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González Moraga FR, Enebrink P, Perrin S, Sygel K, Veling W, Wallinius M. VR-assisted aggression treatment in forensic psychiatry: a qualitative study in patients with severe mental disorders. Front Psychiatry 2024; 15:1307633. [PMID: 38818023 PMCID: PMC11137625 DOI: 10.3389/fpsyt.2024.1307633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/15/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Improvements in virtual reality (VR) have made it possible to create realistic, virtual settings for behavioral assessment and skills training that cannot otherwise be accessed in a safe way in forensic psychiatric settings. VR interventions are under development but little is known how forensic psychiatric patients with severe mental disorders experience VR-assisted assessments or treatments. Methods The present study aimed to help fill this knowledge gap via qualitative interviews with seven patients with severe mental disorders at a high-security forensic psychiatric clinic who had completed the newly revised Virtual Reality Aggression Prevention Training (VRAPT). All participants were interviewed 12 weeks after the VRAPT intervention, and interview data analyzed with manifest inductive content analysis. Results Six manifest content categories were identified: 1. Therapeutic process, 2. VRAPT method, 3. VR technology, 4. Previous treatment experiences, 5. Challenges to treatment of aggression, and 6. Unexpected experiences. The participants had diverse experiences related to both the VRAPT intervention and forensic psychiatric care. Participants described a mixture of positive experiences in relation to VR-assisted role-plays, and less positive in relation to motivation for aggression-focused treatment and technological limitations. Discussion The present findings suggest further studies are needed on how to best implement VR-assisted treatments for aggression in forensic settings, and potentially further modification of treatment content in interventions like VRAPT.
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Affiliation(s)
- Fernando Renee González Moraga
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Kristina Sygel
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Märta Wallinius
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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van Wolffelaar BR, van Horn JE, Hoogsteder LM. Treatment of aggression regulation problems with virtual reality: study protocol for a randomized controlled trial. Front Psychol 2024; 15:1324644. [PMID: 38638522 PMCID: PMC11024330 DOI: 10.3389/fpsyg.2024.1324644] [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: 10/19/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Background Aggressive conduct among delinquents presents a pervasive issue, bearing substantial implications for not only society at large but also for the victims and the individuals displaying the aggression. Traditional approaches to treating aggression regulation deficiencies generally employ Cognitive Behavioral Therapy (CBT) in conjunction with analog role-playing exercises. A body of research supports the efficacy of various therapeutic models for aggression regulation, including Responsive Aggression Regulation Therapy (Re-ART). Role-playing within a therapeutic context has been shown to contribute significantly to reductions in violent reoffending. However, the practical application of these skills in real-world settings remains challenging due to the inherent risk of aggressive outbreaks. Additionally, the conventional role-playing scenarios, often conducted in a therapy room, lack contextual realism and may induce role confusion between the patient and the therapist. Virtual Reality (VR) technology could offer a viable solution to these limitations by allowing for skill training in both behavioral and cognitive domains within a realistic yet safe and controlled setting. The technology also facilitates real-time awareness of emotional states and tension levels in the patient. This paper describes the study protocol of a randomized controlled trial in which Re-ART offered in a virtual environment (Re-ART VR) is compared to Re-ART offered as treatment as usual. Methods and analysis Adult forensic outpatients with aggression regulation problems are randomly assigned to either Re-ART VR or Re-ART. The Controlling Skills, Influence of Thinking and Handling Conflicts modules will be offered to both groups during 3-6 months. Pre- and post-intervention measurements are performed. The primary outcome measurement is the degree of aggression regulation, while secondary outcome measurements include impulsivity and cognitive biases. Additionally, patient motivation and therapist motivation are expected to act as moderating factors. Discussion To date, scarcely previous research has been done on the effectiveness of VR in treatment of aggression regulation problems in forensic outpatients. Forensic outpatients who do not benefit sufficiently from mainly CBT-based interventions may benefit more from experiential learning. The unique capabilities of VR in this regard have the potential to enhance the treatment effect.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NL78265.018.21].
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Affiliation(s)
| | | | - Larissa M. Hoogsteder
- De Forensische Zorgspecialisten, de Waag, Utrecht, Netherlands
- Program Group: Forensic Child and Youth Care, University of Amsterdam, Amsterdam, Netherlands
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Hillert J, Haubrock LS, Dekker A, Briken P. Web-Based Initiatives to Prevent Sexual Offense Perpetration: A Systematic Review. Curr Psychiatry Rep 2024; 26:121-133. [PMID: 38509408 PMCID: PMC10978615 DOI: 10.1007/s11920-024-01489-1] [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] [Accepted: 01/24/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE OF REVIEW Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives. RECENT FINDINGS We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.
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Affiliation(s)
- Jana Hillert
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20251, Hamburg, Germany
| | - Lina Sophie Haubrock
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20251, Hamburg, Germany
| | - Arne Dekker
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20251, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20251, Hamburg, Germany.
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Fisker Christensen L, Sørensen L, Johansen KK. Staff experiences with videoconferences during the COVID-19 pandemic in forensic psychiatry outpatients. Nord J Psychiatry 2024:1-6. [PMID: 38546409 DOI: 10.1080/08039488.2024.2331209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/14/2024]
Abstract
AIM To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. METHOD Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. RESULTS Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact-pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? CONCLUSION Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences.
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Affiliation(s)
- Lone Fisker Christensen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
| | - Line Sørensen
- Department of Psychiatry Odense, Region of Southern Denmark, Odense, Denmark
| | - Kirsten Kjær Johansen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
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Schröder S, Buntrock C, Neumann L, Müller JL, Fromberger P. Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study. JMIR Form Res 2024; 8:e48880. [PMID: 38277200 PMCID: PMC10858427 DOI: 10.2196/48880] [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: 05/10/2023] [Revised: 10/30/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown. OBJECTIVE For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry. METHODS This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline. RESULTS Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants' belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect. CONCLUSIONS For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants' attitudes toward web-based interventions were important in predicting acceptance. TRIAL REGISTRATION German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256.
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Affiliation(s)
- Sonja Schröder
- Clinic for Psychiatry and Psychotherapy - Forensic Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Louisa Neumann
- Clinic for Forensic Psychiatry and Psychotherapy, KRH Psychiatry Wunstorf, Wunstorf, Germany
| | - Jürgen L Müller
- Clinic for Psychiatry and Psychotherapy - Forensic Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Fromberger
- Clinic for Psychiatry and Psychotherapy - Forensic Psychiatry, University Medical Center Göttingen, Göttingen, Germany
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Ivarsson D, Delfin C, Enebrink P, Wallinius M. Pinpointing change in virtual reality assisted treatment for violent offenders: a pilot study of Virtual Reality Aggression Prevention Training (VRAPT). Front Psychiatry 2023; 14:1239066. [PMID: 38034926 PMCID: PMC10687219 DOI: 10.3389/fpsyt.2023.1239066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Preventing relapse into violence and its destructive consequences among persistent re-offenders is a primary concern in forensic settings. The Risk-Need-Responsivity framework models the best current practice for offender treatment, focused on building skills and changing pro-criminal cognitions. However, treatment effects are often modest, and the forensic context can obstruct the delivery of interventions. Developing treatments for offenders should focus on the best method of delivery to make "what works work." Virtual reality (VR)-assisted treatments such as Virtual Reality Aggression Prevention Training (VRAPT) are a new and innovative approach to offender treatment. This pilot study followed 14 male violent offenders who participated in VRAPT in a Swedish prison context and measured changes from pre-treatment to post-treatment and 3-month follow-up in targeted aggression, emotion regulation, and anger. It also investigated potential impact factors (pro-criminal cognitions, externalizing behaviors, psychosocial background, and childhood adverse experiences). In Bayesian linear mixed effects models, participants showed a high probability of change from pre-treatment to post-treatment and to follow-up on all outcome measures. All outcome measures demonstrated a low probability of change from post-treatment to follow-up. Analysis of reliable change showed that participants' results ranged from recovery to deterioration. We discuss the implications of the study for VRAPT's impact on the target group, those who might benefit from the approach, and suggested foci for future studies in the field of VR-assisted offender treatment. The study was preregistered at the International Standard Randomized Controlled Trial Number registry (https://doi.org/10.1186/ISRCTN14916410).
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Affiliation(s)
- David Ivarsson
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Swedish Prison and Probation Service, Norrköping, Sweden
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Delfin
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Märta Wallinius
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
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Klein Haneveld L, Kip H, Bouman YHA, Weerdmeester J, Scholten H, Kelders SM. Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study. Front Psychol 2023; 14:1201485. [PMID: 38023054 PMCID: PMC10666827 DOI: 10.3389/fpsyg.2023.1201485] [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: 04/20/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare. Methods This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison. Results The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP. Conclusion With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.
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Affiliation(s)
- Lisa Klein Haneveld
- Department of Research, Transfore, Deventer, Netherlands
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | | | - Joanneke Weerdmeester
- HKU University of the Arts, Centre for Educational Research and Innovation, Utrecht, Netherlands
- Games for Emotional and Mental Health (GEMH) Lab, Enschede, Netherlands
| | - Hanneke Scholten
- Games for Emotional and Mental Health (GEMH) Lab, Enschede, Netherlands
- Communication Science, Department of Technology, Human and Institutional Behavior, University of Twente, Enschede, Netherlands
| | - Saskia M. Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Opentia Research Unit, North-West University, Vanderbijlpark, South Africa
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Xu RH, Chan HH, Shi L, Li T, Wang D. Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study. JMIR Public Health Surveill 2023; 9:e47556. [PMID: 37773621 PMCID: PMC10576235 DOI: 10.2196/47556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/21/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people's ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown. OBJECTIVE This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults. METHODS The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95% highest density intervals (HDIs) were estimated. RESULTS A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4% (n=2653) were female and 58.7% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from -0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean -0.0016, 95% HDI -0.0022 to -0.0011), depression (posterior mean -0.006, 95% HDI -0.0079 to -0.004), stigma (posterior mean -0.0052, 95% HDI -0.0068 to -0.0036), and irritability (posterior mean -0.0037, 95% HDI -0.0052 to -0.0022). The moderating effects of eHL varied across the rural and urban subsamples. CONCLUSIONS Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19-related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
| | - Ho Hin Chan
- Department of Applied Mathematics, Hong Kong Polytechnic University, Kowloon, China (Hong Kong)
| | - Lushaobo Shi
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Ting Li
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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ter Harmsel JF, Noordzij ML, van der Pol TM, Swinkels LTA, Goudriaan AE, Popma A. Exploring the effects of a wearable biocueing app (Sense-IT) as an addition to aggression regulation therapy in forensic psychiatric outpatients. Front Psychol 2023; 14:983286. [PMID: 36968738 PMCID: PMC10036768 DOI: 10.3389/fpsyg.2023.983286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/18/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectivePreventing and reducing violence is of high importance for both individuals and society. However, the overall efficacy of current treatment interventions aimed at reducing aggressive behavior is limited. New technological-based interventions may enhance treatment outcomes, for instance by facilitating out-of-session practice and providing just-in-time support. Therefore, the aim of this study was to assess the effects of the Sense-IT biocueing app as an addition to aggression regulation therapy (ART) on interoceptive awareness, emotion regulation, and aggressive behavior among forensic outpatients.MethodsA combination of methods was used. Quantitatively, a pretest-posttest design was applied to explore group changes in aggression, emotion regulation, and anger bodily sensations associated with the combination of biocueing intervention and ART. Measures were assessed at pretest, after 4 weeks posttest, and after one-month follow-up. During the 4 weeks, a single-case experimental ABA design was applied for each participant. Biocueing was added in the intervention phase. During all phases anger, aggressive thoughts, aggressive behavior, behavioral control, and physical tension were assessed twice a day, and heart rate was measured continuously. Qualitative information regarding interoceptive awareness, coping, and aggression was collected at posttest. 25 forensic outpatients participated.ResultsA significant decrease in self-reported aggression was found between pre- and posttest. Furthermore, three-quarters of participants reported increased interoceptive awareness associated with the biocueing intervention. However, the repeated ambulatory measurements of the single-case experimental designs (SCEDs) did not indicate a clear effect favoring the addition of biocueing. On group level, no significant effects were found. On the individual level, effects favoring the intervention were only found for two participants. Overall, effect sizes were small.ConclusionBiocueing seems a helpful addition to increase interoceptive awareness among forensic outpatients. However, not all patients benefit from the current intervention and, more specifically, from its behavioral support component aimed at enhancing emotion regulation. Future studies should therefore focus on increasing usability, tailoring the intervention to individual needs, and on integration into therapy. Individual characteristics associated with effective support by a biocueing intervention should be further investigated, as the use of personalized and technological-based treatment interventions is expected to increase in the coming years.
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Affiliation(s)
- Janna F. ter Harmsel
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Janna F. ter Harmsel,
| | - Matthijs L. Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Thimo M. van der Pol
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Research and Quality of Care, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Lise T. A. Swinkels
- Forensic Mental Healthcare, Inforsa, Amsterdam, Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anna E. Goudriaan
- Department of Research and Quality of Care, Arkin Mental Health Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Addiction Research, Amsterdam, Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Mavragani A, Smulders LM, Noordzij ML, Swinkels LTA, Goudriaan AE, Popma A, van der Pol TM. Forensic Psychiatric Outpatients' and Therapists' Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study. JMIR Form Res 2023; 7:e40237. [PMID: 36724008 PMCID: PMC9932871 DOI: 10.2196/40237] [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: 06/12/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor-based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. OBJECTIVE The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. METHODS A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. RESULTS Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients' motivation, and both therapists' and patients' knowledge and skills. Integration into treatment, expertise within the therapists' team, and provision of time and materials were identified as facilitators. CONCLUSIONS The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients' and therapists' perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care.
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Affiliation(s)
| | - Lisanne M Smulders
- Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Matthijs L Noordzij
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Lise T A Swinkels
- Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anna E Goudriaan
- Department of Research and Quality of Care, Arkin Institute for Mental Health, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thimo M van der Pol
- Inforsa Forensic Mental Healthcare, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Quality of Care, Arkin Institute for Mental Health, Amsterdam, Netherlands
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11
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Wood MA, Ross S, Johns D. Primary Crime Prevention Apps: A Typology and Scoping Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:1093-1110. [PMID: 33478344 DOI: 10.1177/1524838020985560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the last decade, an array of smartphone apps have been designed to prevent crime, violence, and abuse. The evidence base of these apps has, however, yet to analyzed systematically. To rectify this, the aims of this review were (1) to establish the extent, range, and nature of research into smartphone apps with a primary crime prevention function; (2) to locate gaps in the primary crime prevention app literature; and (3) to develop a typology of primary crime prevention apps. Employing a scoping review methodology and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were identified via Web of Science, EBSCOhost, and Google Scholar. We included English-language research published between 2008 and 2020 that examined smartphone applications designed explicitly for primary crime prevention. Sixty-one publications met our criteria for review, out of an initial sample of 151 identified. Our review identified six types of crime prevention app examined in these publications: self-surveillance apps, decision aid apps, child-tracking apps, educational apps, crime-mapping/alert apps, and crime reporting apps. The findings of our review indicate that most of these forms of primary crime prevention apps have yet to be rigorously evaluated and many are not evidence-based in their design. Consequently, our review indicates that recent enthusiasm over primary crime prevention apps is not supported by an adequate evidence base.
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Affiliation(s)
- Mark A Wood
- Deakin University, Melbourne, Victoria, Australia
| | - Stuart Ross
- The University of Melbourne, Victoria, Australia
| | - Diana Johns
- The University of Melbourne, Victoria, Australia
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12
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Ross S, Wood MA, Johns D, Murphy J, Baird R, Alford B. Understanding Engagement With Forensic Smartphone Apps: The Service Design Engagement Model. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022:306624X221106323. [PMID: 35730559 DOI: 10.1177/0306624x221106323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Justice services have begun to integrate the use of mobile applications into treatment, support, and rehabilitative programs for forensic clients. One such application that been adopted to support forensic clients is "eRecovery": a smartphone application that provides clients recovering from a substance addiction with support for managing relapse. In this article, we report on evaluation findings from a trial of eRecovery in an Australian Community Justice Centre, and reflect on several issues relating to fostering and sustaining client engagement with similar applications within forensic and justice settings. We propose the Service Design Engagement Model to organize, visualize, and describe the stages and factors important to adoption, appropriation, and on-going routine use of the software by forensic clients. The model recognizes the role of contextual and environmental factors in supporting users through the early stages of engagement, and the importance of user agency in longer-term engagement with therapeutic apps.
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Affiliation(s)
| | | | | | - John Murphy
- Design4Use Pty. Ltd., Melbourne, VIC, Australia
| | - Ron Baird
- Victoria University, Melbourne, Australia
| | - Brooke Alford
- Neighbourhood Justice Centre, Collingwood, VIC, Australia
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13
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Parmigiani G, Tortora L, Meynen G, Mandarelli G, Ferracuti S. Virtual reality interventions for victims of crime: A systematic review. J Trauma Stress 2022; 35:804-812. [PMID: 35229354 PMCID: PMC9306974 DOI: 10.1002/jts.22810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022]
Abstract
In the forensic field, most studies employing virtual reality (VR) interventions have focused on offenders. The validity and safety of VR applications for victims of crime are still unclear. Following PRISMA guidelines, a systematic review on VR interventions for crime victims was performed to assess the efficacy, acceptability by patients, and cost-effectiveness of these interventions compared to in-person care. We identified 34 potentially eligible studies from 188 records obtained from database searches (Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus); four additional articles were identified via alternative sources. In total, nine articles were included for the qualitative synthesis. Patient satisfaction with VR interventions was found to be equivalent to face-to-face interventions. Both VR exposure and control groups found relief from posttraumatic symptoms, with differences either statistically insignificant or in favor of VR. Despite the increased costs linked to the technology required, VR appears to be a promising alternative to in vivo exposure, but further research is needed. Limitations of the review include the varied experimental protocols, which did not allow us to conduct a quantitative analysis and comparison of findings across different studies, and the generally poor quality of the studies included. Further research, preferably in larger groups, is needed to shed more light on the effectiveness of VR interventions for traumatized victims of crime.
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Affiliation(s)
| | - Leda Tortora
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Gerben Meynen
- Willem Pompe Institute for Criminal Law and CriminologyUtrecht UniversityUtrechtThe Netherlands
- Faculty of HumanitiesVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Gabriele Mandarelli
- Section of Criminology and Forensic PsychiatryDepartment of Interdisciplinary MedicineUniversity of BariBariItaly
| | - Stefano Ferracuti
- Department of Human Neurosciences“Sapienza” University of RomeRomeItaly
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14
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Dekkers T, Heirbaut T, Schouten SE, Kelders SM, Beerlage-de Jong N, Ludden GDS, Deenik J, Bouman YHA, Kip H. A mobile self-control training app to improve self-control and physical activity in people with severe mental illness: Protocol for two single-case experiment designs (Preprint). JMIR Res Protoc 2022; 12:e37727. [PMID: 37145845 DOI: 10.2196/37727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice. OBJECTIVE This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels. METHODS A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. RESULTS The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023. CONCLUSIONS The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37727.
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Affiliation(s)
- Tessa Dekkers
- Centre for eHealth and Wellbeing Research, Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Netherlands
| | - Tahnee Heirbaut
- Centre for eHealth and Wellbeing Research, Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Netherlands
| | - Stephanie E Schouten
- Centre for eHealth and Wellbeing Research, Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Netherlands
- Optentia Research Unit, North-West University, Vanderbijlpark, South Africa
| | - Nienke Beerlage-de Jong
- Technical Medical Centre, Section of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Geke D S Ludden
- Department of Design Production & Management, Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Jeroen Deenik
- GGz Centraal, Amersfoort, Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Technology, Human and Institutional Behaviour, University of Twente, Enschede, Netherlands
- Department of Research, Stichting Transfore, Deventer, Netherlands
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15
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Kip H, Keizer J, da Silva MC, Beerlage-de Jong N, Köhle N, Kelders SM. Methods for Human-Centered eHealth Development: Narrative Scoping Review. J Med Internet Res 2022; 24:e31858. [PMID: 35084359 PMCID: PMC8832261 DOI: 10.2196/31858] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Julia Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Marcia C da Silva
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Nienke Beerlage-de Jong
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Nadine Köhle
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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16
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Laporte N, Klein Tuente S, Ozolins A, Westrin Å, Westling S, Wallinius M. Emotion Regulation and Self-Harm Among Forensic Psychiatric Patients. Front Psychol 2021; 12:710751. [PMID: 34504461 PMCID: PMC8421601 DOI: 10.3389/fpsyg.2021.710751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 12/05/2022] Open
Abstract
Emotion regulation has been specifically linked to both non-suicidal self-injury (NSSI) and attempted suicide. It is also known that self-harm is disproportionally higher (30–68.4%) in forensic samples than in the general population, yet knowledge about the association between emotion regulation and self-harm in forensic settings is scarce. The purpose of this study was to describe emotion regulation in a sample of forensic psychiatric patients, to explore dimensions and levels of emotion regulation between forensic psychiatric patients with and without self-harm, and to explore associations between forensic psychiatric patients’ self-reported emotion regulation and self-reported functions of NSSI. A cohort of forensic psychiatric inpatients (N=98) was consecutively recruited during 2016–2020 from a high-security forensic psychiatric clinic in Sweden. Data were collected through the self-report measures Difficulties in Emotion Regulation Scale (DERS) and Inventory of Statements About Self-injury (ISAS). In relation to the first aim, median total and subscales scores for DERS were reported. Results showed a statistically significant difference in emotion regulation between participants with and without self-harm (p=0.004), with a medium effect size (Cohen’s d=0.65) for the DERS total scale. The DERS subscales returned large differences for Impulse (p=0.001, d=0.86), Goals (p=0.014, d=0.58), and Strategies (p=0.012, d=0.54) between participants with and without self-harm. Finally, DERS scores were correlated with both the interpersonal (rs=0.531, p<0.001, n=43) and intrapersonal factors (rs=0.503, p<0.001, n=43) of NSSI as reported on the ISAS. Participants with self-harm (NSSI and/or suicide attempts) demonstrated significantly more difficulties with emotion regulation than those without self-harm. Emotion dysregulation was associated with both interpersonal and intrapersonal functions of NSSI in the participants. We suggest further studies on forensic psychiatric patients’ maladaptive behaviors that focus on substance abuse, self-harm, and aggressive behaviors in relation to the regulation and expression of emotion.
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Affiliation(s)
- Natalie Laporte
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Stéphanie Klein Tuente
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Andrejs Ozolins
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.,Office for Psychiatry and Habilitation, Psychiatric Clinic Lund, Region Skåne, Lund, Sweden
| | - Sofie Westling
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden.,Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Lund, Sweden
| | - Märta Wallinius
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Regional Forensic Psychiatric Clinic, Växjö, Sweden
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17
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Janković M, Masthoff E, Spreen M, de Looff P, Bogaerts S. A Latent Class Analysis of Forensic Psychiatric Patients in Relation to Risk and Protective Factors. Front Psychol 2021; 12:695354. [PMID: 34354640 PMCID: PMC8329083 DOI: 10.3389/fpsyg.2021.695354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/29/2021] [Indexed: 01/06/2023] Open
Abstract
Forensic psychiatric patients form a very heterogeneous population regarding psychopathology, criminal history, and risk factors for reoffending. Therefore, the present study aimed to investigate whether there are more homogeneous classes of forensic patients based on DSM-IV-TR Axis I and II diagnoses and previously committed offenses, by means of explorative latent class analysis (LCA). It was also investigated which risk and protective factors are significantly more prevalent in one class compared to other classes. The study sample contained 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from high-security forensic clinics. Data were retrospectively derived from electronic patient files. Five distinctive patient classes emerged: class with only Axis II diagnosis, class with multiple problems, antisocial class, psychotic class, and intellectually disabled class. These classes differed significantly in risk and protective factors. This study contributes to the understanding of patient classes and provides directions for future, class-tailored interventions.
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Affiliation(s)
- Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Marinus Spreen
- Department of Social Work, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Peter de Looff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
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18
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Upfold C, Chaimowitz G. Forensic psychiatry services in Nunavut. Int J Circumpolar Health 2021; 80:1954362. [PMID: 34278974 PMCID: PMC8291065 DOI: 10.1080/22423982.2021.1954362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is a paucity of research on forensic psychiatry patients from Nunavut, including no published data concerning the prevalence and characterisation of patients in this territory. The lack of basic information hinders the evaluation of services and establishing best practices. The current paper aims to characterise forensic psychiatry patients from Nunavut and further the understanding of the challenges in organising forensic psychiatry healthcare in Nunavut. A retrospective chart review design was used to examine individuals from Nunavut who are engaged with the Ontario forensic psychiatry system. The sample included all Unfit to Stand Trial (26.7%) and Not Criminally Responsible (73.3%) patients (N = 15) under the jurisdiction of the Nunavut Review Board in a one-year period. The average distance between the patient’s place of residence in Nunavut and the Ontario facilities was 2,517 km. Overall, 26.7% were living in Nunavut, 60.0% remained in Ontario, and 13.3% resided in Alberta. Results are presented for sociodemographics, forensic status, personal and familial history, psychiatric and criminal history, diagnoses, index offence characteristics, treatment, assessment tools, and aggression. The prevalence and many characteristics of forensic psychiatry patients from Nunavut differ from the rest of Canada and have important implications for the delivery of services.
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Affiliation(s)
- Casey Upfold
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton - West 5th Campus, Hamilton, ON, Canada
| | - Gary Chaimowitz
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton - West 5th Campus, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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19
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Schuler M, Gieseler H, Schweder KW, von Heyden M, Beier KM. Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data. JMIR Ment Health 2021; 8:e22277. [PMID: 33605895 PMCID: PMC7935650 DOI: 10.2196/22277] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Accepted: 12/16/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively). OBJECTIVE The aim of this study was to describe the characteristics of the users of the Troubled Desire app. METHODS The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire. RESULTS The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities. CONCLUSIONS The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending.
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Affiliation(s)
- Miriam Schuler
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Gieseler
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina W Schweder
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian von Heyden
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus M Beier
- Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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20
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Kip H, Bouman YHA. A Perspective on the Integration of eHealth in Treatment of Offenders: Combining Technology and the Risk-Need-Responsivity Model. Front Psychiatry 2021; 12:703043. [PMID: 34539462 PMCID: PMC8440815 DOI: 10.3389/fpsyt.2021.703043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/04/2021] [Indexed: 11/14/2022] Open
Abstract
While there are multiple ways in which eHealth interventions such as online modules, apps and virtual reality can improve forensic psychiatry, uptake in practice is low. To overcome this problem, better integration of eHealth in treatment is necessary. In this perspective paper, we describe how the possibilities of eHealth can be connected to the risk-need-responsivity (RNR) model. To account for the risk-principle, stand-alone eHealth interventions might be used to offer more intensive treatment to high-risk offenders. The need-principle can be addressed by connecting novel experience-based interventions such as VR and apps to stable and acute dynamic risk factors. Finally, using and combining personalized interventions is in line with the responsivity-principle. Based on research inside and outside of forensic psychiatry, we conclude that there are many possibilities for eHealth to improve treatment-not just based on RNR, but also on other models. However, there is a pressing need for more development, implementation and evaluation research.
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Affiliation(s)
- Hanneke Kip
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Stichting Transfore, Deventer, Netherlands
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Sygel K, Wallinius M. Immersive Virtual Reality Simulation in Forensic Psychiatry and Adjacent Clinical Fields: A Review of Current Assessment and Treatment Methods for Practitioners. Front Psychiatry 2021; 12:673089. [PMID: 34122189 PMCID: PMC8193033 DOI: 10.3389/fpsyt.2021.673089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/30/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Research has indicated that interactive, computerized case simulations using immersive virtual reality (VR) technology may be beneficial in the augmentation of conventional methods of assessment and treatment in forensic psychiatry, primarily through providing an engaging and safe environment in which the user can practice and learn skills and behaviors. However, there does not appear to be an overview of current developments available in the field, which may be an obstacle to clinicians considering the use of VR in their clinical practice. Objectives: Current, clinically relevant assessment and treatment methods applying immersive VR in forensic or adjacent clinical settings, were analyzed. Methods: This review surveyed the practical use of immersive VR in forensic psychiatry and relevant adjacent psychiatric and forensic fields from 2016 to 2020 and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Out of the 1,105 journal articles screened, 14 met criteria for inclusion. Four articles described VR interventions directly addressing forensic psychiatric settings (treatment of general aggression and assessment of sexual offenders against children). The majority of the remaining articles were in the clinical domain of psychosis treatment. Several interventions were designed as part of comprehensive treatment programs, and others were intended as one-off assessments or paired with pre-existing psychological treatment. The degree to which the VR simulations were individualized to the user appeared to be largely dependent upon the extent of provider input. A variety of research methodologies were used in the included articles and the majority had limitations common to small-scale, non-randomized studies. None of the studies reported serious adverse effects. Discussion: There is a lack of large randomized controlled trials of current assessments or treatments using VR simulation in forensic psychiatry, let alone those with long-term follow-up, showing clear advantages of VR over standard practice. The evidence thus far is insufficient to recommend immediate and large-scale implementation of any one VR intervention, however, several have been shown to be feasible and acceptable to the participants and to provide insights and inspiration for future research and development.
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Affiliation(s)
- Kristina Sygel
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
| | - Märta Wallinius
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden.,Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Kip H, Wentzel J, Kelders SM. Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health. JMIR Ment Health 2020; 7:e24245. [PMID: 33185559 PMCID: PMC7695535 DOI: 10.2196/24245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. OBJECTIVE The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting-forensic mental health care-by means of participatory development with therapists. METHODS The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. RESULTS In phase 1, it became clear that the therapists' main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. CONCLUSIONS The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Jobke Wentzel
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Virtual Reality Aggression Prevention Therapy (VRAPT) versus Waiting List Control for Forensic Psychiatric Inpatients: A Multicenter Randomized Controlled Trial. J Clin Med 2020; 9:jcm9072258. [PMID: 32708637 PMCID: PMC7409015 DOI: 10.3390/jcm9072258] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Kip H, Sieverink F, van Gemert-Pijnen LJEWC, Bouman YHA, Kelders SM. Integrating People, Context, and Technology in the Implementation of a Web-Based Intervention in Forensic Mental Health Care: Mixed-Methods Study. J Med Internet Res 2020; 22:e16906. [PMID: 32348285 PMCID: PMC7284403 DOI: 10.2196/16906] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/14/2020] [Accepted: 02/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background While eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and processes should be studied holistically, paying attention to factors related to context, technology, and people. Objective The main objective of this mixed-method study was to holistically evaluate the implementation strategies and outcomes of an eMental health intervention in an organization for forensic mental health care. Methods First, desk research was performed on 18 documents on the implementation process. Second, the intervention’s use by 721 patients and 172 therapists was analyzed via log data. Third, semistructured interviews were conducted with all 18 therapists of one outpatient clinic to identify broad factors that influence implementation outcomes. The interviews were analyzed via a combination of deductive analysis using the nonadoption, abandonment, scale-up, spread, and sustainability framework and inductive, open coding. Results The timeline generated via desk research showed that implementation strategies focused on technical skills training of therapists. Log data analyses demonstrated that 1019 modules were started, and 18.65% (721/3865) of patients of the forensic hospital started at least one module. Of these patients, 18.0% (130/721) completed at least one module. Of the therapists using the module, 54.1% (93/172 sent at least one feedback message to a patient. The median number of feedback messages sent per therapist was 1, with a minimum of 0 and a maximum of 460. Interviews showed that therapists did not always introduce the intervention to patients and using the intervention was not part of their daily routine. Also, therapists indicated patients often did not have the required conscientiousness and literacy levels. Furthermore, they had mixed opinions about the design of the intervention. Important organization-related factors were the need for more support and better integration in organizational structures. Finally, therapists stated that despite its current low use, the intervention had the potential to improve the quality of treatment. Conclusions Synthesis of different types of data showed that implementation outcomes were mostly disappointing. Implementation strategies focused on technical training of therapists, while little attention was paid to changes in the organization, design of the technology, and patient awareness. A more holistic approach toward implementation strategies—with more attention to the organization, patients, technology, and training therapists—might have resulted in better implementation outcomes. Overall, adaptivity appears to be an important concept in eHealth implementation: a technology should be easily adaptable to an individual patient, therapists should be trained to deal flexibly with an eMental health intervention in their treatment, and organizations should adapt their implementation strategies and structures to embed a new eHealth intervention.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Floor Sieverink
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Lisette J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Faculty of Medical Sciences, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | | | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Zapata-Lamana R, Lalanza JF, Losilla JM, Parrado E, Capdevila L. mHealth technology for ecological momentary assessment in physical activity research: a systematic review. PeerJ 2020; 8:e8848. [PMID: 32257648 PMCID: PMC7103204 DOI: 10.7717/peerj.8848] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/03/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To systematically review the publications on ecological momentary assessment (EMA) relating to physical activity (PA) behavior in order to classify the methodologies, and to identify the main mHealth technology-based tools and procedures that have been applied during the first 10 years since the emergence of smartphones. As a result of this review, we want to ask if there is enough evidence to propose the use of the term "mEMA" (mobile-based EMA). DESIGN A systematic review according to PRISMA Statement (PROSPERO registration: CRD42018088136). METHOD Four databases (PsycINFO, CINALH, Medline and Web of Science Core Collection) were searched electronically from 2008 to February 2018. RESULTS A total of 76 studies from 297 potential articles on the use of EMA and PA were included in this review. It was found that 71% of studies specifically used "EMA" for assessing PA behaviors but the rest used other terminology that also adjusted to the inclusion criteria. Just over half (51.3%) of studies (39) used mHealth technology, mainly smartphones, for collecting EMA data. The majority (79.5%) of these studies (31 out of 39) were published during the last 4 years. On the other hand, 58.8% of studies that only used paper-and-pencil were published during the first 3 years of the 10-year period analyzed. An accelerometer was the main built-in sensor used for collecting PA behavior by means of mHealth (69%). Most of the studies were carried out on young-adult samples, with only three studies in older adults. Women were included in 60% of studies, and healthy people in 82%. The studies lasted between 1 and 7 days in 57.9%, and between three and seven assessments per day were carried out in 37%. The most popular topics evaluated together with PA were psychological state and social and environmental context. CONCLUSIONS We have classified the EMA methodologies used for assessing PA behaviors. A total of 71% of studies used the term "EMA" and 51.3% used mHealth technology. Accelerometers have been the main built-in sensor used for collecting PA. The change of trend in the use of tools for EMA in PA coincides with the technological advances of the last decade due to the emergence of smartphones and mHealth technology. There is enough evidence to use the term mEMA when mHealth technology is being used for monitoring real-time lifestyle behaviors in natural situations. We define mEMA as the use of mobile computing and communication technologies for the EMA of health and lifestyle behaviors. It is clear that the use of mHealth is increasing, but there is still a lot to be gained from taking advantage of all the capabilities of this technology in order to apply EMA to PA behavior. Thus, mEMA methodology can help in the monitoring of healthy lifestyles under both subjective and objective perspectives. The tendency for future research should be the automatic recognition of the PA of the user without interrupting their behavior. The ecological information could be completed with voice messages, image captures or brief text selections on the touch screen made in real time, all managed through smartphone apps. This methodology could be extended when EMA combined with mHealth are used to evaluate other lifestyle behaviors.
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Affiliation(s)
| | - Jaume F. Lalanza
- Department of Basic Psychology, Universitat Autónoma de Barcelona, Bellaterra, Spain
| | - Josep-Maria Losilla
- Department of Psychobiology and Methodology of Health Science, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eva Parrado
- Department of Basic Psychology, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lluis Capdevila
- Department of Basic Psychology, Universitat Autónoma de Barcelona, Bellaterra, Spain
- Sport Research Institute UAB, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Fromberger P, Schröder S, Bauer L, Siegel B, Tozdan S, Briken P, Buntrock C, Etzler S, Rettenberger M, Leha A, Müller JL. @myTabu-A Placebo Controlled Randomized Trial of a Guided Web-Based Intervention for Individuals Who Sexually Abused Children and Individuals Who Consumed Child Sexual Exploitation Material: A Clinical Study Protocol. Front Psychiatry 2020; 11:575464. [PMID: 33488416 PMCID: PMC7820175 DOI: 10.3389/fpsyt.2020.575464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background: There is a high demand for evidence-based and cost-effective treatment concepts for convicted individuals who sexually abused children (ISAC) and individuals who consumed child sexual exploitation material (ICCSEM) under community supervision (CS). The @myTabu-consortium developed a guided web-based intervention for convicted ISAC and ICCSEM under CS consisting of six online modules targeting psychological meaningful risk factors. The study aims to evaluate the effectiveness of this guided web-based intervention in reducing dynamic risk factors and the risk to re-offend compared to a placebo condition. Furthermore, these dynamic risk factors are measured before and after every module to evaluate their individual effectiveness to reduce the respective risk factor as well as risk to re-offend. This clinical trial protocol describes the planned methods as well as the intervention concept. Methods: The methodological design is a placebo controlled randomized add-on trial (N = 582) with follow-ups at 8 points in time. The placebo condition controls for attention and expectation effects and comprises the same amount of modules with a comparable temporal effort as the experimental intervention. The trial is conducted as an add-on to community supervision as usually done. Primary outcomes are dynamic risk factors assessed by self-report risk assessment tools and officially recorded re-offenses. Discussion: To the best of our knowledge, the study is the first to compare the (cost-) effectiveness of a guided web-based intervention for convicted ISAC and ICCSEM under community supervision against a placebo condition. Methodological limitations (e.g., potential ceiling- or volunteers-effects) are discussed. Clinical Trial Registration: German Clinical Trial Register (DRKS 00021256). Prospectively registered: 24.04.2020.
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Affiliation(s)
- Peter Fromberger
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Sonja Schröder
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Louisa Bauer
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Bruno Siegel
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Safiye Tozdan
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Center for Psychosocial Medicine, Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Jürgen L Müller
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
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Edge C, Black G, King E, George J, Patel S, Hayward A. Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use. J Telemed Telecare 2019; 27:325-342. [PMID: 31640460 DOI: 10.1177/1357633x19869131] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prison telemedicine can improve the access, cost and quality of healthcare for prisoners, however adoption in prison systems worldwide has been variable despite these demonstrable benefits. This study examines anticipated and realised benefits, barriers and enablers for prison telemedicine, thereby providing evidence to improve the chances of successful implementation. METHODS A systematic search was conducted using a combination of medical subject headings and text word searches for prisons and telemedicine. Databases searched included: PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, Scopus and International Bibliography of the Social Sciences. Articles were included if they reported information regarding the use of/advocacy for telemedicine, for people residing within a secure correctional facility. A scoping summary and subsequent thematic qualitative analysis was undertaken on articles selected for inclusion in the review, to identify issues associated with successful implementation and use. RESULTS One thousand, eight hundred and eighty-two non-duplicate articles were returned, 225 were identified for full text review. A total of 163 articles were included in the final literature set. Important considerations for prison telemedicine implementation include: differences between anticipated and realised benefits and barriers, differing wants and needs of prison and community healthcare providers, the importance of top-down and bottom-up support and consideration of logistical and clinical compatibility. CONCLUSIONS When implemented well, patients, prison and hospital staff are generally satisfied with telemedicine. Successful implementation requires careful consideration at outset of the partners to be engaged, the local context for implementation and the potential benefits that should be communicated to encourage participation.
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Affiliation(s)
- Chantal Edge
- UCL Collaborative Centre for Inclusion Health, London, UK
| | - Georgia Black
- UCL Department of Applied Health Research, London, UK
| | - Emma King
- UCL Collaborative Centre for Inclusion Health, London, UK
| | | | - Shamir Patel
- Central North West London NHS Foundation Trust, London, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology and Health Care, London, UK
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Fleming TM, Gillham B, Bavin LM, Stasiak K, Lewycka S, Moore J, Shepherd M, Merry SN. SPARX-R computerized therapy among adolescents in youth offenders' program: Step-wise cohort study. Internet Interv 2019; 18:100287. [PMID: 31890634 PMCID: PMC6926289 DOI: 10.1016/j.invent.2019.100287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Youth offenders have high rates of unmet mental health needs, including elevated rates of subclinical or clinical depression. Computerized cognitive behavioral therapy (cCBT) has been shown to be effective for depression, and cognitive behavioral therapy (CBT) is among the most effective psychological treatments for offence related behaviours. We planned to evaluate the impact of SPARX-R 1.0 (the first iteration of a revised version of SPARX cCBT) for adolescents in a community day program (Mentoring Youth New Directions or MYND) for male recidivist youth aged between 14 and 17 years. Recruitment and retention in the trial were lower than anticipated. In this brief report we present main findings and discuss implications. METHODS We developed a stepwise cohort design to investigate the acceptability and effectiveness of SPARX-R in a complex, real-world setting. Participants were allocated to the MYND program only (treatment as usual), or MYND with the addition of SPARX-R. All adolescents referred to MYND within a specified period were assigned to one of four social workers, as per usual practice. Each social worker was randomized to begin SPARX-R with consenting new clients from one of four time points. Assessments were completed within the first two weeks of commencing the MYND program and then at 10 and 20 weeks after commencement. We solicited brief feedback on SPARX-R from young people and staff who used it. RESULTS Of 64 eligible youth who began MYND during the trial period, 51 consented but 25 stopped attending MYND despite court orders or because their court orders were changed. Nineteen participants were randomized to SPARX-R but only two completed two or more levels of the 7-level program, so it was not possible to evaluate the impact as planned. The four participants who provided feedback were indifferent or negative about SPARX-R. Staff advised that technical difficulties (such as loading or saving problems) were off putting and that SPARX-R was slow and not appealing to their clients. CONCLUSIONS Computerized CBT was not successfully implemented in this group, highlighting challenges in retention in this non-residential justice program. The findings also indicate that computerized therapies of proven acceptability and effectiveness in one setting may be unappealing in another. Implementation and equity efforts need to consider and test the specialist needs of diverse groups.
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Affiliation(s)
- Theresa M. Fleming
- The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand,Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand,Corresponding author at: Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
| | - Bridgette Gillham
- Graeme Dingle Foundation, PO Box 305 474, Triton Plaza, Auckland 0757, New Zealand
| | - Lynda M. Bavin
- The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand
| | - Karolina Stasiak
- The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand
| | - Sonia Lewycka
- The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand
| | - Julie Moore
- Graeme Dingle Foundation, PO Box 305 474, Triton Plaza, Auckland 0757, New Zealand
| | - Matthew Shepherd
- The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand
| | - Sally Nicola Merry
- The University of Auckland, Private Bag 92019, Victoria Street West, Auckland 1142, New Zealand
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Bengtson S, Lund J, Ibsen M, Långström N. Long-Term Violent Reoffending Following Forensic Psychiatric Treatment: Comparing Forensic Psychiatric Examinees and General Offender Controls. Front Psychiatry 2019; 10:715. [PMID: 31681032 PMCID: PMC6806391 DOI: 10.3389/fpsyt.2019.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Long-term violent re-offending in forensic psychiatric (FP) patients vs. non-FP offenders is largely unknown. Methods: We studied rates and facets of long-term violent reoffending among 1,062 violent forensic psychiatric examinees (FPE) consecutively undergoing pre-trial, forensic psychiatric examination (FPE) in Denmark during 1980-1992. Altogether, 392 were sentenced to FP treatment (FPE+T); the remaining 670 examinees received ordinary non-FP sanctions (FPE-T). FPE+T were compared to 392 contemporary matched violent general offenders (GEN) without FPE or other psychiatric contacts and sentenced to ordinary non-FP sanctions. FPE data were linked to population-based registers with sociodemographic, psychiatric, and crime information, and we estimated relative risks controlling for birth year, sex, educational and marital status, and previous violent crime. Results: During follow-up (mean = 18.0-19.5 years), FPE+T and GEN had any violent recidivism rates of 43% vs. 29% [adjusted hazard ratio (aHR) = 1.5; 95% CI, 1.1-1.9], respectively. Corresponding findings for severe violence (21% vs. 14%; aHR = 1.3; 95% CI, 0.9-1.9) and recurrent violence (3+ violent convictions; 16% vs. 6%; adjusted odds ratio [aOR] = 2.5; 95% CI, 1.5-4.4) also suggested weakly to moderately increased risks in FPE+T, albeit non-significantly for the former. Comparing FPE+T to FPE-T suggested decreased risk of any violence (43% vs. 51%; aHR = 0.8; 95% CI, 0.6-1.1), severe (21% vs. 34%; aHR = 0.6; 95% CI, 0.4-0.8), and recurrent violence [16% vs. 22%; adjusted odds ratio (aOR) = 0.7; 95% CI, 0.5-1.0] in FP patients, though non-significantly for any violence and recurrent violence. Among all FPE examinees, violent reoffending was independently predicted by male sex, younger age, pre-index violent crime, personality disorder (vs. schizophrenia spectrum and other psychiatric disorder), substance use disorder, and 5+ hospital admissions. Conclusion: FPE examinees, untreated followed by treated, reoffend violently more often than GENs. Similar trends are suggested also for severe and recurrent violence suggesting a need for continua of services for FPE examinees, independently of medico-legal status (i.e., sentencing to treatment or not).
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Affiliation(s)
- Susanne Bengtson
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Sexological Clinic, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Jens Lund
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | | | - Niklas Långström
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Kip H, Kelders SM, Bouman YHA, van Gemert-Pijnen LJEWC. The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care. J Med Internet Res 2019; 21:e12972. [PMID: 31429415 PMCID: PMC6718085 DOI: 10.2196/12972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/26/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023] Open
Abstract
Background The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them. Objective The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap). Methods In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method. Results Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal. Conclusions Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Stichting Transfore, Deventer, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | | | - Lisette J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Faculty of Medical Sciences, Universitair Medisch Centrum Groningen, Groningen, Netherlands
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Kip H, Kelders SM, Weerink K, Kuiper A, Brüninghoff I, Bouman YHA, Dijkslag D, van Gemert-Pijnen LJEWC. Identifying the Added Value of Virtual Reality for Treatment in Forensic Mental Health: A Scenario-Based, Qualitative Approach. Front Psychol 2019; 10:406. [PMID: 30873093 PMCID: PMC6400887 DOI: 10.3389/fpsyg.2019.00406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Although literature and practice underline the potential of virtual reality (VR) for forensic mental healthcare, studies that explore why and in what way VR can be of added value for treatment of forensic psychiatric patients is lacking. Goals: This study aimed to identify (1) points of improvements in existing forensic mental health treatment of in- and outpatients, (2) possible ways of using VR that can improve current treatment, and (3) positive and negative aspects of the use of VR for the current treatment according to patients and therapists. Methods: Two scenario-based methods were used. First, semi-structured interviews were conducted with eight therapists and three patients to elicit scenarios from them. Based on these results, six scenarios about possibilities for using VR in treatment were created and presented to 89 therapists and 19 patients in an online questionnaire. The qualitative data from both methods were coded independently by two researchers, using the method of constant comparison. Results: In the interviews, six main codes with accompanying sub codes emerged. Ideas for improvement of treatment were grouped around the unique characteristics of the forensic setting, characteristics of the complex patient population, and characteristics of the type of treatment. For possibilities of VR, main codes were skills training with interaction, observation of situations or stimuli without interaction, and creating insight for others into the patient. The questionnaire resulted in a broad range of insights into potential positive and negative aspects of VR related to the current treatment, the patient, the content of a VR application, and practical matters. Conclusion: VR offers a broad range of possibilities for forensic mental health. Examples are offering training of behavioral and cognitive skills in a realistic context to bridge the gap between a therapy room and the real world, increasing treatment motivation, being able to adapt a VR application to individual patients, and providing therapists with new insights into a patient. These findings can be used to ground the development of new VR applications. Nevertheless, we should remain critical of when in the treatment process and for whom VR could be of added value.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Stichting Transfore, Deventer, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Kirby Weerink
- Department of Research, Stichting Transfore, Deventer, Netherlands
| | - Ankie Kuiper
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Ines Brüninghoff
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | | | - Dirk Dijkslag
- Department of Research, Stichting Transfore, Deventer, Netherlands
| | - Lisette J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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Wild TSN, Fromberger P, Jordan K, Müller I, Müller JL. Web-Based Health Services in Forensic Psychiatry: A Review of the Use of the Internet in the Treatment of Child Sexual Abusers and Child Sexual Exploitation Material Offenders. Front Psychiatry 2018; 9:763. [PMID: 30778306 PMCID: PMC6369176 DOI: 10.3389/fpsyt.2018.00763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
In recent years, web-based health services for a variety of mental disorders have been developed and evaluated. Evidence suggests that guided internet-based therapy can be as effective as conventional face-to-face therapy. In forensic psychiatric practice, few web-based treatments have been implemented up to now. However, to our knowledge, there do not yet exist guided internet-based treatments for child sexual abusers and child sexual exploitation material offenders. This review aims at examining under what conditions patients are most likely to benefit from internet-based treatments. In addition, some computer-based health services in forensic psychiatry will be summarized and their potentials and weaknesses will be discussed. Subsequently, the review focuses on the implications for the development of online treatments for child sexual abusers as well as on a variety of ethical and legal issues that practitioners may encounter during the development, evaluation and delivery of online health services. The review will conclude with proposed quality standards for the development and implementation of web-based interventions for child sexual abusers and child sexual exploitation material offenders. By virtue of the low number of psychotherapists offering therapy to this clientele as well as individual barriers to seeking treatment such as fear of stigmatization, feelings of shame, long access routes, or limited mobility due to physical handicaps, the development of mental eHealth services in this sector could close an important healthcare gap. By increasing the density of supply, more child sexual abusers and child sexual exploitation material offenders would have the chance to engage in treatment and, ultimately, more incidents of sexual assault against minors could be prevented.
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Affiliation(s)
- Tamara S N Wild
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, Human Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Peter Fromberger
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, Human Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Kirsten Jordan
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, Human Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Isabel Müller
- Prevention of Sexual Abuse (PsM), Asklepios Psychiatric Clinic Göttingen, Göttingen, Germany
| | - Jürgen L Müller
- Clinic for Psychiatry and Psychotherapy-Forensic Psychiatry, Human Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
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Nilsson T. Forensic Psychiatry-End of Year Reflection. Front Psychiatry 2018; 9:714. [PMID: 30618884 PMCID: PMC6305276 DOI: 10.3389/fpsyt.2018.00714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Thomas Nilsson
- Department of Forensic Psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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