Testing the Effects of a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME): Study Protocol

Background: Prior laboratory findings indicate that training avoidance movements to angry faces may lower anger and aggression among healthy participants, especially those high in trait anger. To enrich this training and make it more suitable for clinical applications, it has been developed into a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME).Methods: The proposed study will examine the effects of this training in a randomized controlled trial among forensic psychiatric outpatients with aggression regulation problems (N = 60). In addition to the aggression replacement training, participants will play either the VR-GAIME or a control game. Anger will be assessed using self-report. Aggressive impulses will be measured via self-report, a validated laboratory paradigm, and rated by clinicians.Discussion: The authors hypothesize that the combination of the VR-GAIME and regular aggression treatment will be more successful in reducing aggressive behavior. One of the strengths of the proposed study is that it is the first to examine the effects of a motivational intervention in a clinical sample characterized by problems in regulating anger and aggression. Another strength of the proposed study is that the VR-GAIME will be implemented as a multi-session intervention. Additionally, the VR-GAIME applies, for the first time, serious gaming and virtual reality on an avoidance motivation intervention. If positive results are found, the VR-GAIME may be systematically deployed in forensic psychiatric settings.Trial registration: The trial is registered with The Netherlands National Trial Register, number: NTR6986

Exploring the Role of Explicit and Implicit Self-Esteem and Self-Compassion in Anxious and Depressive Symptomatology Following Acquired Brain Injury

[EN] Objectives Acquired brain injury (ABI) can lead to the emergence of several disabilities and is commonly associated with high rates of anxiety and depression symptoms. Self-related constructs, such as self-esteem and self-compassion, might play a key role in this distressing symptomatology. Low explicit (i.e., deliberate) self-esteem is associated with anxiety and depression after ABI. However, implicit (i.e., automatic) self-esteem, explicit-implicit self-discrepancies, and self-compassion could also significantly contribute to this symptomatology. The purpose of the present study was to examine whether implicit self-esteem, explicit-implicit self-discrepancy (size and direction), and self-compassion are related to anxious and depressive symptoms after ABI in adults, beyond the contribution of explicit self-esteem. Methods The sample consisted 38 individuals with ABI who were enrolled in a long-term rehabilitation program. All participants completed the measures of explicit self-esteem, implicit self-esteem, self-compassion, anxiety, and depression. Pearson's correlations and hierarchical regression models were calculated. Results Findings showed that both self-compassion and implicit self-esteem negatively accounted for unique variance in anxiety and depression when controlling for explicit self-esteem. Neither the size nor direction of explicit-implicit self-discrepancy was significantly associated with anxious or depressive symptomatology. Conclusions The findings suggest that the consideration of self-compassion and implicit self-esteem, in addition to explicit self-esteem, contributes to understanding anxiety and depression following ABI.Lorena Desdentado is supported by a FPU doctoral scholarship (FPU18/01690) from the Spanish Ministry of Universities. This work was supported by CIBEROBN, an initiative of the ISCIII (ISC III CB06 03/0052).Desdentado, L.; Cebolla, A.; Miragall, M.; Llorens Rodríguez, R.; Navarro, MD.; Baños, RM. (2021). Exploring the Role of Explicit and Implicit Self-Esteem and Self-Compassion in Anxious and Depressive Symptomatology Following Acquired Brain Injury. Mindfulness. 12(4):899-910. https://doi.org/10.1007/s12671-020-01553-wS899910124Anson, K., & Ponsford, J. (2006). Coping and emotional adjustment following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 21(3), 248–259. https://doi.org/10.1097/00001199-200605000-00005.Baños, R. M., & Guillén, V. (2000). Psychometric characteristics in normal and social phobic samples for a Spanish version of the Rosenberg Self-Esteem Scale. Psychological Reports, 87(1), 269–274. https://doi.org/10.2466/pr0.2000.87.1.269.Beadle, E. J., Ownsworth, T., Fleming, J., & Shum, D. (2016). The impact of traumatic brain injury on self-identity: a systematic review of the evidence for self-concept changes. The Journal of Head Trauma Rehabilitation, 31(2), E12–E25. https://doi.org/10.1097/HTR.0000000000000158.Beck, A. T. (1979). Cognitive therapy of depression. New York: Guilford Press.Beevers, C. G. (2005). Cognitive vulnerability to depression: A dual process model. Clinical Psychology Review, 25(7), 975–1002. https://doi.org/10.1016/j.cpr.2005.03.003.Bos, A. E. R., Huijding, J., Muris, P., Vogel, L. R. R., & Biesheuvel, J. (2010). Global, contingent and implicit self-esteem and psychopathological symptoms in adolescents. Personality and Individual Differences, 48(3), 311–316. https://doi.org/10.1016/j.paid.2009.10.025.Bowerman, B. L., & O’Connell, R. T. (1990). Linear statistical models: An applied approach (2nd ed.). Belmont, CA: Duxbury.Brenner, R. E., Heath, P. J., Vogel, D. L., & Credé, M. (2017). Two is more valid than one: examining the factor structure of the self-compassion scale (SCS). Journal of Counseling Psychology, 64(6), 696–707. https://doi.org/10.1037/cou0000211.Brysbaert, M. (2019). How many participants do we have to include in properly powered experiments? A tutorial of power analysis with reference tables. Journal of Cognition, 2(1), 1–38. https://doi.org/10.5334/joc.72.Carroll, E., & Coetzer, R. (2011). Identity, grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation, 21(3), 289–305. https://doi.org/10.1080/09602011.2011.555972.Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53. https://doi.org/10.1093/clipsy/9.1.35.Creemers, D. H. M., Scholte, R. H. J., Engels, R. C. M. E., Prinstein, M. J., & Wiers, R. W. (2012). Implicit and explicit self-esteem as concurrent predictors of suicidal ideation, depressive symptoms, and loneliness. Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 638–646. https://doi.org/10.1016/j.jbtep.2011.09.006.Creemers, D. H. M., Scholt, R. H. J., Engels, R. C. M. E., Prinstein, M. J., & Wiers, R. W. (2013). Damaged self-esteem is associated with internalizing problems. Frontiers in Psychology, 4, 152. https://doi.org/10.3389/fpsyg.2013.00152.Curvis, W., Simpson, J., & Hampson, N. (2018). Factors associated with self-esteem following acquired brain injury in adults: a systematic review. Neuropsychological Rehabilitation, 28(1), 142–183. https://doi.org/10.1080/09602011.2016.1144515.Elbaum, J., & Benson, D. (Eds.). (2007). Acquired brain injury: an integrative neuro-rehabilitation approach. New York: Springer. https://doi.org/10.1007/978-0-387-37575-5.Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149.FEDACE. (2015). Las personas con daño cerebral adquirido en España. Ministerio de Sanidad, Servicios Sociales e Igualdad. Retrieved May 21, 2020, from: https://fedace.org/index.php?V_dir=MSC&V_mod=download&f=2016-9/26-16-4-11.admin.Informe_FEDACE_RPD_para_DDC-1.pdf.Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., Moran, A. E., Sacco, R. L., Anderson, L., Truelsen, T., O’Donnell, M., Venketasubramanian, N., Barker-Collo, S., Lawes, C. M. M., Wang, W., Shinohara, Y., Witt, E., Ezzati, M., & Naghavi, M. (2014). Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. The Lancet, 383(9913), 245–254. https://doi.org/10.1016/S0140-6736(13)61953-4.Fennell, M. J. V. (1997). Low self-esteem: a cognitive perspective. Behavioural and Cognitive Psychotherapy, 25(1), 1–26. https://doi.org/10.1017/s1352465800015368.Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6.Garcia-Campayo, J., Navarro-Gil, M., Andrés, E., Montero-Marin, J., López-Artal, L., Marcos, M., & Demarzo, P. (2014). Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS). Health and Quality of Life Outcomes, 12(4). https://doi.org/10.1186/1477-7525-12-4.GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. (2018). Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18(1), 56–87. https://doi.org/10.1016/S1474-4422(18)30415-0.Gould, K. R., Ponsford, J. L., Johnston, L., & Schönberger, M. (2011). Relationship between psychiatric disorders and 1-year psychosocial outcome following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 26(1), 79–89. https://doi.org/10.1097/HTR.0b013e3182036799.Gracey, F., Palmer, S., Rous, B., Psaila, K., Shaw, K., O’Dell, J., Cope, J., & Mohamed, S. (2008). “Feeling part of things”: personal construction of self after brain injury. Neuropsychological Rehabilitation, 18(5–6), 627–650. https://doi.org/10.1080/09602010802041238.Gracey, F., Evans, J. J., & Malley, D. (2009). Capturing process and outcome in complex rehabilitation interventions: a “Y-shaped” model. Neuropsychological Rehabilitation, 19(6), 867–890. https://doi.org/10.1080/09602010903027763.Greenwald, A. G., & Farnham, S. D. (2000). Using the Implicit Association Test to measure self-esteem and self-concept. Journal of Personality and Social Psychology, 79(6), 1022–1038. https://doi.org/10.1037/0022-3514.79.6.1022.Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: the Implicit Association Test. Journal of Personality and Social Psychology, 74(6), 1464–1480. https://doi.org/10.1037/0022-3514.74.6.1464.Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the Implicit Association Test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85(2), 197–216. https://doi.org/10.1037/0022-3514.85.2.197.Hackett, M. L., Yapa, C., Parag, V., & Anderson, C. S. (2005). Frequency of depression after stroke: a systematic review of observational studies. Stroke, 36(6), 1330–1340. https://doi.org/10.1161/01.STR.0000165928.19135.35.Haeffel, G. J., Abramson, L. Y., Brazy, P. C., Shah, J. Y., Teachman, B. A., & Nosek, B. A. (2007). Explicit and implicit cognition: a preliminary test of a dual-process theory of cognitive vulnerability to depression. Behaviour Research and Therapy, 45(6), 1155–1167. https://doi.org/10.1016/j.brat.2006.09.003.Ingram, R. E. (1984). Toward an information-processing analysis of depression. Cognitive Therapy and Research, 8(5), 443–477. https://doi.org/10.1007/BF01173284.Izuma, K., Kennedy, K., Fitzjohn, A., Sedikides, C., & Shibata, K. (2018). Neural activity in the reward-related brain regions predicts implicit self-esteem: a novel validity test of psychological measures using neuroimaging. Journal of Personality and Social Psychology, 114(3), 343–357. https://doi.org/10.1037/pspa0000114.Khan-Bourne, N., & Brown, R. G. (2003). Cognitive behaviour therapy for the treatment of depression in individuals with brain injury. Neuropsychological Rehabilitation, 13(1–2), 89–107. https://doi.org/10.1080/09602010244000318.Kim, H. S., & Moore, M. T. (2019). Symptoms of depression and the discrepancy between implicit and explicit self-esteem. Journal of Behavior Therapy and Experimental Psychiatry, 63, 1–5. https://doi.org/10.1016/j.jbtep.2018.12.001.Lane, K. A., Banaji, M. R., Nosek, B. A., & Greenwald, A. G. (2007). Understanding and using the Implicit Association Test: IV. What we know (so far) about the method. In B. Wittenbrink & N. Schwarz (Eds.), Implicit measures of attitudes (pp. 59–102). New York: The Guildford Press.Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: the implications of treating oneself kindly. Personality Processes and Individual Differences, 92(5), 887–904. https://doi.org/10.1037/0022-3514.92.5.887.Lennon, A., Bramham, J., Carroll, À., McElligott, J., Carton, S., Waldron, B., Fortune, D., Burke, T., Fitzhenry, M., & Benson, C. (2014). A qualitative exploration of how individuals reconstruct their sense of self following acquired brain injury in comparison with spinal cord injury. Brain Injury, 28(1), 27–37. https://doi.org/10.3109/02699052.2013.848378.Longworth, C., Deakins, J., Rose, D., & Gracey, F. (2018). The nature of self-esteem and its relationship to anxiety and depression in adult acquired brain injury. Neuropsychological Rehabilitation, 28(7), 1078–1094. https://doi.org/10.1080/09602011.2016.1226185.MacBeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003.McDonald, S., Saad, A., & James, C. (2011). Social dysdecorum following severe traumatic brain injury: loss of implicit social knowledge or loss of control? Journal of Clinical and Experimental Neuropsychology, 33(6), 619–630. https://doi.org/10.1080/13803395.2011.553586.Milne, E., & Grafman, J. (2001). Ventromedial prefrontal cortex lesions in humans eliminate implicit gender stereotyping. The Journal of Neuroscience, 21(12), 1–6.Moors, A., & De Houwer, J. (2006). Automaticity: a theoretical and conceptual analysis. Psychological Bulletin, 132(2), 297–326. https://doi.org/10.1037/0033-2909.132.2.297.Muris, P., & Petrocchi, N. (2017). Protection or vulnerability? A meta-analysis of the relations between the positive and negative components of self-compassion and psychopathology. Clinical Psychology & Psychotherapy, 24(2), 373–383. https://doi.org/10.1002/cpp.2005.Myers, R. (2000). Classical and modern regression with applications (2nd ed.). Belmont, CA: Duxbury.Neff, K. D. (2003). Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032.Neff, K. D., & Vonk, R. (2009). Self-compassion versus global self-esteem: two different ways of relating to oneself. Journal of Personality, 77, 23–50. https://doi.org/10.1111/j.1467-6494.2008.00537.x.Neff, K. D., Tóth-Király, I., Yarnell, L. M., Arimitsu, K., Castilho, P., Ghorbani, N., Guo, H. X., Hirsch, J. K., Hupfeld, J., Hutz, C. S., Kotsou, I., Lee, W. K., Montero-Marin, J., Sirois, F. M., De Souza, L. K., Svendsen, J. L., Wilkinson, R. B., & Mantzios, M. (2019). Examining the factor structure of the Self-Compassion Scale in 20 diverse samples: support for use of a total score and six subscale scores. Psychological Assessment, 31(1), 27–45. https://doi.org/10.1037/pas0000629.Norton, P. J., & Paulus, D. J. (2017). Transdiagnostic models of anxiety disorder: theoretical and empirical underpinnings. Clinical Psychology Review, 56, 122–137. https://doi.org/10.1016/j.cpr.2017.03.004.Nosek, B. A., & Banaji, M. R. (2001). The go/no-go association task. Social Cognition, 19(6), 625–664. https://doi.org/10.1521/soco.19.6.625.20886.Oddy, M., & Herbert, C. (2003). Intervention with families following brain injury: evidence-based practice. Neuropsychological Rehabilitation, 13(1–2), 259–273. https://doi.org/10.1080/09602010244000345.Ouimet, A. J., Gawronski, B., & Dozois, D. J. A. (2009). Cognitive vulnerability to anxiety: a review and an integrative model. Clinical Psychology Review, 29(6), 459–470. https://doi.org/10.1016/j.cpr.2009.05.004.Ponsford, J., Kelly, A., & Couchman, G. (2014). Self-concept and self-esteem after acquired brain injury: a control group comparison. Brain Injury, 28(2), 146–154. https://doi.org/10.3109/02699052.2013.859733.Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702.Romero, M., Sánchez, A., Marín, C., Navarro, M. D., Ferri, J., & Noé, E. (2012). Clinical usefulness of the Spanish version of the Mississippi Aphasia Screening Test (MASTsp): validation in stroke patients. Neurología (English Edition), 27(4), 216–224. https://doi.org/10.1016/j.nrleng.2011.06.001.Rosenberg, M. (1965). Rosenberg Self-Esteem Scale (RSE). Acceptance and Commitment Therapy. Measures Package, 61, 52 /S0034-98872009000600009.Sandstrom, M. J., & Jordan, R. (2008). Defensive self-esteem and aggression in childhood. Journal of Research in Personality, 42(2), 506–514. https://doi.org/10.1016/j.jrp.2007.07.008.Schönberger, M., & Ponsford, J. (2010). The factor structure of the Hospital Anxiety and Depression Scale in individuals with traumatic brain injury. Psychiatry Research, 179(3), 342–349. https://doi.org/10.1016/j.psychres.2009.07.003.Schröder-Abé, M., Rudolph, A., & Schütz, A. (2007). High implicit self-esteem is not necessarily advantageous: discrepancies between explicit and implicit self-esteem and their relationship with anger expression and psychological health. European Journal of Personality, 21(3), 319–339. https://doi.org/10.1002/per.626.Scoglio, A. A. J., Rudat, D. A., Garvert, D., Jarmolowski, M., Jackson, C., & Herman, J. L. (2018). Self-compassion and responses to trauma: the role of emotion regulation. Journal of Interpersonal Violence, 33(13), 2016–2036. https://doi.org/10.1177/0886260515622296.Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review. Clinical Psychology Review, 57, 141–163. https://doi.org/10.1016/j.cpr.2017.09.002.Smeijers, D., Vrijsen, J. N., van Oostrom, I., Isaac, L., Speckens, A., Becker, E. S., & Rinck, M. (2017). Implicit and explicit self-esteem in remitted depressed patients. Journal of Behavior Therapy and Experimental Psychiatry, 54, 301–306. https://doi.org/10.1016/j.jbtep.2016.10.006.Smith, E. R., & DeCoster, J. (2000). Dual-process models in social and cognitive psychology: conceptual integration and links to underlying memory systems. Personality and Social Psychology Review, 4(2), 108–131. https://doi.org/10.1207/S15327957PSPR0402_01.Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213–240. https://doi.org/10.1037/a0028931.Strack, F., & Deutsch, R. (2004). Reflective and impulsive determinants of social behavior. Personality and Social Psychology Review, 8(3), 220–247. https://doi.org/10.1207/s15327957pspr0803_1.Terol-Cantero, M. C., Cabrera-Perona, V., & Martín-Aragón, M. (2015). Hospital Anxiety and Depression Scale (HADS) review in Spanish samples. Anales de Psicología, 31(2), 494–503. https://doi.org/10.6018/analesps.31.2.172701.Tóth-Király, I., & Neff, K. D. (2020). Is self-compassion universal? Support for the measurement invariance of the Self-Compassion Scale across populations. Assessment. Advance online publication. https://doi.org/10.1177/1073191120926232.Turner-Stokes, L., & Wade, D. (2003). Rehabilitation following acquired brain injury: National Clinical Guidelines. Clinical Medicine, 4(1), 61–65. https://doi.org/10.7861/clinmedicine.4-1-61.Tyerman, A., & Humphrey, M. (1984). Changes in self-concept following severe head injury. International Journal of Rehabilitation Research, 7(1), 11–23. https://doi.org/10.1097/00004356-198403000-00002.Valiente, C., Cantero, D., Vázquez, C., Sanchez, Á., Provencio, M., & Espinosa, R. (2011). Implicit and explicit self-esteem discrepancies in paranoia and depression. Journal of Abnormal Psychology, 120(3), 691–699. https://doi.org/10.1037/a0022856.Vickery, C. D., Sepehri, A., & Evans, C. C. (2008). Self-esteem in an acute stroke rehabilitation sample: a control group comparison. Clinical Rehabilitation, 22(2), 179–187. https://doi.org/10.1177/0269215507080142.Whelan-Goodinson, R., Ponsford, J., & Schönberger, M. (2009). Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. Journal of Affective Disorders, 114(1–3), 94–102. https://doi.org/10.1016/j.jad.2008.06.007.Zeigler-Hill, V. (2006). Discrepancies between implicit and explicit self-esteem: Implications for narcissism and self-esteem instability. Journal of Personality, 74(1), 119–144. https://doi.org/10.1111/j.1467-6494.2005.00371.x.Zessin, U., Dickhäuser, O., & Garbade, S. (2015). The relationship between self-compassion and well-being: a meta-analysis. Applied Psychology. Health and Well-Being, 7(3), 340–364. https://doi.org/10.1111/aphw.12051.Zhang, J. W., Chen, S., & Tomova Shakur, T. K. (2020). From me to you: Self-compassion predicts acceptance of own and others’ imperfections. Personality and Social Psychology Bulletin, 46(2), 228–242. https://doi.org/10.1177/0146167219853846.Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Psychological distress and personality factors in takotsubo cardiomyopathy

Background Takotsubo cardiomyopathy (TCC) is a transient condition characterised by severe left ventricular dysfunction combined with symptoms and signs mimicking myocardial infarction. Emotional triggers are common, but little is known about the psychological background characteristics of TCC. This study examined whether patients with TTC have higher levels of psychological distress (depressive symptoms, perceived stress, general anxiety), illness-related anxiety and distinct personality factors compared with healthy controls and patients with heart failure. Methods and Results Patients with TCC (N = 18; mean age 68.3 ± 11.7 years, 77.8 % women) and two comparison groups (healthy controls: N = 19, age 60.0 ± 7.6, 68.4 % women and patients with chronic heart failure: N = 19, age 68.8 ± 10.1, 68.4 % women) completed standardised questionnaires to measure depression (PHQ‑9), perceived stress (PSS-10), general anxiety (GAD-7), illness-related anxiety (WI-7) and personality factors (NEO-FFI and DS-14). Psychological measures were obtained at 23 ± 18 months following the acute TTC event. Results showed that patients with TCC had higher levels of depressive symptoms (5.2 ± 5.2 vs. 2.5 ± 2.4, p = 0.039) and illness-related anxiety (2.1 ± 1.7 vs. 0.7 ± 1.3, p = 0.005) compared with healthy controls. Patients with TCC did not display significantly elevated perceived stress (p = 0.072) or general anxiety (p = 0.170). Regarding personality factors, levels of openness were lower in TCC compared with healthy controls (34.2 ± 4.3 vs. 38.2 ± 5.6, p = 0.021). No differences between TCC and heart failure patients were found regarding the psychological measures. Conclusions TCC is associated with higher levels of depressive symptoms, more illness-related anxiety and less openness compared with healthy controls. These data suggest that TCC is associated with adverse psychological factors that may persist well after the acute episode. Keywords Tako-Tsubo cardiomyopathy, Depression, Anxiety, Personality, Psychological distress, Apical ballooning syndrom

Testing the effects of a virtual reality game for aggressive impulse management: A preliminary randomized controlled trial among forensic psychiatric outpatients

Prior laboratory experiments among healthy samples found that training avoidance movements to angry faces may lower anger and aggression, especially people high in trait anger. To enrich this training and make it more suitable for clinical applications, the present researchers developed it into a Virtual Reality Game for Aggressive Impulse Management (VR-GAIME). The current study examined the effects of this training in a randomized controlled trial among forensic psychiatric outpatients with aggression regulation problems (N = 30). In addition to the aggression replacement training, patients played either the VR-GAIME or a control game. Aggressive behavior was measured pre-, half-way, and post-treatment via self-report and clinicians ratings. No difference was found between the VR-GAIME and the control game. However, the participants reported gaining more insight into their own behavior and that of others. Future VR intervention tools in clinical settings may capitalize more on their benefits for self-reflection within interpersonal settings