Treatment Works, Behaviors Change: Investigating the Impact of Trauma Focused Therapy for Posttraumatic Stress Disorder on Disciplinary Infractions Among Women in Prison

Trauma and subsequent mental illness have been described as a “pathway to prison” for women given their near ubiquity among those who become incarcerated. Less research has investigated women’s pathways within prison including 1) how posttraumatic stress symptoms (PTSS) may influence women’s behaviors in prison and 2) how receiving trauma-focused therapy (TFT) may alter within-prison behavioral trajectories. In this study, we examined these questions using treatment and administrative data on PTSS and infractions, with particular focus on infractions possibly motivated by avoidance (e.g., those related to substance use, medication misuse, and aggression), among women who did and did not complete TFT while incarcerated. All individuals incarcerated in the Washington Correctional Center for Women (WCCW) between January 2015 through December 2021 (N = 5,775) were considered for inclusion. Of these individuals, 159 received a TFT for PTSS and were matched to a control group using propensity score matching. Results revealed a decrease in infractions after therapy, with treatment predicting change over and above other infraction factors. Overall decreases in PTSS severity were correlated with a decrease in total, fighting/assault, and substance use infractions. PTSS analysis of specific symptom clusters reflected that a decrease in intrusive symptoms had the most robust correlation with reduction in infractions. Findings underscore the importance of providing TFTs for PTSS in prisons to reduce infraction behaviors and bolster facility safety.