A mental health therapy program for incarcerated individuals in Wisconsin has been so well received that it is expanding to at least six Wisconsin correctional facilities and is drawing interest from correctional systems in other states and a Canadian province.
The project, which began with a Wisconsin Partnership Program (WPP) Collaborative Health Sciences Program grant, looked at the feasibility and efficacy of delivering therapy for post-traumatic stress disorder (PTSD) in the correctional setting.
Principal investigator Michael Koenigs, PhD, a professor of psychiatry at the University of Wisconsin School of Medicine and Public Health, said the project’s goal was to address the need for more effective mental health care for incarcerated individuals.
“Virtually everyone who enters the correctional system has a history of trauma, often dating back to childhood,” Koenigs said. “The percentage of people with PTSD in the prison population is about five times higher than in the general public.”
The project provided training for psychologists in the Department of Corrections to deliver an evidence-based type of group therapy called cognitive processing therapy (CPT), which is designed to help people with PTSD learn to identify the types of thoughts, feelings and behavior that relate to trauma, and to challenge and change those reactions.
Koenigs said therapy participants have commented on the profound impact that the therapy has had on their outlook on life.
One participant shared, “I am a changed person now. Once I get out, I think I have a chance.”
If you help one person get unstuck in their recovery from trauma, it affects their relationships with their family and children, with other facility residents and staff, and with other people in the community when they come home.
- Michael Koenigs, PhD
Another participant commented, “If a young me had heard these things in a group home, I wouldn’t be here today. I would’ve learned there’s still hope.”
Department of Corrections (DOC) staff are also supportive of the program. Over twenty DOC psychologists have volunteered to join the project as study therapists. In addition, the warden at one participating prison asked the study team to provide special trauma training sessions for their DOC security staff to help them better understand the people in their care.
“We talk a lot about the ripple effect,” Koenigs said. “If you help one person get unstuck in their recovery from trauma, it affects their relationships with their family and children, with other facility residents and staff, and with other people in the community when they come home.”
In this Q&A, Koenigs discusses the project’s impetus and ongoing impact.
Michael Koenigs, PhD
Describe how PTSD can affect incarcerated men and women.
PTSD is associated with behaviors that increase risk for people inside the correctional system, including irritability, substance use for numbing and coping with trauma, and aggression towards others. One common thought among people who have suffered abuse is, “I can’t trust anybody.” The DOC psychologists on our study team are teaching participants a more balanced way to evaluate trust and more balanced ways of thinking, emotional regulation and behavior.
Why did your team select cognitive processing therapy (CPT) for this study?
Cognitive processing therapy has some of the strongest evidence base for treating PTSD. That’s why they use it in the Veterans’ Administration system. The reason we thought it would be ideal for the corrections setting is that it has been shown to be effective in people with other concomitant disorders such as depression, anxiety and substance abuse, and it can also be effective for people with fewer years of formal education as well as those who are experiencing ongoing stress and traumatization. You can do it in a group setting, in a therapist-led group, which is a common treatment format in the prison system.
How did the study work?
First, we offered a two-day CPT training session for interested DOC staff. After that, we offered ongoing consultation and support and helped troubleshoot issues with staff. They delivered the therapy to groups of six to ten people in 12 sessions that were either weekly or twice a week. So far, over 180 individuals at two women’s facilities and three men’s facilities have received the treatment through this study. A key part of the research project was evaluating feasibility and acceptability of it and whether we can make it work safely in a corrections setting. We also evaluated the therapists. Can they provide the therapy with fidelity to the CPT method? The DOC therapists have done an outstanding job. We’re seeing strong and sustained improvement in PTSD symptoms among participants. We’re also currently looking at DOC conduct reports, to see if behavior reports are declining among participants.
Did corrections staff consider the CPT therapy useful?
Many of the DOC therapists leading the groups have commented on the impact that the treatment is having on the participants. They have noticed things like increased self-esteem, increased hope and optimism for the future, and an overall willingness to ‘try to do better’ with things like family relationships, relationships with staff, and seeking new educational or vocational training opportunities. Maybe the clearest indication of the staff’s satisfaction is that they have been willing to continue providing the treatment at their facilities and they are even recommending this treatment to their colleagues at other prison facilities in the state.
What’s next for this project and work?
The findings from our WPP project helped us to obtain a grant from Arnold Ventures for $854,422 that will allow us to expand and evaluate PTSD treatment in six Wisconsin correctional facilities. We hope to serve over 600 incarcerated individuals within the next three-and-a-half years. We have also been contacted by California, New York and Maine, as well as the Ontario provincial correctional system, about their interest in providing this treatment in their prison facilities.
Does this research represent a change in direction for you?
It certainly does. My initial work in prison settings was focused on understanding the psychological and neurobiological characteristics related to conditions and experiences that are relatively common in the prison population, such as substance use, psychopathy and trauma. The key turning point for me was asking, “Who is going to benefit from this research? And when?” Now we’re developing our research priorities in close partnership with staff in DOC and with formerly incarcerated people. The pivot to community partnership as the foundation of our work has led to projects that I believe will have much greater reach and impact.
