TY - JOUR
T1 - Exploring the effects of a wearable biocueing app (Sense-IT) as an addition to aggression regulation therapy in forensic psychiatric outpatients
AU - ter Harmsel, Janna F.
AU - Noordzij, Matthijs L.
AU - van der Pol, Thimo M.
AU - Swinkels, Lise T.A.
AU - Goudriaan, Anna E.
AU - Popma, Arne
N1 - Funding Information:
We would like to thank the study participants and the therapists at Inforsa, Forensic Mental Healthcare in Amsterdam, Netherlands. Furthermore, we would also like to thank Eline Middelhoven, Lisette Stegeman, Wiesje van Overbeek, Lisa Kisters, Roos Brakeboer, Ashira Oude Lenferink, Vera Heugen, Christine van der Beek, Cylia Hendriks, Melanie Haeck, Joris Hagenbeek, and Margreet Flipse for their assistance in data collection. Finally, we would like to thank the organizations involved in the development of Sense-IT for use in this study project: University of Twente, Scelta/GGNet, Amsterdam University Medical Center, Inforsa/Arkin, and Pluryn.
Funding Information:
This study was performed within a larger research project, financially funded by the Dutch Ministry of Justice and Security (no grant code available).
Publisher Copyright:
Copyright © 2023 ter Harmsel, Noordzij, van der Pol, Swinkels, Goudriaan and Popma.
PY - 2023/3/10
Y1 - 2023/3/10
N2 - Objective: Preventing 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. Methods: A 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. Results: A 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. Conclusion: Biocueing 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.
AB - Objective: Preventing 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. Methods: A 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. Results: A 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. Conclusion: Biocueing 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.
KW - aggression
KW - biocueing
KW - biofeedback
KW - emotion regulation
KW - forensic psychiatry
KW - mHealth
KW - wearable technology
UR - http://www.scopus.com/inward/record.url?scp=85149132400&partnerID=8YFLogxK
U2 - 10.3389/fpsyg.2023.983286
DO - 10.3389/fpsyg.2023.983286
M3 - Article
AN - SCOPUS:85149132400
SN - 1664-1078
VL - 14
JO - Frontiers in psychology
JF - Frontiers in psychology
M1 - 983286
ER -