Transcranial direct current stimulation targeting the ventromedial prefrontal cortex reduces reactive aggression and modulates electrophysiological responses in a forensic population

Carmen S. Sergiou*, Emiliano Santarnecchi, Sara M. Romanella, Matthias J. Wieser, Ingmar H.A. Franken, Eric G.C. Rassin, Josanne D.M. van Dongen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

25 Citations (Scopus)
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Abstract

BACKGROUND: Studies have shown that impairments in the ventromedial prefrontal cortex play a crucial role in violent behavior in forensic patients who also abuse cocaine and alcohol. Moreover, interventions that aimed to reduce violence risk in those patients are found not to be optimal. A promising intervention might be to modulate the ventromedial prefrontal cortex by high-definition (HD) transcranial direct current stimulation (tDCS). The current study aimed to examine HD-tDCS as an intervention to increase empathic abilities and reduce violent behavior in forensic substance dependent offenders. In addition, using electroencephalography, we examined the effects on the P3 and the late positive potential of the event-related potentials in reaction to situations that depict victims of aggression.

METHODS: Fifty male forensic patients with a substance dependence were tested in a double-blind, placebo-controlled randomized study. The patients received HD-tDCS 2 times a day for 20 minutes for 5 consecutive days. Before and after the intervention, the patients completed self-reports and performed the Point Subtraction Aggression Paradigm, and electroencephalography was recorded while patients performed an empathy task.

RESULTS: Results showed a decrease in aggressive responses on the Point Subtraction Aggression Paradigm and in self-reported reactive aggression in the active tDCS group. Additionally, we found a general increase in late positive potential amplitude after active tDCS. No effects on trait empathy and the P3 were found.

CONCLUSIONS: Current findings are the first to find positive effects of HD-tDCS in reducing aggression and modulating electrophysiological responses in forensic patients, showing the potential of using tDCS as an intervention to reduce aggression in forensic mental health care.

Original languageEnglish
Pages (from-to)95-107
Number of pages13
JournalBiological Psychiatry-Cognitive Neuroscience and Neuroimaging
Volume7
Issue number1
Early online date1 Jun 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
CSS received a grant from the Prins Bernhard Cultuurfonds (Grant No. 40032672/MAK/ILE) and a grant from the ZonMw (Grant No. 446001064), both located in the Netherlands; ES is supported by the Beth Israel Deaconess Medical Center via the Chief Academic Officer Award 2017; and JDMvD was sponsored by the program Kwaliteit Forensische Zorg of the Expertise Center Forensic Psychiatry (Grant No. 2017-68), Stiching Koningsheide, and Stichting Volksbond Rotterdam in the Netherlands. ES is partially supported by Office of the Director of National Intelligence, Intelligence Advanced Research Projects Activity (Grant No. 2014-13121700007 ); the Defense Advanced Research Projects Agency (Grant No. HR001117S0030 ); and the National Institutes of Health (Grant Nos. P01 AG031720-06A1 , R01 MH117063-01 , and R01 AG060981-01 ). The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the Office of the Director of National Intelligence, Intelligence Advanced Research Projects Activity, or the U.S. Government. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University and its affiliated academic health care centers, or the National Institutes of Health.

Funding Information:
CSS received a grant from the Prins Bernhard Cultuurfonds (Grant No. 40032672/MAK/ILE) and a grant from the ZonMw (Grant No. 446001064), both located in the Netherlands; ES is supported by the Beth Israel Deaconess Medical Center via the Chief Academic Officer Award 2017; and JDMvD was sponsored by the program Kwaliteit Forensische Zorg of the Expertise Center Forensic Psychiatry (Grant No. 2017-68), Stiching Koningsheide, and Stichting Volksbond Rotterdam in the Netherlands. ES is partially supported by Office of the Director of National Intelligence, Intelligence Advanced Research Projects Activity (Grant No. 2014-13121700007); the Defense Advanced Research Projects Agency (Grant No. HR001117S0030); and the National Institutes of Health (Grant Nos. P01 AG031720-06A1, R01 MH117063-01, and R01 AG060981-01). The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the Office of the Director of National Intelligence, Intelligence Advanced Research Projects Activity, or the U.S. Government. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University and its affiliated academic health care centers, or the National Institutes of Health. We thank Nico van Beveren for the supervision of the project at the forensic clinics and the departments Forensic Addiction Clinic and Department of Forensic Care and staff for their cooperation. Furthermore, we thank Alix Weidema, Celine de Reus, Thijs Vlak, Jitse Holl, Rozemarijn Pons, and Aylin Dasdemir for their contribution in collecting the data. A previous version of this article was published as a preprint on PsyArXiv: https://doi.org/10.31234/osf.io/cjgdt. The authors report no biomedical financial interests or potential conflicts of interest. Dutch Trial Register: Trial NL7459; https://www.trialregister.nl/trial/7459; NTR7701.

Publisher Copyright:
© 2021 Society of Biological Psychiatry

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