Virtual Reality Aggression Prevention Training (VRAPT) for (Forensic) Psychiatric Patients

NCT ID: NCT05293834

Last Updated: 2025-07-09

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 68 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-09-21
• Study Completion Date: 2027-05-31

Brief Summary

Violent and aggressive behavior as well as disorders related to aggressive behavior are highly common in both adult and juvenile forensic psychiatric patients, and is also present in a subgroup of non-forensic psychiatric in- and out-patients. One promising new treatment option is Virtual Reality. A newly developed program in this area is the Virtual Reality Aggression Prevention Training (VRAPT). The purpose of the current feasibility and pilot study is to test VRAPT in a Swiss forensic and non-forensic psychiatric setting, including both adult and juvenile patients, and to examine whether VRAPT is an effective treatment method for aggressive behavior.

Detailed Description

Violent and aggressive behavior as well as disorders related to aggressive behavior are highly common in both adult and juvenile forensic psychiatric patients, and is also present in a subgroup of non-forensic psychiatric in- and out-patients. In order to minimize the risk for future violent offending it is important to intervene in these high-risk populations. Previous research showed that punishment alone is counterproductive for repeated offending behavior. In contrast, treatment was found to have a positive effect on reoffending (i.e., less reoffending). However, although knowledge about the treatment of (forensic) psychiatric patients has increased significantly in recent decades, it is still not fully understood what works for whom under which circumstances. One promising new treatment option is Virtual Reality. A newly developed program in this area is the Virtual Reality Aggression Prevention Training (VRAPT). This training is currently implemented and examined in correctional and forensic psychiatric facilities in the Netherlands and in Sweden. Results from the first randomized controlled trial (RCT) on the effectiveness of the intervention showed that the VRAPT group showed a decrease in some aggressive behaviors at post-test, but not anymore at 3-month follow-up. The purpose of the current feasibility and pilot study is to test VRAPT in a Swiss forensic and non-forensic psychiatric setting, including both adult and juvenile patients, and to gather information needed for the design of a large, international, high-quality, multicenter RCT. The research questions will address the effect of VRAPT on aggressive behavior, state-trait anger expression, stages of motivational change, emotion regulation, and therapeutic alliance. The present investigation will be the first study to include juvenile forensic psychiatric patients as well as to test VRAPT in Switzerland, thereby increasing the generalizability of the research to other populations. Furthermore, it will be the first time VRAPT will be tested in a non-forensic psychiatric sample exhibiting aggressive behaviour. In addition, it will address problem awareness and therapy motivation as possible factors influencing treatment outcome, and address some of the limitations of previous research.

Conditions

Forensic Psychiatry

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

VRAPT intervention group

Data collection process:

1. Pre-intervention (t0): patients self-reports and staff observation;

2. VRAPT: 8-16 weeks;

3. Post-intervention (t1): patients self-reports, staff observations, and qualitative interview with participants and VRAPT therapists conducted by research staff;

4. Follow-up 12 weeks after completion of the intervention (t2): patients self-reports and staff observations.

Group Type: EXPERIMENTAL

Virtual Reality Aggression Prevention Training (VRAPT)

Intervention Type: BEHAVIORAL

VRAPT consists of sixteen 45- to 60-minute sessions that take place once or twice per week (total duration of the intervention = 8 to 16 weeks). Session time and intensity will be adapted to the individual participant and the sessions will be delivered by specially trained VRAPT therapists in individual settings. The immersive and interactive three-dimensional virtual environment will be presented via headphones and head-mounted displays, using software developed by CleVR. In the virtual environment, participants will interact with virtual characters that are controlled by the psychotherapist and practice new skills . The therapy program is targeted at factors and processes related to aggression and the underlying theoretical framework is based on cognitive behavioural therapy and the General Aggression Model (GAM).

The VRAPT consists of 4 phases:

1. Introduction (Session 1)

2. Inventory phase (Sessions 2-6)

3. Skills-training (Sessions 6-15)

4. Evaluation (Session 16)

Interventions

Virtual Reality Aggression Prevention Training (VRAPT)

VRAPT consists of sixteen 45- to 60-minute sessions that take place once or twice per week (total duration of the intervention = 8 to 16 weeks). Session time and intensity will be adapted to the individual participant and the sessions will be delivered by specially trained VRAPT therapists in individual settings. The immersive and interactive three-dimensional virtual environment will be presented via headphones and head-mounted displays, using software developed by CleVR. In the virtual environment, participants will interact with virtual characters that are controlled by the psychotherapist and practice new skills . The therapy program is targeted at factors and processes related to aggression and the underlying theoretical framework is based on cognitive behavioural therapy and the General Aggression Model (GAM).

The VRAPT consists of 4 phases:

1. Introduction (Session 1)

2. Inventory phase (Sessions 2-6)

3. Skills-training (Sessions 6-15)

4. Evaluation (Session 16)

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• forensic and non-forensic psychiatric in- and out-patients of the Forensic Department or Adult Department of the Psychiatric University Hospitals Basel with aggressive behavior problems according to their clinical treatment team (which includes senior medical doctor, therapist, nursing staff).

Exclusion Criteria

• insufficient German language skills (in speech or reading);
• intellectual disabilities (IQ < 70);
• epilepsy;
• acute psychotic state.

• Minimum Eligible Age: 12 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University Psychiatric Clinics Basel

NETWORK

Sponsor Role: collaborator

University Hospital, Basel, Switzerland

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Cyril Boonmann, PhD

Role: PRINCIPAL_INVESTIGATOR

Psychiatric University Hospitals (UPK) Basel

Locations

Psychiatric University Hospitals (UPK) Basel

Basel, Canton of Basel-City, Switzerland

Site Status: RECRUITING

Countries

Switzerland

Central Contacts

Cyril Boonmann, PhD

Role: CONTACT

cyril.boonmann@upk.ch

+41 61 325 82 91

Henning Hachtel, PD. Dr. med.

Role: CONTACT

henning.hachtel@upk.ch

+41 61 325 51 11

Facility Contacts

Cyril H Boonmann, PhD

Role: primary

cyril.boonmann@upk.ch

+41 61 325 82 91

Henning Hachtel, PD Dr. med.

Role: backup

henning.hachtel@upk.ch

+41 61 325 51 11

Other Identifiers

2021-02439; pk22Graf

Identifier Type: -

Identifier Source: org_study_id