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Title: An investigation into the feasibility of psychological interventions for managing the symptoms of trauma and insomnia for women in prison
Author: Jones, G. A.
ISNI:       0000 0004 6351 472X
Awarding Body: University of the West of England
Current Institution: University of the West of England, Bristol
Date of Award: 2017
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Background Female prison populations, when compared to a general population, appear to contain higher prevalence’s of trauma histories with the majority of women in prison having experienced sexual or physical violence in childhood or during their adult lives (Moloney and Moller, 2009). Resultantly, many women in prison exhibit psychological difficulties as a consequence of past victimization including conditions such as Post-Traumatic Stress Disorder, Borderline Personality Disorder, emotional dysregulation, depression, insomnia and also physical morbidity (Zlotnick, 1997). Objective The objective of this investigation at an HMP was to recognise the experiences and mental health of women who access psychological support in prison and to provide a preliminary understanding of the effectiveness of group psychological intervention to improve symptoms of trauma and insomnia. Design This HMP investigation was a cohort feasibility study, which utilized a mixed-method approach to enhance the understanding of the participant’s experiences of accessing psychological support in prison (Sandelowski, 2000). The 71 women invited to participate in the study were designated into one of four psychological group interventions through a process of purposive sequential sampling. The psychometric evaluations of the Post-Traumatic Stress Disorder Symptom Scale (PSS-SR), the General Health Questionnaire – 28 (GHQ-28) and the Insomnia Severity Index (ISI) were administered to measure symptoms of trauma and insomnia before the commencement of the respective psychological group interventions, and three weeks subsequent at the participant’s attendance in the matching intervention focus group. Results Descriptive statistics were used to interpret the clinical effectiveness of the 4 group interventions; and at the 3-week follow-up points the group mean percentage outcomes indicated the ‘exercise as therapy’ (PSS-SR, -16%; GHQ-28, -14%; ISI, -12%) and the ‘improving your sleep’ (PSS-SR, -12%; GHQ-28, -12%; ISI -36%) groups to be more effective at treating the patients symptoms of trauma and sleep than the ‘introduction to anxiety management’ (PSS-SR, -11%; GHQ-28, +8%; ISI, +4%) and the ‘introduction to mindfulness’ (PSS-SR, +1%; GHQ-28, +3%; ISI, +21%) interventions. The quantitative approach also provided information about group intervention non-participation and this illustrated that 30% of women were released or transferred prior to their clinical appointment. Whereas, the qualitative findings from undertaking thematic analysis of the focus groups discourse provided the emergence of six themes that helped to explain the women’s experiences of accessing psychological treatment in prison. These themes were, ‘a pathway to care’, ‘stigma as a therapeutic barrier’, ‘the patient or prisoner paradox’, ‘the retraumatising nature of prison’, ‘the significance of sleep’ and ‘women as stakeholders’. Conclusion The findings of the HMP investigation indicate that prison is an unhelpful environment for women who have trauma histories, as prison can be a factor for the continuation or exacerbation of trauma symptoms and insomnia, even when the women have access to group psychological support. The HMP investigation recommends a series of interim interventions to address the prison culture unhelpful to the psychological wellbeing of detained women. The study’s ultimate recommendation proposes the transformation of HMP into a specialised trauma-focused hospital to manage women detained within the criminal justice system who exhibit symptoms of trauma and insomnia.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Health Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: forensic ; prison ; psychology ; interventions ; trauma ; hyperarousal ; sleep ; anxiety ; depression ; post-traumatic stress disorder ; mindfulness ; exercise ; cognitive ; behavioural ; CBT ; women ; health ; illness