulation Scale (DERS): self-assessment of emotion recognition and emotion regulation strategies, at pre-, (T1), post-, (T2) and follow-up (T3) 3. Anger is measured using State-Trait Anger Expression Inventory-2-S (STAXI-2S): self-assessment of aggression, both current and in habitual state, at pre-, (T1), post-, (T2) and follow-up (T3) T1: Before start of VRAPT; T2:Directly after VRAPT; T3: 3 months follow up |
| Secondary outcome measures | Secondary measures are targeting potential confounders on the primary outcome and use both file data from SPPS file registers and self-assessment data: 1. Mental illness and psychiatric disorders measured using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) at (T1) 2. Lifelong externalizing behaviors measured using the Externalizing Spectrum Inventory-Brief Form (ESI-BF) at (T1) 3. Procriminal attitudes measured using Measures of Criminal Attitudes and Associates (MCAA) at (T1) 4. Childhood trauma measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF) at (T1) Other secondary measures are: 5. Participant experiences of virtual reality measured using the I-group presence questionnaire (IPQ) at (T2). Note that the version used in the current study is revised specifically based on the needs of the current study and so as not to burden the clients with unnecessary questions. T1: Before start of VRAPT; T2:Directly after VRAPT; T3: 3 months follow up |
| Overall study start date | 01/09/2019 |
| Overall study end date | 19/04/2022 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Sex | Male |
| Target number of participants | 15 |
| Total final enrolment | 14 |
| Participant inclusion criteria | Offenders who are: 1. Sentenced to prison at the sites for the study 2. Have been assessed with an increased risk of recidivism in violent crimes (medium to high risk) 3. Indications of a need for treatment of aggression problems (identified through screening for study inclusion) |
| Participant exclusion criteria | 1. Inability to understand and provide informed consent 2. Major deficits in understanding the Swedish language preventing active participation 3. Epilepsy 4. Indications of acute psychotic state 5. Intellectual disabilities (IQ <70) 6. Suicide risk 7. Current and serious security risks that prevent participation in a safe way 8. Less than 10 weeks remaining time at the prison The criteria are set for the study to be conducted in a safe way for offenders, staff, and researchers. For those offenders who are excluded from participation, the violence prevention interventions offered in their regular care will continue as usual. |
| Recruitment start date | 01/03/2020 |
| Recruitment end date | 01/01/2022 |
Locations
Countries of recruitment
- Sweden
Study participating centres
Borås
504 62
Sweden
Kumla
692 35
Sweden
Sponsor information
Government
Slottsgatan 78
Norrköping
60180
Sweden
| Phone | +46 (0)077 228 08 00 |
|---|---|
| mia.smith@kriminalvarden.se |
Hospital/treatment centre
Rättspsykiatriska regionkliniken
Johan Allgulins väg 1
Växjö
35257
Sweden
| Phone | +46 (0)470 559933 |
|---|---|
| marta.wallinius@kronoberg.se |
Funders
Funder type
Government
No information available
Government organisation / Local government
- Location
- Sweden
Results and Publications
| Intention to publish date | 01/07/2023 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | Spring 2022 - Fall 2022: Data collection, data analysis and manuscript writing. Spring 2023: Finishing and submitting the manuscript for the study. Planned publication in a high-impact peer-reviewed journal. |
| IPD sharing plan | The datasets generated during and/or analysed during the current study will be available upon request from David Ivarsson (david.ivarsson@kriminalvarden.se). The type of data that will be shared: Group data When the data will become available: Available upon request after publication of results For how long: at least 10 years after publication By what access criteria data will be shared including with whom: To other researchers For what types of analyses: Group-level analysis By what mechanism: Not specified Whether consent from participants was obtained: Informed consent was obtained Comments on data anonymization: All data is fully anonymized. Any ethical or legal restrictions: No Any other comments: No |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Basic results | 31/05/2023 | No | No | ||
| Protocol file | 31/05/2023 | No | No | ||
| Protocol file | Self-assessment protocol T1 | 31/05/2023 | No | No | |
| Protocol file | Self-assessment protocol T2 after treatment | 31/05/2023 | No | No | |
| Protocol file | Self-assessment protocol T3 follow-up | 31/05/2023 | No | No | |
| Statistical Analysis Plan | Data collection protocol files | 31/05/2023 | No | No | |
| Results article | 16/11/2023 | 05/12/2023 | Yes | No |
Additional files
- ISRCTN14916410_BasicResults.pdf
- ISRCTN14916410_Protocol_T2.pdf
- Self-assessment protocol T2 after treatment
- ISRCTN14916410_Protocol_T1.pdf
- Self-assessment protocol T1
- ISRCTN14916410_Protocol_T3.pdf
- Self-assessment protocol T3 follow-up
- ISRCTN14916410_SAP.pdf
- Data collection protocol files
- ISRCTN14916410_Protocol.pdf
Editorial Notes
06/12/2023: IPD sharing plan added.
05/12/2023: Publication reference added.
11/10/2023: The scientific title was changed from 'Treatment of aggressive behaviors in violent offenders with the support of virtual reality: a pilot study of virtual reality aggression prevention training (VRAPT) in the Swedish Prison and Probation Service' to 'Pinpointing change in virtual reality assisted treatment for violent offenders: a pilot study of Virtual Reality Aggression Prevention Training (VRAPT)'.
31/05/2023: The following changes have been made:
1. The basic results have been uploaded to the study outputs table.
2. Uploaded statistical analysis plan.
3. Uploaded protocol files (not peer reviewed).
24/01/2023: The study setting has been updated from ‘Other’.
08/11/2022: Trial's existence confirmed by the Swedish Ethical Review Authority.
