The human brain to me is the most fascinating feature in life. For numerous years researchers have tried to unravel the mechanism behind the way we function in life.
My interest focusses on the criminal brain. How does an individual come to committing a crime? And how can we contribute in to reducing crime and reduce recidivism?
During my time as a researcher I have worked in many different forensic institutions. In the Netherlands we are prominent in the forensic justice system. We have a separate facility and punishment system for the individuals who have committed a crime and have a mental disorder. We call that TBS. In the TBS system, individuals also get treatment after they have fulfilled there punishment in jail. Although a very prominent system, to me after all these years is still not a system I would like to give treatment in. In my opinion there is still a large group that is not benefiting from the treatment given. The treatment is mainly focusing on psychotherapy and medication. What would work for a lot of the groups in the forensic field, don’t get me wrong. But the group that I am focusing on is a difficult to treat forensic patient group.
I work with patients that have committed a violent crime, and also have a substance use dependence. This group of patients have often been in many forensic institutions, have tried to follow many therapies and have received numerous types of medications. Following this, they have encountered a lot of side effects of the medications and due to the many years of using substances, there brains have been effected. This combination leads to a lack in motivation in trying therapies and the side effects of the medications make this even worse.
Aggressive behavior is still a major problem in society. Therefore, research into the neural underpinnings of aggression has grown exponentially. Predicting aggressive behavior in forensic patients is crucial for treatment in forensic care. Nevertheless, there is still a large gap between neuroscience and the forensic practice, and the useful insights of the neurological mechanism underlying aggressive behavior are not well understood or communicated towards forensic care. Current treatment interventions to reduce aggression in forensic patients are not found to be effective and are not leading to a reduction in violent reoffending (Greeven & Bosma, 2012; Koeter et al., 200 9). One underlying cause to the ineffectiveness of the current treatments may be that a large part of these forensic patients also suffers from a substance use disorder. This group of forensic patients with a substance dependence is highly unmotivated to treatment due to side effects of medication and the repeated use of substances that has led to structural neuroadaptations in the brain. Substance use can enhance violent behavior through the psychopharmacological properties of drugs and alcohol, which can lead to- wards more aggression and with that an increase in crime (Collins, 1981; De Looff et al., 2017; Virkkunen & Linnoila, 1993; White, & Gorman, 2000). Therefore, the treatment of forensic patients with a substance use dependence is of significant importance to society. Nevertheless, current treatment options within forensic care often seem insufficient to reduce aggressive behavior and violent recidivism. Therefore, the need for a new add-on treatment in this difficult to treat patient group is needed. Studies have started investigating the neurological underpinnings of violent behavior, aiming towards neuropsychology in the treatment of violent forensic patients. A promising new treatment option to investigate this is transcranial Direct Current Stimulation (tDCS), which can modulate brain regions of interest and regulate deficits in the brain.
Deficits in the Prefrontal Cortex (PFC) are associated with aggression and violent behavior (Anderson et al., 1999b; Blair, 2004; Calzada-Reyes et al., 2013, 2016; Krämer et al., 2009; Raine, 1993; Raine et al., 2000). An important part of the PFC in regulating emotion and aggression is the Ventromedial Prefrontal Cortex (vmPFC). This is an area located in the lower (ventral) central (medial) region of the PFC and is known for regulating emotions, inhibition, impulsivity and aggression (See Figure 1). In particular, impairments in the vmPFC in alcohol and cocaine use patients play a crucial role in these predictions towards violent behavior (Gizewski et al., 2012; Preller et al., 2014). Therefore, changes in neural substrates through substance use, the increased odds of aggression in these patients and the prediction of violent behavior can be associated to abnormalities in these areas of the brain. Due to this, investigating the brain abnormalities of forensic patients could be of substantial importance to gain knowledge on the neurobiological underpinnings of aggressive behavior
If you want to read more on this topic, you can find a few articles in the manuscript section as well as my dissertation covering the whole research. Also the most recent publication in the link below published in Biological Psychiatry CNNI.
Transcranial Direct Current Stimulation Targeting the Ventromedial Prefrontal Cortex Reduces Reactive Aggression and Modulates Electrophysiological Responses in a Forensic Population - ScienceDirect
Feel free to contact me at any time to discuss, brainstorm or collaborate on future plans.
