ArticleFrontiers in psychology2026
Reducing aggressive behavior in forensic inpatients with virtual reality aggression prevention training-intellectual disability: a pilot study.
Article in Frontiers in psychology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Patients with mild to borderline intellectual disability (MBID) are overrepresented in forensic settings. In forensic psychiatric centers (FPCs), aggressive incidents are more frequent among offenders with MBID. Enhancing regular aggression regulation training with Virtual Reality (VR) technology could be effective by providing immersive roleplays and focusing on learning new behavior. Objective: This pilot study aimed to preliminary investigate the effects of the VR Aggression Prevention Training - Intellectual Disability (VRAPT-ID) on reducing aggressive behavior in forensic inpatients with MBID. Methods: A single case experimental design (SCED) study with a multiple baseline approach was conducted. Arousal levels during training sessions were monitored using the Empatica E4, a wristband that measured pulse rate (PR), pulse rate variability (PRV) and electrodermal activity (EDA). Aggressive behavior was measured using the Social Dysfunction and Aggression Scale (SDAS). Therapeutic alliance was assessed with the Session Rating Scale (SRS), a qualitative questionnaire. Results: Five out of 10 participants completed the entire training. The results showed that VRAPT-ID was associated with a decrease in aggressive behavior in four of the five participants who completed the intervention. Analysis showed that skin conductance responses (electrodermal activity), as an indicator of arousal, increased significantly during training sessions, which may reflect increased physiological activation during sessions, although no direct link with behavioral change was established. No significant changes were observed in pulse rate (PR). Pulse rate variability (PRV) data contained too many artifacts and therefore could not be reliably analyzed. Regarding therapeutic alliance, all participants who completed the training reported that VRAPT-ID helped them manage anger more effectively and that they found the training enjoyable. Conclusion: The results of this pilot study suggest that VRAPT-ID may be a feasible and potentially promising intervention for addressing aggressive behavior in individuals with MBID in a forensic setting. Future research, including RCT, is needed to further examine these preliminary findings and to investigate the proposed underlying mechanisms of VRAPT-ID.
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