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Templeton JM, Dixon WE, Williams S, Morelen D, Driggers-Jones L, Robertson C. The mediating role of social support on the link between adverse childhood experiences and adult mental health. J Exp Child Psychol 2024; 252:106148. [PMID: 39706049 DOI: 10.1016/j.jecp.2024.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 11/12/2024] [Accepted: 11/14/2024] [Indexed: 12/23/2024]
Abstract
Adverse childhood experiences (ACEs) have been associated with adult mental health, especially anxiety and depression. We aimed to explain these relationships by investigating perceived social support as a mediating factor. In this model, it is proposed that individuals who experience more ACEs will have less perceived social support in adulthood, which in turn will increase reported anxiety and depression symptoms. Data were collected on ACEs, anxiety, depression, and perceived social support using an anonymous REDCap survey distributed through various social media outlets and relevant listservs. Respondents (N = 494) were caregivers who primarily resided in the United States and identified as White, well-educated, middle class, and female. ACEs were measured using the expanded ACE questionnaire extracted from the Health-Resiliency-Stress Questionnaire. Anxiety and depression were measured by the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively. Social support was measured with the Multidimensional Scale of Perceived Social Support. Results confirmed partial mediating effects of social support on the relation between (a) ACEs and anxiety and (b) ACEs and depression. Increased exposure to ACEs was associated with less social support in adulthood and, consequently, to greater mental health symptomatology. Implications of these findings highlight the potential role of social support as a preventative strategy and adult social support as a mitigating strategy.
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Affiliation(s)
- Jessica M Templeton
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA
| | - Wallace E Dixon
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Stacey Williams
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA
| | - Diana Morelen
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA
| | | | - Chelsea Robertson
- Department of Psychology, Community College of Baltimore County, Hunt Valley, MD 21031, USA
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Moyers SA, Doherty EA, Appleseth H, Crockett-Barbera EK, Croff JM. Positive Childhood Experiences are Associated With Alcohol Use in Adolescent and Emerging Adult Females by Adverse Childhood Experiences Dimension. J Adolesc Health 2024; 75:890-903. [PMID: 39340496 PMCID: PMC11568941 DOI: 10.1016/j.jadohealth.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/27/2024] [Accepted: 07/11/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE Experiencing multiple adverse childhood experiences (ACEs) is associated with alcohol use in female adolescents and emerging adults. Protective and compensatory experiences (PACEs) have been theorized to off-set the health and behavioral consequences from the accumulation of ACEs throughout childhood. This study examines the association between protective experiences and subsequent alcohol and binge alcohol use frequency over one month among female adolescent and emerging adults reporting high and low levels of two ACE dimensions (household dysfunction and emotional abuse/neglect). METHODS One hundred 43 females between the ages of 15-24 who indicated at least one binge episode in the past two weeks completed the six-item ACEs scale, the PACEs scale, and demographics at baseline. Alcohol consumption was measured prospectively over the next month during weekly appointments using the timeline follow back approach. RESULTS Two PACEs factors had significant direct associations, a source of unconditional love was associated with less frequent alcohol use (β = -0.437, 95% confidence interval [CI] -0.744, -0.131, exp(β) = 0.65, p = .005) in the context of high household dysfunction; and having a trusted adult to count on for help and advice (β = -1.373, 95% CI -2.283, -0.464, exp(β) = 0.25, p = .003) predicted fewer binge occasions in the context of high emotional abuse/neglect. Regardless of ACE dimension exposure, nonsport social group membership was associated more frequent alcohol use over the month across all ACE dimensions (β = 0.11-0.74, 95% CI -0.11, 0.74, exp(β) = 1.37 - 1.62, p ≤ .002); and having a trusted adult to count on for help and advice was associated with a 5.7 times more frequent of alcohol use among those with low household dysfunction (β = 1.74, 95% CI 0.83, 2.65, exp(β) = 5.70, p < .001). DISCUSSION Few PACE items are associated with direct reductions in alcohol outcomes. Indeed, there is consistently heightened risk associated with nonsport group membership for alcohol use frequency, regardless of experiences of childhood adversity. Future research should identify which protective factors have the most potential to off-set alcohol use by ACE dimension.
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Affiliation(s)
- Susette A Moyers
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Emily A Doherty
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Hannah Appleseth
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Erica K Crockett-Barbera
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Julie M Croff
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma.
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Gilroy H, Anderson K, Berry DM, Hirsch S, Johnson Makiya D, Ratcliff C. Stress and Trauma Among Nurses in Development (STAND): A Descriptive Study. Issues Ment Health Nurs 2024; 45:840-849. [PMID: 38843035 DOI: 10.1080/01612840.2024.2352588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
BACKGROUND Mental health conditions related to traumatic stress exposure are common in practicing nurses. Less is known about the impact of trauma on nursing students and how it affects their transition to practice. OBJECTIVES The purpose of this study is to understand the experience of trauma exposure and resulting symptoms in undergraduate nursing students. DESIGN This is an analysis of baseline data from a longitudinal study. Students in an undergraduate nursing program completed a survey with validated instruments to measure trauma exposure, risk and protective factors, and trauma symptoms. SETTINGS The study took place in an undergraduate nursing program in the United States. PARTICIPANTS A total of 248 nursing students participated in the study. RESULTS The nursing students reported a higher number of adverse childhood experiences and post-traumatic stress disorder (PTSD) symptoms than the general population. Additionally, mental health symptoms and burnout symptoms increased over time. CONCLUSIONS Nursing students are at high risk for PTSD and other mental health conditions due to cumulative trauma. Interventions are needed to address trauma in developing nurses.
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Affiliation(s)
- Heidi Gilroy
- Memorial Hermann Health System, The Woodlands, Texas, USA
| | - Kennedy Anderson
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
| | - Devon M Berry
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
| | - Sarah Hirsch
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
| | | | - Chelsea Ratcliff
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
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Hughes K, Bellis MA, Cresswell K, Hill R, Ford K, Hopkins JC. Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK. BMJ Open 2024; 14:e081924. [PMID: 38692715 PMCID: PMC11086514 DOI: 10.1136/bmjopen-2023-081924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. DESIGN National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile. SETTING Households in Wales, UK. PARTICIPANTS 1880 Welsh residents aged ≥18 years. MEASURES Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation. RESULTS The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships. CONCLUSIONS Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.
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Affiliation(s)
- Karen Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Katie Cresswell
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Rebecca Hill
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
| | - Kat Ford
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Joanne C Hopkins
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
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Dharma C, Keyes KM, Rudolph KE, Shrader CH, Chen YT, Schneider J, Duncan DT. Adverse childhood experiences among black sexually minoritized men and Black transgender women in Chicago. Int J Equity Health 2024; 23:74. [PMID: 38622612 PMCID: PMC11020455 DOI: 10.1186/s12939-024-02168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACE) are important predictors of mental health outcomes in adulthood. However, commonly used ACE measures such as the Behavioural Risk Factor Surveillance System (BRFSS) have not been validated among Black sexually minoritized men (SMM) nor transgender women (TW), whom are known to have higher rates of ACE and poorer mental health outcomes. Assessing the psychometric properties of the measure is important for health equity research, as measurements that are not valid for some populations will render uninterpretable results. METHODS Data are drawn from the Neighborhoods and Networks (N2) study, a longitudinal cohort of Black SMM and TW living in Southern Chicago. We conducted confirmatory factor analysis, correlation analysis and a two-parameter Item Response Theory (IRT) on the BRFSS ACE measure, an 11-item measure with 8 domains of ACE. RESULTS One hundred forty seven participants (85% cisgender male) completed the BRFSS ACE measurement in the N2 study with age ranges from 16-34. The cohort were from a low socioeconomic background: about 40% of the cohort were housing insecure and made than $10,000 or less annually. They also have a high number of ACEs; 34% had endorsed 4 or more ACE domains. The three-factor structure fit the BRFSS ACE measure best; the measurement consisted of three subscales: of "Household Dysfunction", "Emotional / Physical", and "Sexual Abuse" (CFI = 0.975, TLI = 0.967, and RMSEA = 0.051). When the 8 domains of ACE were summed to one score, the total score was is correlated with depressive symptoms and anxiety scores, establishing concurrent validity. Item Response Theory model indicated that the "parental separation" domain had a low discrimination (slope) parameter, suggesting that this domain does not distinguish well between those with and without high ACE. CONCLUSIONS The BRFFS ACE measure had adequate reliability, a well-replicated structure and some moderate evidence of concurrent validity among Black SMM and TW. The parental separation domain does not discriminate between those with high and low ACE experiences in this population. With changing population demographics and trends in marriage, further examination of this item beyond the current study is warranted to improve health equity research for all.
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Affiliation(s)
- Christoffer Dharma
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168Th St, New York, NY, 10032, USA
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168Th St, New York, NY, 10032, USA
| | - Kara E Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168Th St, New York, NY, 10032, USA
| | - Cho-Hee Shrader
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168Th St, New York, NY, 10032, USA
| | - Yen-Tyng Chen
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA
| | - John Schneider
- Department of Medicine, University of Chicago School of Medicine, Chicago, IL, USA
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168Th St, New York, NY, 10032, USA.
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Decrop R, Nowalis S, Yannon M, McGraw J, Docherty M. Unveiling hidden dimensions: A novel bifactor approach to unraveling adverse childhood experiences. CHILD ABUSE & NEGLECT 2024; 147:106599. [PMID: 38113570 DOI: 10.1016/j.chiabu.2023.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/25/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are associated with diverse negative health outcomes and are commonly screened for in primary care, research, and clinical practice. However, more research is needed surrounding the conceptualization, measurement, and application of ACEs measures. OBJECTIVE This study examines the bifactor structure and internal reliability of a short, practical, and commonly used ACEs questionnaire and assesses how the factor structure is associated with correlates of ACEs. PARTICIPANTS AND SETTING Data from Utah's 2020 Behavioral Risk Factor Surveillance System, a telephone survey assessing the prevalence of health-related behaviors among a sample of adults in Utah (N = 8978, Mage = 51.5, SD = 19.4, Range = 18-99; 50 % female, 87.1 % White) was analyzed. METHODS Exploratory and confirmatory factor analyses were conducted to determine the best-fitting factor structure and examined correlations between the identified factors and poor health and substance use with structural equation modeling. RESULTS A three-factor bifactor model best fit the data and its components had associations of different direction and magnitude with outcomes (bifactor: health β = 0.83, p < .001, substance use β = 0.14, p = .025; household hardship: health ß = -0.49, p < .001, substance use ß = 0.23, p < .001; general abuse: health ß = -0.63, p < .001, substance use ß = 0.18, p = .036; sexual abuse: health ß = -0.25, p < .001). CONCLUSIONS Results highlight the importance of using a bifactor approach to examine and score ACEs measures rather than a traditional total sum score method.
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Affiliation(s)
- Romain Decrop
- Department of Psychology, Bowling Green State University, 822 E Merry Ave. 0000-0002-5128-1135, Bowling Green, OH 43403, USA.
| | - Sarah Nowalis
- Department of Psychology, Bowling Green State University, 822 E Merry Ave. 0000-0002-5128-1135, Bowling Green, OH 43403, USA.
| | - Miranda Yannon
- Department of Psychology, Bowling Green State University, 822 E Merry Ave. 0000-0002-5128-1135, Bowling Green, OH 43403, USA.
| | - James McGraw
- Department of Psychology, Bowling Green State University, 822 E Merry Ave. 0000-0002-5128-1135, Bowling Green, OH 43403, USA.
| | - Meagan Docherty
- Department of Psychology, Bowling Green State University, 822 E Merry Ave. 0000-0002-5128-1135, Bowling Green, OH 43403, USA.
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Hietamäki J, Laajasalo T, Lindgren M, Therman S. Development and initial validation of the THL Adverse Childhood Experiences Questionnaire (ACE-THL). CHILD ABUSE & NEGLECT 2023; 146:106483. [PMID: 37922617 DOI: 10.1016/j.chiabu.2023.106483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The research on adverse childhood experiences (ACEs) has deepened our understanding of the long-lasting and cumulative effects of childhood adversities. However, the instruments measuring ACEs have several shortcomings, including limited item coverage, collapsing of items and response options, simplistic scoring, and inadequate psychometric assessments. OBJECTIVE To design and conduct preliminarily psychometric testing for a brief new self-report instrument-the THL Adverse Childhood Experiences questionnaire (ACE-THL)-with a comprehensive set of clearly formulated items and appropriate response options. METHODS A previously published process model was applied to develop the ACE-THL questionnaire, which was validated by cognitive interviews (N = 20). Interviewers and interviewees completed the questionnaire separately for a cross-informant comparison. In a separate survey panel validation, the respondents filled out the ACE-THL twice, two weeks apart (N = 513, with 426 in the follow-up). Interview data were used to improve item clarity, and test-retest reliability and structural validity were assessed with repeated survey data. RESULTS The final 14-item questionnaire, including 12 ACE items and two items measuring protective experiences, was highly acceptable to the respondents. In the factor analysis of the quantitative data, a sufficiently single-dimensional construct was found, remaining stable in retesting two weeks later. The internal consistency (omega) of the a priori one-dimensional model was 0.89 and 0.90 at baseline and follow-up, respectively. The high test-retest reliability (mean score rank order correlation 0.93) of the ACE-THL indicated that the probed perceptions of childhood experiences are stable. CONCLUSION Based on the initial validation, the 14-item ACE-THL questionnaire is a reliable and valid instrument to measure adverse childhood experiences, as well as protective experiences.
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Affiliation(s)
- Johanna Hietamäki
- Competence Cluster for Violence Prevention Work, Special Services Unit, Finnish Institute for Health and Welfare, Finland; Faculty of Social Sciences and Business Studies, University of Eastern Finland, Finland.
| | - Taina Laajasalo
- Competence Cluster for Violence Prevention Work, Special Services Unit, Finnish Institute for Health and Welfare, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maija Lindgren
- Mental Health, Public Health and Welfare, Finnish Institute for Health and Welfare, Finland
| | - Sebastian Therman
- Mental Health, Public Health and Welfare, Finnish Institute for Health and Welfare, Finland
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Gordon JB, Felitti VJ. The Importance of Screening for Adverse Childhood Experiences (ACE) in all Medical Encounters. AJPM FOCUS 2023; 2:100131. [PMID: 37790951 PMCID: PMC10546489 DOI: 10.1016/j.focus.2023.100131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Jeoffry B. Gordon
- California Citizens Review Panel on Critical Incidents, Sacramento, California
| | - Vincent J. Felitti
- Emeritus, University of California School of Medicine, San Diego, California
- Emeritus, Department of Preventive Medicine, Kaiser Permanente Medical Group, San Diego, California
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Woicik K, Geraets CNW, Klein Tuente S, Masthoff E, Veling W. Virtual reality aggression prevention treatment in a Dutch prison-based population: a pilot study. Front Psychol 2023; 14:1235808. [PMID: 38034305 PMCID: PMC10683795 DOI: 10.3389/fpsyg.2023.1235808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Treating violent behavior in prisons comes with challenges, such as the inability to practice safely with triggering situations and motivational issues. A solution may be the use of Virtual Reality (VR). With VR, specific conditions or needs can be tailored for individual practice, it can enhance motivation and VR has proven to be a safe and effective tool in mental health treatment. Objective A pilot study was conducted to test the acceptability, feasibility, and preliminary effects of VR Aggression Prevention Treatment (VRAPT) in a prison-based population. Methods In total 17 detainees with aggressive behavior were included in this single-group pilot study. Acceptability and feasibility were assessed using qualitative measures for participants and therapists. Preliminary treatment effects were measured with self-report and observational measures on aggression, anger, emotion regulation, and impulsiveness. Results Participants and therapists were predominantly positive about VRAPT. Participants rated the sessions with an average satisfaction score of 9.2 out of 10 (SD = 0.3). Qualitative data showed that participants reported having learned to respond more adequately to aggressive behavior and gained insights into their own and others' triggers and tension. The combination of VR and theory was experienced as a strength of the treatment, as well as the ability to trigger aggression in VR which provided insights into aggression. However, the theoretical framework was found to be too complex, and more aggressive and personal scenarios should be incorporated into the sessions. Self-reported aggression, anger, provocation, emotion regulation, and observed verbal aggression decreased and seemed to stabilize after the treatment ended, with small to medium effect sizes. Conclusion VRAPT proved feasible and acceptable for most participants and therapists. An adapted treatment protocol called Virtual Reality Treatment for Aggression Control (VR-TrAC), will be used in a future RCT to investigate the effects of the treatment in a prison-based population.
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Affiliation(s)
- Kasja Woicik
- Penitentiary Institution Vught, Vught, Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Chris N. W. Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Stéphanie Klein Tuente
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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