Edinburgh Napier University

  Interpersonal trauma is endemic in female prisons. Implementing trauma informed interventions to assist the recovery of women in custody has long been advocated for. It has been argued that psychoeducation should constitute a critical first phase of trauma informed interventions. The main objective of psychoeducation being to stabilise symptoms and behaviours thereby enabling survivors to cope with subsequent trauma memory processing (TMP). Although group based psychoeducation interventions have been frequently delivered they have received scant empirical testing particularly within forensic environments.

The first part of this thesis involved conducting a systematic review and meta-analysis to investigate the efficacy of group based interventions. The results were considered with respect to five outcome domains (PTSD symptoms, Depression, Psychological Distress, Substance Misuse and Dissociation). This was the first time that a detailed analysis was conducted specifically for group interventions. Whilst TMP treatments computed large statistically significant effect sizes, for PTSD symptoms, compared to usual care (k=6, g= -0.98 [95%CI, -1.53 to -0.43], psychoeducation interventions (after outliers were removed) had only small non-significant effect sizes k=7, g=−0.25 [95%CI −0.66 to 0.16]. However, when TMP and psychoeducation were directly compared only small non-significant differences were apparent in favour of the former (k=4, g= -0.34 [95%CI, -1.05 to 0.36]) for the amelioration of PTSD symptoms. Similarly, trauma informed interventions were also as efficacious as non-trauma informed interventions (k=5, g= 0.36 [95%CI, -0.24 to 0.96]).

The second part of this thesis concerned a randomised control trial (RCT) which investigated the efficacy of Survive & Thrive, a pure psychoeducational intervention, which was delivered to female prisoners. This brief 10 session intervention (was compressed to a 2 session per week format to accommodate short sentences. Participants who received this intervention (n=44) were compared to those who received usual care (n=42). Results from an intent-to-treat (ITT) analysis indicated that there were no statistically significant differences between the two arms across the three assessment time points (including one month after the intervention) for the main outcomes (Behavioural Assessment Checklist-Revised, β= 4.60 [95%CI, -1.60 to 10.88], p= 0.148; PTSD Checklist, β= -1.47 [95%CI, -4.30 to 1.36], p= 0.303). Subscales from other measures however indicated that participants in the intervention arm reported significantly more Depression (β= 0.95 [95%CI, 0.11 to 1.79], p=.027) and less emotional Non-Acceptance (β= -1.65 [95%CI, -3.22 to -0.07], p=.041). All ITT results were only statistically significant at follow up. However, an adequate dose (≥7 sessions) analysis indicated that interactions between time and study arm were significant at post assessment. This included for the Distress subscale in the main behaviour outcome measure (β= -3.51 [95%CI, -6.55 to -0.47], p=.024). Post hoc Reliable Change analyses suggested twice an many AD participants made progress in addressing PTSD symptoms compared to usual care (30.3% vs 17.6%, OR 2.03 [95%CI, 0.64 to 6.43]).

The trial undertaken for this thesis is the first comprehensive RCT for a group based psychoeducational intervention with female prisoners. The clinical and research utility of the results from this trial and the meta-analysis are discussed with respect to the stabilisation and amelioration of symptomatology associated with interpersonal trauma. It suggested that there is still further work to be done if psychoeducational interventions are to demonstrate greater efficacy than usual care.