Proefschrift

7 149 DISCUSSION daily measurement frequency, duration completing a personalized ESM questionnaire, and duration of the entire registering period (two weeks)?; and 5) What is the level of participant adherence to, or compliance with, and engagement with the ESM assessments? The findings of this study indicate that not the daily ESM measurement of riskrelevant features by forensic patients as such, but the blended, interactive ESM procedure resulted in increased awareness in personal patterns of risk-relevant features. That is, the procedure in which participant and therapist collaboratively search for possible risk-relevant features, forming hypotheses about these features’ interrelationship, monitoring them by the participant, discussing the resulting feedback report, and integrating new findings in the forensic case formulation. Patients perceived the daily ESM measurements as neither burdensome nor invasive. Also, high degrees of cognitive and behavioral adherence and engagement with ESM measurements were found. Furthermore, participants indicated that network graphs had the highest added value to their case formulation as they showed clear patterns in time of the dynamic course of risk-relevant features. 7.2.4 NETWORK-BASED MODEL OF RISK OF SEXUAL REOFFENDING The network-based model of risk of sexual reoffending (NBM-RSR), introduced in Chapter 6, was inspired by our meta-analytic and network analytic results, and our series of case studies. The NBM-RSR aims to fill the theoretical gap of two prevailing approaches to understand dynamic risk factors’ causal interference, the statistical perspective and the Propensities Model, which fail to provide insight in the causal processes by which dynamic risk factors contribute to the risk of sexual reoffending and in how these variables may cause sustained changes in this risk. The NBM-RSR approaches the risk of sexual reoffending from a self-sustaining network of causally connected dynamic risk factors. According to this model, the risk of sexual reoffending is determined by the network topology. This topology involves the number and strength (i.e., degree of being presence; degree of activity) of included dynamic risk factors, the density of the network (the number of existing connections relative to the possible number), and the network’s connectivity (how various parts of a network connect to one another). Variables outside the self-sustaining network of dynamic risk factors, the so-called external field, might affect not only the operation of dynamic risk factors but also the network activity as such. These variables include biological factors (e.g., genetics, brain structures and functioning, hormone levels), (early) life experiences (e.g., childhood sexual abuse or neglect), sociocultural factors (e.g., being part of a masculine (sub)culture or sexualized environment, legal variables), situational factors (e.g., access to potential victims, absence of a guardian, changes in employment), and psychological and behavioral factors (such as human agency, motivation for treatment, intelligence, extraversion, level of social emotional development). A sustained change

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