They Are Coming Home: The Effect of Trauma-Related Cognitions on Vocational Readiness of Incarcerated Women

Abstract

The prevalence of trauma in the lives of incarcerated women has been well-documented. Yet, few studies have included trauma-related cognitions, a common response to interpersonal trauma, in their analyses. The purpose of this study was to examine the relationship between trauma (pre-incarceration trauma [PIT] and incarceration-based trauma [IBT]), trauma-related cognitions [TRC] (i.e., Total; Self, Blame, and World), posttraumatic stress disorder (PTSD) severity, and vocational readiness-motivation (VR-M) in a random sample of incarcerated women in three prison facilities. A cross-sectional research design was employed using a stratified random sampling procedure. The stratum was housing security levels 1 to 4. The study was conducted in three prisons located in the midwestern region of the United States. Self-administered questionnaires measured PIT, IBT, TRC, PTSD, and VR-M. The study sample included (N = 250) female inmates: 152 White (60.8%), 50 Black (20.4%), 18 Biracial (7.3%), 13 Native American/Pacific Islander (5.3%), and 12 Latina (4.8%) females. The average age of participants was 36.2, and 82.4% were mothers. A key finding in this study was that TRC-Total was best predicted by trauma associated with the prison environment (IBT) and PTSD severity. Our findings indicated that for Black and Latina women, higher levels of trauma-related cognitions about “self” were predictive of a lower potential for vocational readiness in the area of motivation. Future examination of trauma’s effect on the development of negative trauma-related cognitions about self (e.g., self as incompetent) has the potential to inform prison mental health practice and the development of clinical interventions to decrease trauma-related cognitions about self for incarcerated women with multiple trauma experiences.

Keywords

women offenders mental health and violence PTSD criminology violence exposure

Introduction

Previous studies report the number of incarcerated women exposed to violence prior to incarceration being as high as 90% (King, 2015; Lynch, Fritch, & Heath, 2012; Messina & Grella, 2006; Miller & Najavits, 2012), with approximately 50% to 60% having been exposed to sexual abuse as a child and/or as an adult (Carson & Sobel, 2012). Likewise, prison-based experiences may be characterized as trauma (Anderson, 2015; Clark, 2001; Dirks, 2004; Douglas, Plugge, & Fitzpatrick, 2009; Haney, 2003; Soffer & Ajzenstadt, 2010). For instance, in 2014, 30.9% of women in federal and state facilities were victims of substantiated inmate-on-inmate sexual victimization, and 58.1% were victims of corroborated staff-on-inmate sexual victimization (Beck, Rantala, & Rexroat, 2014).

Despite the prevalence of trauma in the lives of incarcerated women (e.g., prior to incarceration and during incarceration), few studies have included trauma-related cognitions in their analysis. Trauma-related cognitions, a criterion for a diagnosis of posttraumatic stress disorder (PTSD) and a common response to interpersonal trauma (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5]; American Psychiatric Association [APA], 2013), often results in distorted views about self (e.g., “I can’t do anything right”), feelings of guilt and blame (e.g., “It was my fault”), and a sense of being unsafe in the world (e.g., “The world is a frightening place”; Foa, Riggs, Dancu, & Rothbaum, 1993; Foa & Rothbaum, 1998; Moser, Hajcak, Simons, & Foa, 2007). Left unchallenged, trauma-related cognitions can become self-hindering, leading to the development of negative trauma-related cognitions (Anderson, 2015; Foa & Cahill, 2001; Moser et al., 2007). Prolonged negative trauma-related cognitions can become entrenched and difficult to overcome unless day-to-day activities provide experiences that challenge the posttraumatic cognitions (Moser, Cahill, & Foa, 2010; Moser et al., 2007). The inability to confront and question the thoughts and emotions that are an outcome of trauma may result in the development of PTSD (Moser et al., 2010; Moser et al., 2007). Research suggests that untreated PTSD leads to verbal and memory loss (Qureshi et al., 2011), learning impairments (Yehuda, Golier, Tischler, Stavitsky, & Harvey, 2005), and attentional dysfunction (Jenkins, Langlais, Delis, & Cohen, 2000). Such deficiencies can serve as roadblocks to securing viable employment during reentry. The effect of trauma on the cognitive processes of incarcerated women suggests a need for comprehensive treatment for survivors of trauma to improve vocational readiness and post-release adjustment.

Pre-Incarceration Trauma (PIT)

PIT represents childhood and adult trauma that has occurred prior to incarceration. The prevalence of personal victimization (women: 78% vs. men: 15%) and mental health problems (women: 73% vs. men: 55) have been reported as being higher among incarcerated women than incarcerated men (Tripodi & Pettus-Davis, 2013). Visher and Bakken (2014) reported that incarcerated women, who often experience mental health distress associated with anxiety and depression-based disorders (i.e., PTSD), reported poorer health outcomes, hospitalizations, suicidal ideations, and difficulty securing employment and housing. Given that incarcerated women are more prone to experience interpersonal violence (compared with the general population), given that these experiences are linked to the development of PTSD and other anxiety-based disorders (Berliner & Elliott, 2002; Jones, Worthen, Sharp, & McLeod, 2017), and given that mental health resources are scarce within many communities, the effect of PIT on incarcerated women’s vocational readiness is an important issue to consider.

Incarceration-Based Trauma (IBT)

For women, the prison experience is distinctive. A previous study conducted in 13 prisons (12 for men and 1 for women) reported that inmates typically live under the threat of physical and sexual assault, theft, robbery, and property damage, with one out of every 10 inmates being victims of physical assault within a 6-month period (Wolff, Blitz, Shi, Siegel, & Bachman, 2007). Therefore, the prison environment can be interpreted as one of “danger, deprivation and degradation” (C. Haney, 2012, p. 3). Indeed, the prison environment has been described as “neither normal nor natural” and one of the most degrading experiences one can endure (DeVeaux, 2013, p. 259). We suggest that the ability to survive IBT is relative to incarcerated women’s ability to navigate this unnatural environment. For previously incarcerated persons, the “atypical patterns and norms” associated with institutionalization present challenges when returning to their communities. For instance, the adaptive behavior necessary for managing the prison culture may be interpreted as dysfunctional by family, friends, and community members, making it difficult to rebuild interpersonal relationships and engage in work-related activities once released from prison (Haney, 2003). The effects of incarceration will be different for everyone and the subtle process of institutionalization makes it difficult for previously incarcerated persons to challenge the psychological adaptive measures that were implemented while incarcerated.

Motherhood and Incarceration

Women, unlike men, are more often the primary caregivers of their children (Glaze & Maruschak, 2008). For incarcerated women, the fear of losing custody of their children may further exacerbate trauma-related cognitions (e.g., guilt, shame, feeling sad or hopelessness, self-blame, self as incompetent), resulting in trauma-related cognitions becoming negative (Moser et al., 2010; Moser et al., 2007). For incarcerated women, being separated from their children has been considered as the most “difficult” and “damaging” part of incarceration (Arditti & few, 2006, p. 104; Covington & Bloom, 2003). Negative trauma-related cognitions associated with trauma experiences, specifically interpersonal traumas and PTSD, are often more common with women than with men (Bonnan-White, Hetzel-Riggin, Diamond-Welch, & Tollini, 2018; Kessler, 2000). Experiences expressed as IBT may lead to retraumatization for incarcerated women with prior trauma histories (Anderson, 2015; Boxer, Middlemass, & Delorenzo, 2009; Haney, 2001, 2012), and an initial trauma for incarcerated women without prior trauma experiences (Dirks, 2004). This, inevitably, would further compromise her negative trauma-related cognitions and limit her ability to engage in future-oriented behavior such as securing employment (vocational readiness) during post-release adjustment.

Herman’s Theory on Complex Trauma

Exposure to any amount of trauma may disturb the continuity of self (Herman, 1992). The fragmenting of one’s self happens through a systematic process of questioning one’s ideals and values—ideals and values that have traditionally provided a rationale for one’s existence. This process may cause the self to become unrecognizable (Herman, 1992). Janoff-Bulman and Frieze (1983) refer to this process as “cognitive baggage,” which they define as “assumptions and expectations” about “self” and the “world” that are no longer recognizable or valid after a traumatic event. This inability to recognize personal indicators that confirm the existence of self may result in a fragmented self, hindering the ability to engage in future-oriented behavior (e.g., setting goals, planning activities, and obtaining employment; Janoff-Bulman & Frieze, 1983). In contrast, survivors of multiple, prolonged, and/or chronic trauma may lose the sense that self exists. For instance, following a single traumatic event, one may respond by saying, “I am not myself” (Herman, 1992, p. 386). This fragmentation of the self becomes more complex in individuals exposed to childhood trauma (Herman, 1992; Phillips & Daniluk, 2004). These results suggest that incarcerated women exposed to childhood abuse may develop negative and long-standing trauma-related cognitions that ultimately hinder her post-release adjustment. Previous research suggests a significant relationship between negative trauma-related cognitions about one’s self, gender, and presenting symptoms in relation to anxiety and anxiety-based mental disorders such as PTSD (Moser et al., 2007).

Vocational Readiness

Vocational readiness, a term used in vocational rehabilitation literature, refers to the skills necessary to compete in the current work environment. The globalization of the economy demands a competitive workforce that has the ability to (a) understand and remember detailed instructions (Memory); (b) carry out work-related tasks and meet production requirements (Concentration and Persistence); (c) get along with coworkers, customers, and supervisors (Interpersonal Skills); and (d) adapt to a new and/or changing environment (Adaptation; Strauser & Lustig, 2001). In a recent study, survivors with significant PTSD showed a decrease in vocational readiness in comparison with accident survivors without PTSD (Matthews, Harris, & Cumming, 2009).

Previous research has shown that “disabled individuals, especially women, reported more incidents of trauma, abuse and violence in comparison to their non-disabled peers (Watson-Armstrong, O ’Rourke, and Schatzlein, 1995)” (Strauser & Lustig, 2001, p. 26). In addition, individuals with mental disorders often lack work experience, education, and training opportunities, and can have trouble navigating the current job market (Duwe, 2017; Pager, 2003). PTSD, a mental disorder that disproportionately affects women, accounts for a large portion of the disabled population (e.g., Moser et al., 2007; Strauser & Lustig, 2001). Diagnostic interviews from a prior study reported that 14.5% of incarcerated males and 31% of incarcerated women met the criteria for a mental disorder (Steadman, Osher, Robbins, Case, & Samuels, 2009). Given this, it seems reasonable to surmise that incarcerated women can be at a higher risk for developing PTSD in comparison with the general population (Choe, Teplin, & Abram, 2008; Friedman, Collier, & Hall, 2014; Grella, Lovinger, & Warda, 2013). We posit that it is these risk factors that can impede the ability to secure viable employment during the reentry process (Sadeh & McNiel, 2013).

In this study, we measured intrinsic and extrinsic motivation indicators of vocational readiness. Extrinsic motivation refers to external rewards (e.g., money, status, position), while intrinsic motivation refers to internal rewards (e.g., personal satisfaction, meaningful, purposeful; Rowe, 2004, p. 32). We used a sample of incarcerated women to investigate the following research questions:

Are PIT, IBT, and PTSD severity associated with trauma-related cognitions in a sample of incarcerated women?

Are there differences between PIT, IBT, and PTSD severity in the ability to predict trauma-related cognitions?

Are trauma-related cognitions about self, blame, and the world, and PTSD severity associated with vocational readiness-motivation (VR-M) in a sample of incarcerated women?

Are there differences between trauma-related cognitions about self, blame, and the world, and PTSD severity in their ability to predict VR-M?

Method

Participants

A random sample of incarcerated women (N = 250) was obtained from three state prisons located in the midwestern region of the United States. The total population for each facility, as of July 2013, was Prison 1 (N = 888), Prison 2 (N = 2083), and Prison 3 (N = 621). Each prison facility housed minimum-, medium-, and maximum-security inmates. An oversample list of participants was chosen from each prison facility to increase the chance of reaching the targeted number of participants (n = 300). A stratified random sampling procedure based on housing security levels (1-4) was used. Two months prior to data collection, the randomly selected list of female inmates was provided to each facility: Prison 1 (n = 185); Prison 2 (n = 140); and Prison 3 (n = 65). The response rate and final sample size resulted in the following statistics: Prison 1/47.6%/n = 88; Prison 2/88.6%/n = 124; and Prison 3/58.5%/n = 38. Data collection took place within a span of 1 week in July 2013. The demographic characteristics of the sample are provided in Table 1. The age range for the sample was 18 to 73. Female inmates between the ages of 40 and 49 (32.2%), followed by 29 or younger (31.8%), represented the majority of the sample population. Approximately 61% of the participants were White, 20% were Black, 5% were Latina, 7% were Biracial, and 5% were Native American and/or Pacific Islander. A total of 87% (n = 212) had at least a high school diploma/general education diploma (GED) or higher. In addition, 82% (n = 201) of participants were mothers, with 55% (n = 118) of them having their children living with them prior to incarceration. The majority of participants (71%) had no income prior to incarceration.

Table 1.

Demographics Characteristics by Prison.

Prisons	Prison 1	Prison 2	Prison 3	Total
Prisons	n (%)	n (%)	n (%)	N (%)
Respondents	88 (35.2)	124 (49.6)	38 (15.2)	250 (100)
Age**
18-29	30 (34.1)	42 (33.9)	4 (10.5)	76 (30.4)
30-39	4 (4.5)	6 (4.8)	0 (0.0)	10 (0.04)
40-49	34 (38.6)	30 (24.2)	13 (34.2)	77 (30.8)
50-59	14 (15.9)	28 (22.6)	11 (28.9)	53 (21.2)
60 or more	2 (2.3)	15 (12.1)	6 (15.0)	23 (9.2)
Race***
White	37 (42)	98 (79.0)	17 (44.7)	152 (60.8)
Black	31 (35.2)	11 (8.9)	8 (22.1)	50 (20.0)
Latina	6 (6.8)	1 (0.8)	5 (13.2)	12 (4.8)
Biracial	8 (9.1)	8 (6.5)	2 (5.3)	18 (7.2)
Native American/Pacific Islander	4 (4.5)	5 (4.0)	4 (10.5)	13 (5.2)
Education
Middle School	16 (18.2)	8 (6.5)	6 (15.8)	30 (12.0)
High School	39 (44.3)	44 (35.5)	11 (28.9)	94 (37.6)
College/Cert.	9 (10.2)	33 (26.6)	13 (34.2)	85 (34.0)
College Degree	2 (2.3)	25 (20.2)	6 (15.8)	33 (13.2)
Annual Income
No Income	69 (78.4)	80 (64.5)	28 (73.7)	177 (70.8)
1,500-13,000	4 (4.5)	11 (8.9)	4 (10.5)	19 (7.6)
13,001-26,000 26,001-39,000	8 (9.1)4 (4.5)	14 (1.3)11 (8.9)	3 (7.9)2 (5.3)	25 (10.0)17 (6.8)
39,001-52,001+	3 (3.4)	8 (6.4)	1 (2.6)	12 (4.8)
Living with children prior to incarceration?	43 (55.1)	58 (53.2)	17 (60.7)	118 (54.9)

Note. Race: χ²(8) = 45.066, p < .001. Age: χ²(8) = 21.52, p = .006.

p < .05. **p < .01. ***p < .001.

Procedures

This study received approval from the University of South Carolina’s Institutional Review Board. Prior to each session, respondents were informed that participation was voluntary and that they could discontinue the process at any time. Surveys were self-administered. Female inmates on death row and/or residing in level 4 security housing levels completed the surveys sitting one-on-one with the research staff member. Only one participant had not completed the survey and was excluded from the final count. One participant was partially blind, and the survey was read aloud in a sectioned-off area to accommodate the female inmates’ personal choice to take part in the study. The final sample size was 250. According to Green (1991), this sample size is considered adequate for multiple regression models with an N that is at least 10 times the maximum number of independent variables in the model.

Measures

A multiple-assessment survey was used in this study. Trauma-related cognitions (TRC) were measured by the Posttraumatic Cognitions Inventory (PTCI; Foa, Ehlers, Clark, Tolin, & Orsillo, 1999), which is a 36-item survey that assesses trauma-related beliefs and thoughts associated with traumatic events. These events were categorized into three areas: (a) negative cognitions about self, which focused on helplessness, alienation, and incompetence; (b) negative cognitions about the world, which focused on lack of trust and ideas that the world is not safe; and (c) negative cognitions about blame, which were beliefs that a traumatic event occurred because of something the person did or did not do. A PTCI total score was created by summing together the subscales of self, world, and blame. Higher score indicated higher levels of trauma-related cognitions. The internal consistency reliability scores for the PTCI composite scale (.95) and the PTCI subscales: self (.94), world (.90), and blame (.70) were good.

PIT was measured by responses to the Childhood Trauma Questionnaire (CTQ) and the Trauma Events Questionnaire (TEQ). The CTQ is a 28-item questionnaire that assesses five areas in relation to childhood trauma and victimization (sexual abuse, emotional abuse, emotional neglect, physical abuse, and physical neglect; Bernstein, Fink, Handelsman, & Foote, 1994). We created a CTQ composite variable, where higher scores indicated higher levels of pre-incarceration trauma. The TEQ is an 11-item questionnaire that assesses nine traumatic events (Vrana & Lauterbach, 1994). For this study, we used a modified TEQ, because we were only interested in the items that pertained to adult trauma, as childhood trauma was assessed by the CTQ. The internal consistency reliability for the composite scale for PIT (.89), CTQ (.84), and TEQ (.90) were good.

IBT was measured by the Incarceration-Based Trauma Scale (IBTS). This self-developed scale assessed prison experiences that contribute to stress and/or distress in the lives of incarcerated women in relation to the prison environment (e.g., psychological distress, etc.). Higher scores indicated higher levels of IBT. The internal consistency reliability for the IBTS was .70. PTSD severity was measured with a modified version of the Posttraumatic Diagnostic Scale (PDS; Foa, Cashman, Jaycox, & Perry, 1997). The PDS is a 31-item self-report measure that assesses multiple forms of childhood and adult trauma, as well as PTSD severity. As stated above, adult trauma was assessed with the TEQ and childhood trauma with the CTQ. Thus, we only used the 17 items from the PDS that assessed PTSD. Higher scores on the PDS indicated higher levels of PTSD severity. The internal consistency reliability for the PDS (.94) was good.

The Work Potential Profile (WPP) was used to assess vocational readiness (Rowe, 2004). The full version of this scale is 171 items. However, for this study, we used a modified version, which was 147 items. The WPP is comprised of three components: freedom from barriers, motivation, and physical ability. In this study, we used vocational readiness motivation, which refers to aspects related to work motivation, goal attainment, and need for status (e.g., intrinsic and extrinsic motivation). The internal consistency reliability for VR-M was .83. Higher scores indicated lower potential for vocational readiness in the area of motivation.

Data Analysis

One-Way ANOVA Between Prison Facilities

Because the sample sizes for each prison were unequal, it was important to first examine whether the prisons differed on key study variables. A series of one-way ANOVAs was conducted to determine if mean differences existed between prison facilities on trauma-related cognitions (e.g., total: self, blame, and world), PTSD severity, PIT, IBT, and vocational readiness (e.g., motivation). From the p values, trauma-related cognitions—total and subscales—significantly differed by prison facilities: trauma-related cognitions–total (4.49, p < .05), trauma-related cognitions–self (TRC-S = 4.28, p < .05.), trauma-related cognitions–blame (TRC-B = 4.78, p < .01), and trauma-related cognitions–world (TRC-W = 3.04, p < .05). Post hoc analyses (Tukey) showed that Prison 3 differed significantly from Prison 1 (p < .05) and Prison 2 (p < .01) for total trauma-related cognitions (TRC-T). The mean scores were comparable on all other measures (Table 2).

Table 2.

Summary of ANOVA Analyses for Mean Differences Between Prisons on Main Study Variables.

Predictors	Prison 1	Prison 2	Prison 3
	n = 88	n = 124	n = 38
	M (SD)	M (SD)	M (SD)	F	p
TRC	10.59 (3.03)	10.76 (3.94)	8.77 (3.48)	4.49*	.012
TRC-S	2.89 (1.30)	2.98 (1.43)	2.24 (1.23)	4.28*	.015
TRC-B	2.94 (1.28)	3.28 (1.53)	2.49 (1.32)	4.78*	.010
TRC-W	4.78 (1.28)	4.49 (1.58)	4.04 (1.74)	3.04*	.050
PTSD	19.91 (13.20)	20.43 (13.30)	15.22 (11.34)	2.37	.096
PIT	150.57 (64.26)	140.27 (56.34)	134.30 (55.09)	1.24	.291
IBT	40.83 (9.64)	41.43 (7.36)	39.50 (9.01)	0.70	.496
VR-M	20.70 (2.69)	21.15 (2.58)	20.48 (2.44)	1.21	.300

Note. TRC = Trauma-Related Cognitions; TRC-S = Trauma-Related Cognitions (Self); TRC-B = Trauma-Related Cognitions (Blame); TRC-W = Trauma-Related Cognitions (World); PTSD severity = Posttraumatic Stress Disorder; PIT = Pre-Incarceration Trauma; IBT = Incarceration-Based Trauma; VR-M = Vocational Readiness (Motivation).

p < .05. **p < .01. ***p < .001.

Association Among Study Variables

There were positive significant correlations between the observed variables representative of trauma (Table 3). For instance, PIT was positively correlated with IBT (r = .31, p < .01). Further examination indicated positive significant correlations between PIT and trauma-related cognitions: TRC-T (r = .37, p < .01), TRC-S (r = .42, p < .01), TRC-W (r = .38, p < .01), TRC-B (r = .13, p < .05). The most influential correlation was between PIT and TRC-S. In addition, there were positive significant correlations between IBT and trauma-related cognitions: TRC-T (r = .34, p < .01), TRC-S (r = .38, p < .01), TRC-W (r = .25, p < .01), TRC-B (r = .24, p < .01). As with PIT, the highest positive significant correlation was between IBT and TRC-S.

Table 3.

Bivariate Correlations.

Measure	PIT	IBT	TRC-T	TRC-S	TRC-W	TRC-B	PTSD	VR-M
1. PIT	1.00
2. IBT	.308**	1.00
3. TRC-T	.368**	.344**	1.00
4. TRC-S	.415**	.377**	.899**	1.00
5. TRC-W	.379**	.252**	.826**	.664**	1.00
6. TRC-B	.132*	.242**	.791**	.613**	.390**	1.00
7. PTSD	.544**	.365**	.634**	.683**	.545**	.373**	1.00
8. VR (M)	.148*	.223**	.212**	.268**	.147*	.125	.242**	1.00

Note. PIT= Pre-Incarceration Trauma; IBT = Incarceration-Based Trauma; TRC-T = Trauma-Related Cognitions (Total); TRC-S = Trauma-Related Cognitions (Self); TRC-W = Trauma-Related Cognitions (World); TRC-B = Trauma-Related Cognitions (Blame); PTSD severity = Posttraumatic Stress Disorder; VR-M = Vocational Readiness (Motivation).

p < .05. **p < .01. ***p < .001.

Likewise, there were significant positive correlations between PTSD and trauma-related cognitions: TRC-T (r = .63, p < .01), TRC-S (r = .68, p < .01), TRC-W (r = .55, p < .01), TRC-B (r = .37, p < .01). As with PIT and IBT, the important positive significant correlation was between PTSD and TRC-S. Further analysis of the correlations indicated a positive significant correlation between VR-M and trauma-related cognitions: TRC-T (r = .21, p < .01), TRC-S (r = .27, p < .01), TRC-W (r = .15, p < .05). Unlike previous correlations, TRC-B was not significant (r = .13, NS). However, in line with previous results, the highest significant positive correlations were between VR-M and PTSD (r = .24, p < .01) and TRC-S (r = .27, p < .01).

These results may indicate that incarcerated women in this sample that have experienced trauma prior to and/or during incarceration may result in negative cognitions that may influence their perception of self. These results are in line with previous studies that showed a stronger relationship between TRC-S and PTSD severity than TRC-W and TRC-B (Foa & Rauch, 2004; Moser et al., 2007).

Results

Predicting Trauma-Related Cognitions

To answer the first research question, a multiple linear regression was calculated to examine if PIT, IBT, PTSD severity, demographics (e.g., race, age), and prison facilities predicted trauma-related cognitions (Table 4). Overall, the independent variables in the model were statistically significant predictors of trauma-related cognitions, F(10, 214) = 16.35, p < .001, and accounted for 43.3% of the variance. The total score for TRC-T was positively associated with higher levels of PTSD severity (β = .56, p < .001) and higher levels of IBT (β = .16, p < .01). Other demographic variables in the model were not significant predictors of trauma-related cognitions.

Table 4.

Multiple Linear Regression Analysis of Predictors of Trauma-Related Cognitions-Total (TRC-T).

IV	β	t	p
PIT	−.027	−0.43	.668
IBT	.161	2.80	.006**
PTSD	.558	8.62	.001***
Age	−.066	−1.24	.218
Black	−.006	−0.11	.914
Latina	−.067	−1.23	.221
Biracial	−.016	−0.30	.769
Native American/Pacific Islander	.038	0.71	.476
P1	−.021	−0.35	.724
P3	−.064	−1.11	.267

Note. F(10, 214) = 16.35, p =.001; R² = .433; TRC = Trauma-Related Cognitions; PIT= Pre-Incarceration Trauma; IBT = Incarceration-Based Trauma; PTSD severity = Posttraumatic Stress Disorder; IV = independent variable; DV = dependent variable.

p < .05. **p < .01. ***p < .001.

Predicting Vocational Readiness Motivation

To answer the second research question, a multiple linear regression was employed to examine whether trauma-related cognitions about self, blame, and the world, and PTSD were associated with VR-M, and, if so, were there differences between trauma-related cognitions about self, blame, and the world, and PTSD in their ability to predict VR-M (Table 5). Vocational readiness in the area of motivation was primarily predicted by higher levels of trauma-related cognitions about self (β = .22, p < .05). In addition, the predicted value of VR-M was lower for incarcerated women who identified as Black (β = −.16, p < .05) or Latina (β = −.13, p < .05) compared with those who identified as White.

Table 5.

Multiple Linear Regression Analysis of Predictors of Vocational Readiness-Motivation (VR-M).

IV	β	t	p
TRC-S	.223	2.11	.036*
TRC-W	−.051	−0.59	.553
TRC-B	−.043	−0.54	.589
PTSD	.136	1.60	.112
Age	.024	0.38	.708
Black	−.160	−2.32	.021*
Latina	−.131	−2.02	.044*
Biracial	.050	0.78	.434
Native American/Pacific Islander	−.112	−1.76	.837
P1	.013	−0.21	−.711
P3	−.014	−0.19	−1.165

Note. F(11, 224) = 3.554, p =.001; R² = .149; TRC-S = Trauma-Related Cognitions–Self; TRC-W = Trauma-Related Cognitions–World; TRC-B = Trauma-Related Cognitions–Blame; PTSD severity = Posttraumatic Stress Disorder; IV = independent variable; DV = dependent variable.

p < .05. **p < .01. ***p < .001.

Discussion

The purpose of this study was to examine the relationship between trauma (PIT and IBT), trauma-related cognitions (i.e., Total; Self, Blame, and World), PTSD severity, and VR-M in a random sample of incarcerated women in three prison facilities. First, this study addressed the relationship between trauma (PIT and IBT) and PTSD as predictors of total trauma-related cognitions (TRC-T). For incarcerated women in this study, TRC-T was best predicted by trauma associated with the prison environment (IBT) and PTSD severity. Further examination of the results showed that PTSD was the best predictor of TRC-T. These results are consistent with previous studies that indicated negative trauma-related cognitions played an important role in the development and maintenance of PTSD (Foa & Rothbaum, 1998; Moser et al., 2007). We contend that the prevalence of higher trauma-related cognitions may be an indication that, without trauma-informed care, the ability to engage in post-release work-related activities may be hindered. Likewise, this study showed that higher levels of IBT were good predictors of higher levels of trauma-related cognitions. Our findings add to the literature base in that they show the critical role that IBT plays in retraumatizing incarcerated women with PIT, and how this may exacerbate their negative trauma-related cognitions. Our results also indicate that IBT serves as an initial trauma for incarcerated women without prior trauma histories, which may lead to the development of trauma-related cognitions. In this study, IBT and trauma-related cognitions were shown to be significantly and positively associated.

Second, a key aspect of this study was to examine the association between trauma-related cognitions about self, blame, and the world, PTSD, and VR-M in incarcerated women. Our findings indicated that trauma-related cognitions about self were the strongest predictor of VR-M. This result is in line with prior research that has shown TRC-S as having more influence in the development of PTSD than TRC-W and TRC-B (Moser et al., 2010; Moser et al., 2007; Tripodi & Pettus-Davis, 2013). Hence, the self-fragmentation associated with trauma-related cognitions predicted VR-M over and above trauma-related cognitions around blame, the world, and PTSD. As mentioned earlier, vocational readiness is a concept used mainly in rehabilitation research. Yet, it has relevance for the trauma literature, and the current study adds to that literature by applying this concept to incarcerated women and post-release adjustment.

Our findings indicated that for Black and Latina women, higher levels of trauma-related cognitions about “self” were predictive of a lower potential for vocational readiness in the domain of motivation. By contrast, higher levels of trauma-related cognitions about the world and self-blame did not predict vocational readiness. These results align with previous research that identified a direct relationship between trauma-related cognitions about “self” and trauma (Moser et al., 2007); yet they differ from other studies.

For instance, Matthews et al. (2009) examined trauma-related cognitions and trauma in accident survivors and showed that all three domains of trauma-related cognitions (i.e., self, world, and self-blame) had negative effects on employment activities. The incongruity in these findings suggests that trauma perceived to be accidental may not only cause one to question the existence and capabilities of self, but also to contemplate safety in the world, feelings of guilt, and self-blame. For the incarcerated women in this study, the most significant forms of trauma were caused by personal violations to self (e.g., childhood and adult sexual and physical abuse), which were not accidental. It could be that without an external nonhuman factor to attribute the traumatic event to, such as an accident, incarcerated women’s self-perception may be further challenged. This, of course, is speculative, and future research should more comprehensively explore this issue.

Likewise, this finding may be related to historical differences in housing for Black incarcerated women (custodial housing) and White incarcerated women (reformatory housing; Freedman, 1981; Rafter, 1985). Custodial settings often provided limited rehabilitative services and/or programs in comparison with reformatories. Prison 1 aligned more closely with a custodial facility because of its limited variety and accessibility of vocational training and reentry services at the time of this study. Prison 2, by contrast, provided a variety of work-related training and reentry programs. In this study, most Black and Latina incarcerated women were housed at a custodial facility, and most White incarcerated women were housed at a reformatory facility (see Table 1).

Our study is not without limitations, and the findings should be interpreted within this context. First, this study is cross-sectional; thus, causal conclusions cannot be drawn. Second, the study’s reliance on memory in recording traumatic events is a limitation because of the potential for inaccuracy in remembering details. Moreover, these questions could have potentially triggered negative emotions in some participants, which could have influenced their recall of events. Last, a modified version of the vocational readiness scale (i.e., Work Potential Profile) was utilized in this study. The slight decrease in the number of questions may have potentially resulted in a loss of information. Despite these limitations, the findings from this study are important and contribute to theory and research in the area of incarcerated women’s experiences with trauma and their vocational readiness upon reentry.

Implications and Conclusion

The combination of PIT and IBT can have negative effects on incarcerated women’s trauma-related cognitions, and, subsequently, on their vocational readiness. Vocational readiness, as this study suggests, is a concern that warrants further empirical examination. This is particularly important for women of color who are often incarcerated in facilities where there are fewer vocational programs, as indicated in this study. Prior research found that income from employment was associated with a likelihood of a 24% reduction in rearrests for incarcerated women. These results suggest that the ability to gain viable employment is an important effort in the reintegration process. For instance, Black women often return to communities facing the same challenges they faced prior to incarceration, such as unemployment, poverty, addiction, and abuse that is compounded by incarceration (Brown, 2010). As a large number of incarcerated Black women are overrepresented in the incarcerated population, and with most of incarcerated women being mothers, the ability to obtain and maintain viable employment is pertinent for her ability to meet the basic needs for herself and her children when she returns to her community.

Future examination of trauma’s effect on the development of negative trauma-related cognitions about self (e.g., self as incompetent) has the potential to inform prison mental health practice and the development of clinical interventions to decrease trauma-related cognitions about self for incarcerated women with multiple trauma experiences. Prior research has shown that individuals with psychiatric disorders associated with trauma and PTSD often lack work experience, education, and training opportunities, leading to difficulty engaging in employment activities (Anderson, 2015; Lu, et al., 2017; Strauser & Lustig, 2001). Hence, it is pertinent to address these issues in a comprehensive way to increase incarcerated women’s ability to become a productive member of family and community improving post-release adjustment.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Joi D. Anderson

Author Biographies

Joi D. Anderson, PhD, LMSW, is currently a co-investigator on a grant-funded project investigating stigma as trauma in Black women in the South affected by HIV at the University of South Carolina in the Department of Health Promotion, Education, and Behavior, in the Arnold School of Public Health and an adjunct professor in the College of Social Work at the University of South Carolina. Her research focus includes incarcerated women living with HIV/AIDS and their experiences with trauma, stigma, and resilience. Her broad interests include trauma-related cognitions; stigma; self-efficacy; and resilience, health disparities, and future-oriented behavior (e.g., academic achievement, employment, etc.) in vulnerable populations. Her previous study examined social support as a mediator between Traumatic Life Events and Health Related Quality of Life (HRQOL). She earned her PhD in Social Work from the University of South Carolina.

Ronald O. Pitner, PhD, is an associate professor and the associate dean for curriculum in the College of Social Work and is in the Faculty Excellence Initiative (FEI) position for African American Health and Social Disparities. He was named endowed chair after serving in the role of director for 3 years. The Newman Institute is named after The Reverend I. DeQuincey Newman, an important leader in the history of social justice and poverty issues in South Carolina. His research interests can broadly be defined in terms of culture and social cognition, youth violence, community violence, community civic engagement, and social justice-related issues. His current research examines the effects that community-based civic engagement has on residents’ perceptions of community ownership, community safety, and positive community development. He uses a range of research methods, including survey research, experimental design, and semistructured interviews. He holds a PhD in social work and psychology from the University of Michigan.

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