Primary Objective: The objectives of this study are to adapt the VRAPT protocol and manuals for people with MBID, and to test the feasibility of VRAPT-ID in a sample of people with MBID and aggressive behavior. Feasibility will be assessed by…
ID
Source
Brief title
Condition
- Other condition
- Psychiatric and behavioural symptoms NEC
Synonym
Health condition
verstandelijke beperking
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
- Feasibility and utility: The Session Rating Scale (SRS; Duncan et al., 2003)
will be used at the end of each session to assess how satisfied clients are
about VRAPT-ID. The SRS consists of four items: (1) Relationship (i.e., I felt
heard, understood, and respected); (2) Goals and Topics (i.e., we worked on and
talked about what I wanted to work on and talk about); (3) Approach or Method
(i.e., the therapist*s approach is a good fit for me); (4) Overall (i.e.,
overall, today*s session was right for me). In addition, after each VRAPT-ID
session, participants are asked:
(1) *What was the most important part of this session for you personally?*,
(2) *How easy was this session to understand?*,
(3) *What do you think about the VR assessments?*.
Finally, participants will be asked to rate the session with a grade from 1
(very low) to 10 (high). After completion of all VRAPT-ID sessions and the
post- intervention measurements, we will have a semi-structured interview with
each participant and therapist individually. During this interview,
participants are for example asked what they understood of VRAPT-ID, whether
they think they benefited from it, if they liked it and what should be improved
or changed.
- Aggression: the Modified Overt Aggression Scale (MOAS; Kay, Wolkenfeld, &
Murrill, 1988) will be used. The MOAS is a four-part behavior rating scale
designed to measure four types of aggressive behavior: (1) verbal aggression;
(2) physical aggression against objects; (3) physical aggression against self;
and (4) physical aggression against others, as witnessed by staff members on a
day-to-day basis. Furthermore, the MOAS is standardized in a sample of people
with intellectual disabilities (Oliver, Crawford, Rao, Reece, & Tyrer, 2007).
Clinicians will fill out the MOAS once a week starting four weeks before the
start of the intervention, during the intervention, and four weeks after the
last session of the intervention.
- Emotions: Participants are asked to complete the Outcome Rating Scale (ORS)
weekly, starting four weeks before the intervention. Before the start of every
VR-session and once a week after the last VR-session. In total 20 ORS will be
gathered to receive an impression of the emotions (especially anger) of
participants.
Secondary outcome
N.A.
Background summary
Recently, an innovative highly interactive Virtual Reality aggression
prevention training (VRAPT) has been developed and studied in a multicenter
randomized controlled trial in forensic psychiatric centers (FPCs) in the
Netherlands (Klein Tuente, Bogaerts, Ijzendoorn, & Veling, 2018;
https://nos.nl/l/m/2209845). Inclusion of 128 clients is completed. Our first
impression, based on evaluations with both therapists and participants, is that
VRAPT helps clients to understand how aggression works, how they can control
their aggression and de-escalate aggression of other people. Therapists and
participants are enthusiastic, and although the analyses of the data are still
ongoing, the participating FPCs already decided unanimously to continue working
with VRAPT. This VR training is likely to be of added value for people with
mild intellectual disabilities to borderline intellectual functioning (MBID).
Many people with MBID have problems with processing social information, as a
result of which they react inappropriate in social interactions
(Nieuwenhuijzen, Vriens, Scheepmaker, Smit, & Porton, 2011). Also, they lack
the social-emotional skills needed to handle challenging social situations.
Because of this, they are often involved in conflicts and engage in aggressive
behaviour. The existing aggression regulation therapies for people with MBID
are not effective in many cases (VOBC, 2014), because it takes people with MBID
relatively long to learn new behaviour, whereas repeated practising in real
life is not always possible or safe. Also, they experience difficulties
generalizing the skills they have learnt in therapy to their daily life
(Kleinert, Browder, & Towles- reeves, 2005). Furthermore, therapies are often
predominantly verbal, whereas people with MBID often experience difficulties
processing verbal information (Iglesia, Buceta, & Campos, 2005).
VRAPT may offer a solution to these issues. The advantages of VR are: 1) the
main focus of VR is on visual information processing and practising instead of
verbal information processing; 2) the VR environment can be adjusted to the
level of the participant; 3) VR offers a safe, controlled environment, which
allows repeated and tailored practising All in all, it is expected that VRAPT
overcomes the limitations of current aggression regulation therapies and
provides a more suitable method to treat aggressive behaviour in people with
ID. However, the limitation of VRAPT as it is currently used, is that the
training is not adapted to the cognitive disabilities of people with MBID.
First, VRAPT is based on the theoretical framework of the Social Information
Processing (SIP) model and this model is intertwined and very prominently
present in the VRAPT materials. Understanding and using this model demands a
certain level of cognitive functioning, especially to integrate this model in
daily life (i.e., transfer of training). Second, VRAPT is designed for forensic
psychiatric inpatients, so clients residing in highly secured environments.
Therefore, currently there are no homework assessments, and this makes it
difficult to practice the new learned skills in everyday life. Third, the
language used in the VRAPT manuals is often too complicated, also for people
with mild to moderate ID, which makes people with MBID not able to use VRAPT
whereas we think they could certainly benefit from this method. To overcome
these limitations, we will adapt the current VRAPT protocol and manuals, and
test those in a sample of people with MBID and aggressive behavior.
Study objective
Primary Objective: The objectives of this study are to adapt the VRAPT protocol
and manuals for people with MBID, and to test the feasibility of VRAPT-ID in a
sample of people with MBID and aggressive behavior. Feasibility will be
assessed by measuring: user experiences, acceptability, utility and preliminary
efficacy of VRAPT-ID.
Study design
Two focus group meetings will be organized to improve and finalize the
adaptations of the protocol and manuals. These focus groups will consist of
people with MBID, clinicians working with people with MBID, and researchers.
After developing the VRAPT-ID protocol, 15 participants will be recruited.
Baseline measures will be conducted by staff with an aggressive behavior
observation scale (MOAS). After these four weeks of observation, 15 people with
MBID and aggressive behaviour will receive the VRAPT-ID. Four weeks before the
intervention starts, participants are asked about their emotions once a week
with the ORS.
Before each VR-session participants are asked about their emotions with the
ORS. After each session, participants are asked to complete the SRS by/together
with their therapist.
During (weekly) and after the intervention (4 weeks), participants will be
rated by staff with the aggressive behavior observation scale (MOAS).
Intervention
Current VRAPT intervention
VRAPT consists of 12-biweekly individual training sessions. In an interactive
three-dimensional virtual environment, participants have the opportunity to
practice new behavior with virtual characters and learning to cope with their
own aggressive behavior in an adequate manner. In the last part of the VRAPT
the different exercises will be integrated in more challenging interactive
virtual role-plays. Different interactive provocative social scenarios were
designed during an iterative process with software engineers, VR experts,
clinicians, and researchers. The primary focus of these provocative social
scenarios is teaching participants to cope with their reactive aggression in an
adequate manner. During the VRAPT sessions, participants wear headphones and a
head-mounted display while interacting with a virtual character that is
controlled by the trainer. The trainer takes the role of the virtual character
using a microphone with voice distortion for speech, and also manually
controlling facial emotion expression and body movements of the virtual
character. This highly dynamic interactive nature of the VR system means VRAPT
can be tailored to the specific needs of the participants, and participants
have the opportunity to practice with their own learning goals and
difficulties. At all times the trainer is in control of the virtual environment
and is able to immediately change and/or stop the virtual environment if
necessary.
Study burden and risks
Benefits and risks assessment, group relatedness
The participating clients are expected to benefit from the given therapy.
Worsening of the symptoms is not expected to happen. Currently, our VR mental
health lab has performed several studies using VR as therapeutic tool, and
based on our experience(s) no risks are expected.
Hanzeplein 1
Groningen 9713 GZ
NL
Hanzeplein 1
Groningen 9713 GZ
NL
Listed location countries
Age
Inclusion criteria
- residing and/or in therapy at one of the participating health care
institutions for people with MBID (and other psychiatric diagnoses);
- referred to aggression training by their therapist, or primary caretaker;
- a sufficient command and understanding of the Dutch language;
- an IQ between 50-85;
- age 16 * 65;
Exclusion criteria
A potential subject who meets any of the following criteria will be excluded
from participation in this study:
- A (history of) epilepsy;
- A substance use disorder.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL71646.042.19 |