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Working with Trauma in a Prison Setting
This is the protocol for a Campbell systematic review. The objectives are as follows. The proposed systematic review is an update to, and extension of, Lipsey et al. (2007). As such we build on their previous aims to: (i) Assess and synthesise the overall impact of cognitive behavioural therapy (CBT) on offender recidivism; (ii) Examine possible sources of variability in the effectiveness of CBT. Data permitting, we will examine if the effectiveness of CBT varies by: (a) Characteristics of the CBT intervention (e.g., cognitive restructuring vs. cognitive skills training, group v. individual implementation; and/or custodial v. community setting, and/or), (b) Characteristics of the population (e.g., juveniles vs. adult offenders), (c) Implementation factors (e.g., implementing practitioner, use of structured/manualised approaches, delivery mode, and/or programme duration or intensity), (d) Evaluation methods (e.g., randomised vs. non‐randomised research designs); (iv) Determine whether there is a decline in the effect of CBT on recidivism over time; and (v) Investigate whether there is an interaction between implementation factors and time in terms of the effect on recidivism.
Background
Retention of participants to programs of psychological therapy in a prison setting is problematic. Intensively delivered therapy has emerged in recent years, in contrast to the traditional format of weekly sessions of psychological therapy.
Method
This study aimed to evaluate the feasibility of an intensive program of cognitive behavior suicide prevention therapy within a male prison, for the first time. Thirteen participants consented to take part. Up to 10 h of therapy was offered, across five sessions, within a 3-week delivery window. Outcome measures were completed at baseline and follow-up.
Results
Program completion and client satisfaction with the intensive program were high. Outcomes related to suicidal distress were assessed, with effect sizes reported. Large and statistically significant effect sizes were found for suicidal ideation and emotional regulation when comparing baseline to follow-up. Small and non-significant effects were found for social support and problem solving when comparing the same.
Conclusion
The study holds promise for the feasibility and efficacy of delivering an intensive cognitive behavior suicide prevention therapy for people in prison. Further exploration on a larger scale is warranted [Clinical Trial ID: NCT03499548].
Medicine has seen many advances, and viewing violence as a health problem has revolutionized our ability to study, predict, and prevent it. As this approach takes on more international, epidemiological, and public health dimensions, however, there is a need to return soberly to the original medical principles of caregiving and a human‐centered approach. Doing so involves combining the local and human aspects of medicine's tradition with an awareness of the global needs of our era. A model for caring needs always to remain close to all practices, including wider‐system applications, in order to have relevance. In this chapter, we propose a model of compassion, altruism, respect, and encouragement for the foundation of a person‐centered, humanistic approach. Also, it is important to remember that the global requires grounding in the local, sensitive to cultural and psychological needs, certainly, but also to each person's universal humanity. Further, as the application of a health approach to violence extends across the globe, there is an ever stronger need to preserve the knowledge that comes from close contact as between a medical provider and a patient. Taking into account human suffering and the principles of caregiving, fostering of resilience and creativity in an increasingly globalizing world becomes a foundation for building collaborations between healthcare givers and policymakers to achieve good governance.
Our aim was to investigate whether early detection was feasible in prison and whether it could improve mental health outcomes in young prisoners. A secondary aim was to explore whether it can reduce returns to prison. Between 2011 and 2014, a total of 2115 young prisoners were screened, 94 (4.4%) met criteria for ultra-high risk for psychosis and were offered an intervention, 52 actually received it. Return to prison data were sought on the 52 participants, receiving a formal intervention. Of the 52 prisoners who received an intervention, 30.8% returned to custody compared to national average reconviction rates of between 45.4 and 66.5%. Our results suggest that early detection is a feasible option in a prison setting, improving mental health outcomes and reducing returns to prison. Mental health outcomes were recorded for a sub-sample of those receiving the intervention. The results indicated statistically significant improvements on measures of depression, anxiety and psychological distress.
Children and young people in secure settings present with a complex range of vulnerabilities, needs and risks. A significant number of them have been looked after in local authority care and have experienced trauma, neglect, loss and disruption (Bailey, Thornton and Weaver 1994; Casswell, French and Rogers 2012). These children and young people’s early lives are reflected in behaviour that can be both risky to themselves and those around them. Across the range of secure settings, we will examine how young people present with similar levels of need and complexity and often have histories of trauma and deprivation. Young people may make transitions between secure settings, but psychological provision within these settings can provide consistency by helping the systems of care be psychologically informed to achieve the best possible outcomes.
This article examines the provision of psychological therapy in prisons in the legal jurisdiction of England and Wales and argues that it is important for researchers, practitioners and policy-makers to acknowledge and understand the complexities involved in therapy provision. Drawing on interviews with clinical psychologists working in prisons in England and Wales, this article explores three contexts of complexity which need to be understood when working therapeutically with prisoners: the wider psychosocial experiences which prisoners import with them into custody; the deprivations of prison life itself; and the interaction between the individual and the prison environment. In order to understand these complexities more effectively, therapists need to be aware of research on this socially excluded group in general and on the effects of imprisonment. Moreover, it is important that therapists act almost as though they are ‘researching’ the broader aspects of the prison in which they work – its setting, its ‘moral performance’, its history and culture. Doing so requires the practitioner to hone skills akin to those of an ‘ethnographic’ prison researcher, so that he or she comes to understand the interaction between the individual prisoner and the systems in which he or she is immersed.
The impact of dealing with a death in custody was explored in 49 prison officers who had dealt with such an event in the period 3-7 months prior to the study. A 36.7% incidence rate of post-traumatic stress disorder (PTSD) was identified. Optimism, avoidance problem solving style, prior experience of suicide and level of involvement in the incident were direct mediators of the impact of the event for the total sample, while perceived control, emotional support and other aspect of problem-solving style had an indirect effect. Separate analysis of the PTSD and non-PTSD groups showed that the only mediator for the PTSD group was prior experience. For the non-PTSD group a range of variables mediated the impact. It is argued that this provides a case for preventive rather than treatment interventions.
Program and is chief, Laboratory of Developmental Psychopharmacology, at McLean Hospital. His recent studies have been of the neurobiological effects of childhood mistreatment and the neurobiology of attention deficit/hyperactivity disorder. Neuropsychologist Teicher reveals the alarming connections scientists are discovering between child abuse—even when it is psychological, not physical—and permanent debilitating changes in the brain that may lead to psychiatric problems. The discoveries are a wake-up call for our society, but they may also hold hope for new treatments for abused children and the adults that they become.
Eye movement desensitization and reprocessing (EMDR), though controversial, is increasingly utilized for treatment of posttraumatic stress disorder (PTSD). This article reviews the debate concerning efficacy and concludes that the evidence, though not definitive, supports EMDR's positive treatment effects. The authors argue that EMDR is a therapeutic intervention different from exposure. The authors set forth three interrelated hypotheses to explain EMDR's therapeutic mechanism: bilateral hemispheric activation, normalized brain activation patterns, and activation/desensitization of emotion/arousal; avoidant/constricted attention is disrupted, allowing normalizing processes to occur. Lowered arousal then leads to a resumption of more adaptive cognitive processing. Some predictions to test this model are presented. Copyright © 2002 John Wiley & Sons, Ltd.
In experimental studies of stress, the focus has been largely on psychophysiological reactions or global defensive styles. This study focused on cognitive responses after a stress film, as compared with responses after a neutral film and in a base line condition. Thirty-one subjects in a counterbalanced design had significantly more intrusive thoughts and recollections of film scenes after the stress film (p < .05). These experimental variables were not affected by film order or variations in instructional demand. The frequency of visual images was found to be a less reliable measure since it was significantly affected by varied instructions. Those subjects who reported the most negative affects immediately after the stress film were the subjects highest on intrusive thought during the following performance periods
The development of eye movement desensitization and reprocessing (EMDR) has been marked by an emphasis on research, beginning with its introduction by a controlled study in 1989. However, misconceptions regarding the method abound. A recent inaccurate literature review demonstrates the need for more careful scrutiny. To date, 12 controlled studies have been completed in the area of PTSD, most of which support EMDR's efficacy. Nevertheless, a careful examination of a number of studies and of a recent literature review reveal the need for greater methodological rigor and higher clinical standards in both the research and research evaluation process.