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. 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. 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. Dutch Trial Register, NTR7701. Registered on 12 January 2019. Prospectively registered before the recruitment phase. https://www.trialregister.nl/trial/7459. Recruitment started on the 1st of February 2019 and will be finished approximately in the winter of 2019. Protocol version 1. 22 May 2019.

中文翻译：

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经颅直流电刺激（tDCS）作为提高法医罪犯共情能力和减少暴力行为的干预措施：随机对照试验的研究方案

最近的研究表明，与共情能力相关的大脑区域之一（即腹内侧前额叶皮层（vmPFC））的变化在酒精和可卡因滥用者的暴力行为中发挥着重要作用。根据詹姆斯·布莱尔的模型，同理心是暴力行为的潜在抑制剂。共情能力较差的人可能不太容易受到影响，也不太有动力去抑制暴力行为，从而导致更高的暴力风险。最近的神经科学研究表明，调节（刺激或抑制）某些大脑区域可能是药物滥用和减少暴力行为的一种有前途的新干预措施，例如神经刺激技术经颅直流电刺激（tDCS）。本研究旨在调查 tDCS 作为一种干预措施，以提高法医物质使用罪犯的共情能力并减少暴力行为。总共 50 名男性法医药物滥用患者样本（25 名主动刺激和 25 名假刺激）将在双盲安慰剂对照研究中进行测试，其中一半患者将接受主动刺激加照常治疗 (TAU) 和另一半将接受假刺激（安慰剂）加 TAU。处于活动状态的患者将接受针对双侧 vmPFC 的多通道 tDCS，每天两次，每次 20 分钟，连续五天。在刺激期前后，患者将完成自我报告测量、执行点减法攻击范式（PSAP）和被动观看移情任务。将在治疗期之前和之后进行静息态脑电图（rsEEG）。6个月后将进行随访。主要成果是研究多通道 tDCS 作为一种新的干预措施，以提高有药物滥用问题的罪犯的共情能力并减少暴力行为。此外，我们将确定大脑的电生理反应是否受到 tDCS 干预的影响。最后，将研究经颅直流电刺激 (tDCS) 对减少烟瘾的影响。这项研究是针对法医样本中 vmPFC 进行多通道 tDCS 的首批研究之一。这项研究将探索引入新干预措施的机会，以提高法医药物使用罪犯的共情能力并减少暴力。具体来说，这项研究可以深入了解如何在这个复杂、多问题的目标群体的日常临床实践中实施 tDCS 干预，从而有助于减少累犯。荷兰审判登记册，NTR7701。2019年1月12日注册。预计在招聘阶段之前注册。https://www.Trialregister.nl/Trial/7459。招募于2019年2月1日开始，大约将于2019年冬季完成。协议版本1.2019年5月22日。