How Does Timing Affect Trauma Treatment for Women Who Are Incarcerated? An Empirical Analysis

• Author: Ana J. Bridges,Marie Karlsson,Danielle E. Baker,Lauren E. Hurd,Morgan A. Hill,Melissa J. Zielinski,Kaitlyn D. Chamberlain
• DOI: 10.1177/0093854820903071
• Published date: 01 June 2020
• Date: 01 June 2020
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2020, Vol. 47, No. 6, June 2020, 631 –648.

DOI: https://doi.org/10.1177/0093854820903071

Article reuse guidelines: sagepub.com/journals-permissions

© 2020 International Association for Correctional and Forensic Psychology

631

HOW DOES TIMING AFFECT TRAUMA

TREATMENT FOR WOMEN WHO ARE

INCARCERATED?

An Empirical Analysis

ANA J. BRIDGES

DANIELLE E. BAKER

LAUREN E. HURD

KAITLYN D. CHAMBERLAIN

MORGAN A. HILL

University of Arkansas

MARIE KARLSSON

Murray State University

MELISSA J. ZIELINSKI

University of Arkansas for Medical Sciences

Most women who are incarcerated have experienced sexual violence; difficulties adjusting to prison could interfere with

women’s ability to benefit from trauma-focused therapy. Here, we explored whether therapeutic benefits of trauma treat-

ment varied as a function of time since incarceration. Women (N = 128) participated in an 8-week group treatment for

sexual violence victimization while incarcerated in a community corrections center for nonviolent offenses. Ninety partici-

pants consented to the study and completed self-report questionnaires assessing internalizing symptoms (depression, post-

traumatic stress, and shame) before and after treatment. Bivariate correlations revealed a significant negative association

between time since incarceration and pretreatment depression but not posttraumatic symptoms or shame. Dependent-sample

t tests revealed significant improvements from pretreatment to posttreatment in internalizing symptoms. Longer time since

incarceration did not significantly predict internalizing symptoms after controlling for pretreatment symptom severity.

Findings suggest trauma-focused treatments can be offered to women shortly after they are incarcerated.

Keywords: sexual abuse; incarcerated women; trauma; treatment; PTSD

AUTHORS’ NOTE: This project was supported by a grant from the American Psychological Foundation (PI:

A. J. Bridges) and the National Institute on Drug Abuse (PI: Zielinski; K23 DA048162). Correspondence con-

cerning this article should be addressed to Ana J. Bridges, Department of Psychological Science, University of

Arkansas, 216 Memorial Hall, Fayetteville, AR 72701; e-mail: abridges@uark.edu.

903071CJBXXX10.1177/0093854820903071Criminal Justice and BehaviorBridges et al. / Timing of Trauma Treatment

research-article2020

632 CRIMINAL JUSTICE AND BEHAVIOR

When we began offering trauma-focused group therapy in a women’s minimum-secu-

rity prison, women began their sentence with a 30-day orientation period that prohib-

ited participation in most voluntary programs. The programming embargo was lifted after

policy changes led to shorter average sentence lengths. We noticed an increasing number of

women joining our groups early in their incarceration, some as early as their first week. This

led us to wonder about the advantages and/or disadvantages of beginning trauma-focused

therapy while adjusting to incarceration. Here, we examined whether there is evidence that

women should not participate in trauma-focused therapy while adjusting to prison—or if

nearly simultaneous engagement in adjustment-focused programming and trauma therapy

could still be beneficial—by analyzing whether the therapeutic benefits of participation in

a voluntary exposure-based trauma treatment for sexual assault victimization varied as a

function of time since incarceration. We viewed this question as important given that entry

to prison has been described as potentially traumatic and as an experience that may exacer-

bate existing trauma symptoms (Yardley & Wilson, 2013).

TRAUMA EXPOSURE IN INCARCERATED WOMEN

Although women make up only 7% to 10% of incarcerated people in the United States

(Federal Bureau of Prisons, 2018), women have been the fastest growing demographic seg-

ment of prison and jail populations throughout the past several decades (Carson, 2018). In

fact, the population of women in state prisons has increased by over 700% since the 1970s

(Carson, 2018). Rising rates of incarceration have largely been driven by increased enforce-

ment and prosecution of drug-related offenses, especially low-level nonviolent offenses

(Fellner, 2000). Because many survivors of sexual assault, who are most often women,

commonly use drugs and/or alcohol to cope with posttraumatic symptoms (Ullman et al.,

2013), greater enforcement of drug laws disproportionately increases women’s justice

involvement. Indeed, a recent review found that 56% to 82% of incarcerated women have

experienced lifetime sexual victimization, with 50% to 66% having experienced sexual

abuse in childhood (Karlsson & Zielinski, 2018).

Not surprisingly, sexual victimization is associated with worse mental health. For

instance, 30% of women who were raped met criteria for a depressive disorder (vs. 10% for

non-victims), and 31% reported symptoms consistent with posttraumatic stress disorder

(PTSD) (vs. 5% of non-victims; Kilpatrick, 2000). In a nationally representative sample of

adult women, child sexual abuse survivors were significantly more likely than non-victims

to have alcohol use problems (33.9% vs. 18.2%), other drug problems (27.6% vs. 10.1%),

depression (39.3% vs. 19.2%), and PTSD (39.1% vs. 5.7%) during their lifetime (Molnar

et al., 2001). Among women with rape-related PTSD, 20.1% had alcohol problems and

7.8% had problems related to other drug abuse (Kilpatrick, 2000). Few studies have inves-

tigated the association between trauma exposure and mental health in incarcerated women;

however, those that have done so found that childhood and adult sexual assault are associ-

ated with higher rates of mental illness including depression, PTSD, and substance use

disorders (Karlsson & Zielinski, 2018).

Mental illness is not the sole negative emotional consequence of sexual victimization;

maladaptive emotions such as shame often emerge following trauma (Saraiya & Lopez-

Castro, 2016). Shame is an emotion tied to perceptions that the self is defective, inadequate,

or “bad,” and tends to lead to negative outcomes such as self-criticism, poor self-esteem,