Background: Recent studies show that changes in one of the brain areas related to empathic abilities (i.e. the
ventromedial prefrontal cortex (vmPFC)) plays an important role in violent behavior in abusers of alcohol and
cocaine. According to the models of James Blair, empathy is a potential inhibitor of violent behavior. Individuals
with less empathic abilities may be less susceptible and motivated to inhibit violent behavior, which causes a
higher risk of violence. Recent neuroscientific research shows that modulating (stimulation or inhibition) certain
brain areas could be a promising new intervention for substance abuse and to reduce violent behavior, such as the
neurostimulation technique transcranial direct current stimulation (tDCS). This study aims to investigate tDCS as an
intervention to increase empathic abilities and reduce violent behavior in forensic substance use offenders.
Methods/design: A total sample of 50 male forensic substance abuse patients (25 active and 25 sham stimulation)
will be tested in a double-blind placebo-controlled study, from which half of the patients will receive an active
stimulation plus treatment as usual (TAU) and the other half will receive sham stimulation (placebo) plus TAU. The
patients in the active condition will receive multichannel tDCS targeting the bilateral vmPFC two times a day for 20
min for five consecutive days. Before and after the stimulation period, the patients will complete self-report
measurements, perform the Point Subtraction Aggression Paradigm (PSAP) and a passive viewing empathy task.
Resting state electroencephalography (rsEEG) will be performed before and after the treatment period. A follow up
will be conducted after 6 months. The primary outcome is to investigate multichannel tDCS as a new intervention
to increase empathic abilities and reduce violent behavior in offenders with substance abuse problems. In addition,
we will determine whether electrophysiological responses in the brain are affected by the tDCS intervention. Finally,
the effects of tDCS on reducing craving will be investigated.
Discussion: This study is one of the first studies using multichannel tDCS targeting the vmPFC in a forensic sample.
This study will explore the opportunities to introduce a new intervention to improve empathic abilities and reduce
violence in forensic substance use offenders. Specifically, this study may give insight into how to implement the
tDCS intervention in the setting of daily clinical practice in this complex, multiple-problem target group and with
that contribute to reduction of recidivism.
- Sept. 10, 2022, 9:40 p.m. - Transcranial direct current stimulation (tDCS) as an intervention to improve empathic abilities and reduce violent behavior in forensic offenders: study protocol for a randomized controlled trial
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