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Int J Offender Ther Comp Criminol. 2018 Sep;62(12):3834-3852. doi: 10.1177/0306624X17747052. Epub 2017 Dec 18.

Treatment Responsivity of Aggressive Forensic Psychiatric Outpatients.

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1 Department of Psychiatry, Radboud University Medical Centre Nijmegen, The Netherlands.
2 Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
3 Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands.
4 Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands.
5 Department of Cognitive Neuroscience, Radboud University Medical Centre Nijmegen, The Netherlands.


Aggression replacement training (ART) is widely used to reduce aggression. Results regarding its effectiveness, however, are inconclusive regarding adults and specific populations displaying severe aggression. The current open uncontrolled treatment study aimed at assessing the social skills and anger control modules of the ART to reduce aggression in forensic psychiatric outpatients (FPOs). Furthermore, characteristics associated with treatment outcome and dropout were examined. The results suggested that aggression changed during the ART. In addition, higher baseline levels of trait aggression were associated with greater reductions of aggression, whereas more cognitive distortions were associated with less reduction. Treatment dropouts were characterized by higher levels of psychopathic traits, proactive aggression, and more weekly substance use. As there was a considerable amount of dropout; it is important to assess risk of dropping out of treatment and, subsequently, improve treatment motivation. This might enhance treatment adherence which may lead to a more successful reduction of aggression.


aggressive behavior; forensic psychiatric patients; responsivity; treatment

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