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Many individuals who are incarcerated have co-occurring substance use disorders that can lead to continued substance use and criminal activity post-release. The insidious and cyclic nature of substance use disorder limits the ability of these individuals fulfill meaningful life roles and engage in an occupationally rich life upon their return to the community. The current field of research examining effective in-prison treatment for those with substance use disorders highlights the need for evidence-based, occupation-focused treatment programs to address substance use disorder in an incarcerated population. After a review of recent literature, it was found that effective substance use treatment programs in correctional settings are occupation-focused, gender-responsive, and trauma-informed; include multiple treatment modalities and an aftercare component; and facilitate the creation of trust-based relationships. The author considered these essential elements while creating The Power to Choose, a 16-session manualized group treatment protocol that is occupation-focused and recovery-oriented. The protocol was reviewed by field experts to determine social validity. Recommendations from experts were implemented into the final version of the group treatment protocol and submitted to the correctional facility for program implementation and evaluation.

Extant treatments for borderline personality disorder (BPD) are time-intensive, consist of multiple components, and are informed by different theoretical perspectives. Comprehensive evaluation of the driving mechanism(s) maintaining BPD is warranted to maximize cost-effectiveness and efficiency of treatment. Focusing on impaired interpersonal functioning in BPD, a hallmark characteristic of the disorder, may provide a useful microcosm for evaluating different approaches to understanding what drives the full expression of the disorder. This study evaluated two brief, theoretically distinct interventions for BPD and their effects on interpersonal conflict using single case experimental design. Patients (N = 8; 6 female, mean age 27.00, range 19–55) were randomized to receive an intervention either informed by emotion dysregulation theory or attachment theory. Patients reported their frequency of daily interpersonal conflicts using ecological momentary assessment and completed weekly questionnaires including measurement of theoretically-consistent mechanisms and global BPD symptoms. It was hypothesized that patients would demonstrate a significant response (50% decrease in daily interpersonal conflicts) during either intervention compared to baseline. It was also hypothesized that patients would evidence decreases in the purported mechanism of whichever intervention they received. Regarding change in interpersonal conflicts, three participants responded after the first module (two in the attachment security intervention, one in the emotion regulation intervention), three were partial responders (two in attachment security, one in emotion regulation), and two were classified as non-responders (both in emotion regulation). Furthermore, there were decreasing trends in both mechanisms for the majority of patients who received the corresponding interventions. Interestingly, there were decreasing trends in the alternate mechanism even when patients did not receive the corresponding intervention. No significant differences between conditions were observed related to interpersonal conflict or mechanisms. Notably, there were decreases in global BPD symptoms across both conditions. Results indicate that interpersonal conflict specifically and BPD symptoms can improve in brief interventions informed by different theories. This study suggests that multiple mechanisms may be driving BPD symptomatology and/or mechanisms may be more similar than previously stated in the literature, and points to the importance of idiographic evaluation in BPD research and treatment.

Background: Digital mental health interventions (DMHI) hold promise for addressing mental health needs on a large scale. Among these interventions, Internet-based Cognitive Behavioral Therapy (iCBT) has proven effective in tackling various mental health issues. However, the effectiveness of these interventions is hindered by a lack of sustained user engagement. A lack of knowledge on what specific iCBT content is the most engaging and the absence of a standardized approach to measure engagement hampers progress in this area. Aim: To conduct an evaluation of engagement based on usage data to learn which and what kind of iCBT content from a self-tailored blended iCBT application is the most engaging in order to inform strategies and enhance efforts to improve the overall effectiveness of the intervention. Methods: An observational, quantitative study of real-world usage data was conducted to evaluate engagement levels across various iCBT modules available in the app. Four engagement metrics were obtained from the users´ usage data: Adherence Rate, Rate of Max. Progress, Return Rate, and Average Time Spent to create rank and compare engagement levels across the iCBT modules. Results: The results included data from the 1st of January to the 30th of April of 2023 for 138 iCBT modules. The mean engagement score for all iCBT modules was 56.41±9.85, with a median of 57.30 and a range of 67.97. The most engaging iCBT modules were “Thought traps and questioning thoughts” (81.4), “A model for social anxiety” (80.5), and “Safety Behaviors” (78.1). The most engaging iCBT module classifications were “Social phobia” (92.10), “Depressive disorder” (80.70), and “Post-traumatic stress disorder” (80.40). Conclusions: Based on real-world usage data of patients, it was possible to determine the extent to which users engaged with different iCBT modules comprehensively. The findings shed light on the strengths and weaknesses of the iCBT modules regarding engagement levels. The quantitative evaluation of “in the wild” patient usage data proved useful for assessing engagement levels of specific content within the app.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13571号 / 論医博第2297号 / 新制||医||1069(附属図書館) / (主査)教授 川上 浩司, 教授 渡邉 大, 教授 村井 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

This study uses data from HopeWorks, a Christian, faith-based vocational program inside the Shelby County Division of Corrections in Memphis, Tennessee, to examine factors affecting reentry success. Specifically, this research examines how spirituality - using measures that assess both spirituality (measured at the end of the program) and change in spirituality (measured as the difference between pre- and post-program measures of spirituality) - affects released offenders' reengagement with the program, ability to obtain employment, and ability to refrain from reoffending.

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