Three-Principles Approach for Incarcerated Adults
Condition: Psychological Distress; Recidivism
Study type: Interventional

Summary: 
      The purpose of the study is to examine the feasibility, acceptability and preliminary
      efficacy of an acceptance-based, insight-oriented treatment approach for US incarcerated
      adults. Feasibility and acceptability will be assessed through attendance and retention
      throughout the intervention period. Primary outcomes include negative affect, psychological
      flexibility, emotion regulation, purpose in life, impulsivity, and trauma. Changes will be
      assessed from baseline to post-course, post-course to 6-month follow up, and baseline to
      6-month follow up for all primary outcomes. Researchers hypothesize that, 1) retention rates
      will be similar to previous trials with 70% retention from pre- to post-course; 2) there will
      be significant baseline-to-post-course reductions in psychological symptoms, impulsivity, and
      trauma, and an increase in psychological flexibility, purpose in life, and emotion
      regulation; and 3) there will be significant baseline-to-6-month reductions in psychological
      symptoms, impulsivity, and trauma, and an increase in psychological flexibility, purpose in
      life, and emotion regulation.
    

Detailed description: 
      Prevailing correctional counseling methods (e.g., cognitive-behavior therapy, social
      learning) often operate from an "outside-in" paradigm attempting to put mental health "into"
      people in prison using various strategies and techniques. Three Principles Correctional
      Counseling (3PCC), informed by theosophy of Sydney Banks, with a subsequent intervention
      based on Banks's work, is grounded in a different paradigm-in which all individuals,
      including incarcerated, have innate positive mental health; however, their belief systems
      convince them otherwise. When incarcerated individuals learn to navigate daily challenges
      with mental clarity, affective states shift from negative to positive, allowing for
      state-dependent positive recall, leading to lower likelihood of responding to negative
      thoughts and feelings with deviant and other health-damaging behavior.

      Studies suggest 3PCC leads to improvements in negative affect such as depression, anxiety,
      and rumination, and increases in positive outcomes including mindfulness, mental health,
      social well-being, emotional regulation and non-attachment in non-correctional samples,
      reductions in stress and anxiety for HIV-positive patients; improvements in substance use
      problems, criminal justice involvement, employment, housing, and psychological wellbeing for
      women in in-patient substance abuse treatment; improved resilience in high-risk children and
      adolescents, improved mental health and resilience in young trauma-exposed sex offenders,
      improvements in thought recognition, mindfulness, and psychological well-being in a
      correctional sample, and improved in mental well-being, purpose in life, anxiety and anger,
      and behavior in a UK prison. 3PCC has also shown feasibility and acceptability in refugee
      women with trauma, and demonstrated feasible retention rates of 76% in an English prison
      setting.

      The current trial is designed to further assess efficacy of 3PCC in incarcerated individuals.
      3PCC classes will be facilitated by practitioners with several years of experience working
      with diverse client populations. Each 3PCC class will meet weekly for 10 consecutive weeks,
      with each session approximately 3 hours long. Classes will include the following modules:
      Building Rapport, Exploration of "Reality"; Separate Realities; Exploration of Thought and
      Insight; Consciousness-Where Does it Come From?; Exploring Feelings/Moods/Behavior; Exploring
      Innate Health/Natural Intelligence; What is Mind?; Exploring Infinite Potential; Exploring
      Mental Clarity Versus a Busy Mind; Stepping into the Unknown, Implications of the Principles
      for Life in Prison; and Living Outside of Prison.

      Hypothesis 1: Compared with the control group, participants in the 3PCC condition will
      demonstrate significant increases in psychological flexibility, quality of life, clear mind,
      emotional regulation, impulse control and purpose in life at post-course, which will be
      maintained at 3- and 6-month follow-up.

      Hypothesis 2: Compared with the control group, participants exposed to 3PCC will show
      significant decreases in depression, anxiety, anger, and trauma symptoms at post-course,
      which will be maintained at 3- and 6-month follow-up.

      Hypothesis 3: Compared with the control group, participants exposed to 3PCC will show greater
      improvement in behavior within the prison community at post-course, which will be maintained
      at 3- and 6-month follow-up. Behavior will be measured by prison records measuring
      participants' behavioral violations and rewards for prosocial behavior.
    

Intervention name(s): Three Principles Counseling
Intervention type(s): Behavioral
Intervention description(s): A 10-week insight-based program offered in prisons in a group setting for 2 hours each week. Approximately 15 - 20 adults or youth in custody participate at a time, led by two trained teachers. The curriculum is designed to teach an understanding of the mind and human experience for the purpose of reducing risk factors, uncovering resiliency and to promote emotional and psychological well-being for adults and youth in the criminal justice system. This is taught through a compilation of sessions that speak to the potential, ability and resilience inherent in every individual. Sessions include a mix of lessons, experiential learning, and group conversations.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment