Uncovering Naturalistic Rewards and their Subjective Value in Forensic Psychiatric Patients

Abstract

The use of relevant reinforcers during treatment is essential for successful interventions. This especially applies to forensic psychiatric populations, which are known to be resistant to treatment. However, it is not clear which rewards are of importance for different types of forensic patients. The aim of the present study was to investigate reward preferences in two forensic patient populations. Applying the concept mapping methodology, 34 male incarcerated violent offenders under imposed psychiatric treatment and 41 male forensic outpatients generated, prioritized and categorized 98 and 115 rewards, respectively. Multidimensional scaling and hierarchical cluster analyses resulted in two concept maps with eight (inpatients) and five (outpatients) reward categories. In both maps, one dimension represented the effort required to achieve the rewards. The other dimension represented either the rewards' independency of the clinical environment (inpatients) or the level of arousal associated with the rewards (outpatients). Both inpatients and outpatients tended to rate high-effort rewards as the most valuable, especially when the rewards involved the clinical environment of the patient or when rewards were associated with lower levels of arousal. The results highlight the importance of considering individual differences in reward preferences in the development of therapeutic interventions.