Virtual Reality Aggression Prevention Therapy (VRAPT) versus waiting list control for forensic psychiatric inpatients: A multicenter randomized controlled trial

Stephanie Klein Tuente*, Stefan Bogaerts, Erik Bulten, Marije Keulen-de Vos, Maarten Vos, Hein Bokern, Sarah van IJzendoorn, Chris N. W. Geraets, Wim Veling

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Downloads (Pure)


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.

Original languageEnglish
Article number2258
Number of pages18
JournalJournal of Clinical Medicine
Issue number7
Publication statusPublished - 2020


  • aggressive behavior
  • forensic psychiatry
  • social information processing model
  • randomized controlled trial
  • virtual reality
  • severe psychopathology

Cite this