Prisoners frequently encounter a variety of hardships, which puts them at risk for developing a variety of psychological issues, including anxiety, thought, and mood disorders. In jail, people with poor mental health are quite frequent. In the United Kingdom, approximately 45 per cent of individuals in jail suffer from depression or anxiety, and eight per cent have been diagnosed with psychosis (Jakobowitz et al., 2017). Being imprisoned may worsen mental health issues, and there are far too many needless short sentences and remands that might have been avoided if appropriate therapy options were implemented for such offenders. Cognitive-behavioural therapy (CBT) is a type of psychotherapy that can be useful for offenders with various conditions, such as depression, mood and anxiety disorders, substance abuse disorders, eating disorders, and serious mental disease.
CBT seeks to alter the way a person thinks as well as the things they do. Numerous research findings indicate that CBT significantly improves functionality and quality of health (Freeman et al., 2017). As a result, I will use CBT to assist Jodie, a female offender, in adjusting to prison and making new acquaintances. She came three months ago to jail and has struggled to adjust and establish friends. Jodie’s situation deteriorated further following an encounter in the kitchen, during which her coworkers blamed her for being indolent and assigned her the more demanding tasks. She has also begun to use various drugs (e.g.’ spice’) when she can obtain them but regrets it later because they give only momentary pleasure and ultimately make her feel miserable. Jodie’s mood began to decline upon her arrival in jail. She describes the following symptoms: sleep disturbances with early morning awakenings, a lack of energy, and excitement for formerly pleasurable activities. Additionally, she describes feeling depressed and melancholy, having difficulties concentrating, particularly on prison duties, having a poor appetite, frequently pondering, and feeling guilty about abandoning her kid. Consequently, she ends up avoiding socialising and conversing with others.
Cause of the Problem
CBT can be employed to treat Jodie, who happens to be experiencing a wide range of difficulties that her early childhood encounters might have influenced. Jodie is suffering from substance abuse which can be attributed to her report that her father was an alcoholic who was often abusive to her mother and two brothers. Her mother’s partners were also moody and frequently used physical or violent verbal abuse on Jodie and the other siblings. Jodie stated that she had a strained connection with her mother, whom she said lacked sufficient time for her and her brothers.
When Jodie was ten years old, Social Services took custody of all three children. Jodie detailed her experiences of abuse and neglect while in several foster situations. From these childhood events, she learnt not to trust others and that she needed to care for herself because no one else would. As a result, she met friends who eventually exposed her to substance abuse. Also, Jodie experienced lonesomeness while staying alone in her apartment until she met another man, Darren, who ultimately introduced her to drug dealing and supply. After a while, Jodie moved into Darren’s house and gave up her apartment. Jodie saw Darren as her only means of emotional and financial protection. Because of the increased lifestyle they were enjoying; she had put aside her misgivings about Darren’s large dealing and supply of drugs.
The contingency management as a CBT concept can help Jodie abstain from substance abuse. This concept entails awarding clients for positive actions such as abstinence with tangible rewards (Magill et al., 2019). Extensive research in methadone treatment regimens and psychosocial counselling programs has demonstrated that incentive-based therapies are extremely successful in enhancing treatment retention and achieving abstinence from substance abuse (Magill et al., 2019). Contingency management strategies are based on providing a non-drug motivator in exchange for demonstrating substance abstinence.
Jodie shared her stories of abuse and neglect while in care in a series of foster homes. She stated how she was treated as ‘slave labour’ by some families in which she was constantly pressured to work for them. These experiences may have contributed to her lack of motivation to do active kitchen responsibilities while in prison. Scheduling activities and assigning graded tasks as a principle of CBT aim to improve functioning and gradually increase enjoyable or productive experiences. Each day is meticulously scheduled utilizing task scheduling. The psychologist and client work to condense the client’s overwhelming list of responsibilities into a manageable list, so avoiding the need for repeated judgment. The graded work assignments simplify complicated circumstances by breaking them down into simple steps that assist clients in overcoming anxiety-provoking situations and procrastination. These techniques entail establishing a baseline of daily activities, rating them on a scale of pleasure, and jointly designing improvements that will reactivate the client and induce a greater feeling of pleasure in life. By increasing problem solving, these techniques assist clients in re-establishing daily routines and increasing pleasurable tasks.
Potential Causes of Recurrence of the Issue
Jodie’s anxiety, lack of sleep, trouble concentrating, and sense of guilt may be recurrent due to her previous experience when her father neglected her. This is strikingly identical to her behaviour when she occasionally abandoned her son to her friends and neighbours in order to socialise. As she tells it, her failure to provide complete care for her kid both when she was accessible and while imprisoned has instilled in her a tremendous sense of guilt. According to Jodie, she thinks she has failed as a mother since she has been absent from her son’s life. She is scared that her kid will end up in the same circumstances because she grew up in the same scenario without parental vigilance.
An important component of CBT that can assist in preventing the relapse of substance abuse is the relapse prevention approach. This strategy has placed emphasis on functional understanding of drug-use cues and rigorous training of alternate reactions to these cues. It focuses on identifying and preventing high-risk scenarios in which a client may be more prone to substance use due to acquaintances who also consume the substances. Relapse prevention techniques include questioning the patient’s anticipation of perceived beneficial benefits and giving psychoeducation to assist the patient in making a more educated choice in a dangerous scenario (Magill et al., 2019). In a certain systemic review, alcohol and drug use disorders were studied for the effectiveness of relapse prevention, which discovered a comparatively small effect on substance use reduction but a large impact on overall psychosocial adjustment (Magill et al., 2019). In addition to focusing on the functional indicators for drug use, similar CBT treatments have been created that encompass a broader range of psychoeducation, skills training, cognitive reappraisal, and other behavioural tactics.
Over time, it has been demonstrated that particular CBT components can help treat sleeplessness. Cognitive-behavioural treatment for insomnia (CBT-i) can help sleep difficulties while having little influence on the patient (Davidson et al., 2019). Another comprehensive analysis discovered that CBT-I had a modest to substantial effect on insomnia and that the effects persisted after the treatment session ended (Davidson et al.2019). This indicates that it was feasible to re-establish normal sleep patterns following CBT-i therapy. These evaluations do not address whether CBT-i therapy effectiveness can be compared to that of sleep medicines. In other words, they do not explicitly propose which type of therapy should be employed by people who have insomnia.
Most patients prefer nonpharmacological treatment choices such as CBT, possibly due to avoidance of swallowing pills. While psychopharmacological agents have been suggested as the first-line management for insomnia, data shows that cognitive behavioural therapy is relatively cost-effective and is linked with lower recurrence rates (Magill et al., 2019). Accordingly, the expectation has been that combining treatment modalities, e.g., cognitive behavioural therapy and medication, will significantly improve drug treatment results. However, similar to the findings for anxiety and mood disorders, this strategy has frequently produced ambiguous results (Magill et al., 2019). For instance, several studies have demonstrated the efficacy of combining naltrexone and CBT in treating substance abuse. However, a particular study reviewed that naltrexone and behavioural therapies resulted in the best drinking patterns; nevertheless, combination treatment did not show cumulative efficacy relative to monotherapy (Magill et al., 2019). Thus, a combination of treatment modalities provides a good platform in avoiding the recurrence of substance drug abuse.
Factors That May Contribute To Change
Jodie’s present health and psychosocial problems result from her previous heinous experiences. Her prior interactions are the primary reason she is imprisoned at all. After being neglected by her parents, she developed a drug and substance misuse problem, which led to her meeting new people and, unfortunately, getting pregnant. Her sense of guilt is exacerbated by the fact that she cannot care for her son while she is incarcerated. Jodie was isolated from her younger siblings at a young age, which exacerbated her loneliness. She adds that it has been difficult for her to establish friends or simply trust anyone since then. This scenario contributed to her current condition of avoidance of social interaction and communication with other inmates.
In helping Jodie change her behaviours, core concepts of CBT need to be put in place. The term “cognitive restructuring” refers to the process of overcoming unfavourable thinking patterns that contribute to behavior and mood disorders and substituting with good ones (Magill et al., 2019). Jodie’s issues appear to stem from a lack of sleep and waking up early. Therefore, I will assist her in identifying the negative ideas that are causing her to have sleeplessness. Perhaps she feels she is unable to sleep because she is separated from her child and fears he is suffering in her absence. I will let Jodie do the work of identifying this misguided notion and then together work on eliminating it. Thus, I may urge Jodie to examine this notion by challenging the evidence that supports it. An illustration of this is letting her know that her kid has been placed in the care of a trustworthy foster home, and soon he will be permitted to visit her shortly. As Jodie’s sense of guilt lessens, she will begin to alter her sleep schedule.
The same strategy may be used to counteract the dysfunctional ideas that contribute to her drug consumption. Thus, I will assist Jodie in identifying the erroneous thinking linked with these negative behaviours. Perhaps they are her only ways of erasing fond memories of her son lifting his poor mood. To counteract these erroneous assumptions, I will encourage Jodie to recall her son’s situation in a more positive light rather than as if he is suffering. Consistently, to refute the assumption that she can only lift her bad moods by drinking and smoking. I will ask Jodie to explain the sensation she often experiences when she engages in her hobbies or pastime activities. If these actions also improve her mood, then the claim that she can only get the same satisfaction from substance abuse is incorrect.
Cognitive-behavioral therapy (CBT) examines the relationships between one’s thoughts, emotions, and behavior. It is an approach that is guided and is utilized to treat a variety of mental health disorders. It aims to alleviate discomfort by encouraging patients to establish more adaptive ideas and behaviors. Occasionally, law offenders often experience many challenges while in prison, trying to adapt to the new environment. Like any other patient, they also need closer attention in counselling, and CBT proves to be the best psychotherapy for them. Various CBT concepts have been proved to be effective in addressing mental disorders. These concepts include the use of contingency management, which involves using tangible rewards to commend positive behaviours, relapse prevention, and pharmacotherapy, among others.
Jakobowitz, S., Bebbington, P., McKenzie, N., Iveson, R., Duffield, G., Kerr, M. and Killaspy, H., 2017. Assessing needs for psychiatric treatment in prisoners: 2. Met and unmet need. Social Psychiatry and Psychiatric Epidemiology, 52(2), pp.231-240.
Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B. and Slater, M., 2017. Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine, 47(14), pp.2393-2400.
Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J.S. and Carroll, K., 2019. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 87(12), p.1093.
Davidson, J.R., Dickson, C. and Han, H., 2019. Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes. British Journal of General Practice, 69(686), pp.e657-e664.