Evaluation of ProReal-Based Therapy within a Prison Setting Dr Biljana van Rijn, Metanoia Institute Professor Mick Cooper, University of Roehampton Ciara Wild, Metanoia Institute
Research Background ProReal is an avatar-based therapeutic intervention Pilot evaluation within a prison setting between May 2014 and July 2014 Funded by Small Business Research Initiative for Healthcare (SBRI,www.sbrihealthcare.co.uk)
ProReal in Mental Health
ProReal in Healthcare
Research Aims Evaluation of ProReal impact on: Levels of psychological distress Interpersonal difficulties Achievement of personal goals Evaluation of: Feasibility within a prison setting Participants and staff experience of using ProReal
Method Intervention: 6 group sessions, once a week, 60 minutes Quantitative evaluation: personal distress (CORE- 10), interpersonal difficulties (IIP-32), achievement of personal goals (Goals Measure), system usability (SUS) Qualitative evaluation: semi-structured individual interviews, sessional notes Sample: 4 participants, 1 member of staff, 6 nonparticipants
Results Mean psychological distress (CORE-10) score at assessment: 15.0 points on 40 point scale Mean score at end of intervention: 11.3 Mean reduction of 3.7 Non-significant results Changes on interpersonal difficulties and goals not significant
30 Individual changes in distress scores 25 20 15 Participant 1 Participant 4 Participant 7 Participant 8 10 5 0 Assessment #1 #2 #3 #4 #5 #6
Interviews Intensity Length and Structure Personal Gains Therapy Research Relationship to authority Experience of measures Ease of use Props Avatars Landscape Software Overall Rating Average 7.5 out of 10
Making a decision to participate I thought what the hell is this what is going on? What s this rubbish? I thought it was. You know. I thought what are they trying to put us on now. I think everyone in the room thought, you know what I m just going to kill six week they just want us to do something. So let s just kill six week
Therapy and the Intervention: I did start doing it about my abuse and all that, I didn t want to, but I needed to because I struggled doing that in the groups in me therapy and that. If I did it that way (using ProReal) it was a lot easier. (p.4) [It was] very good because you could put as many in place as you want to. I have four avatars myself, I have the good me, the selfish me, the resentment me and the thief me ; and, you know, there is a few of them-- it s good to look at those (p.8) First of all I found it a bit daunting to start with, it opened all different sorts of emotions for me, so I d talk about my mum, stepdad, my sisters and all that. There was a time I came away from it, felt quite drained go back in my cell and lock myself off to contemplate these things. Stuff that I hadn t forgotten about but were buried deep inside of me, so I would go away with a bit of bad head on me, if you like. Then I would, after a couple of sessions I wouldn t feel so bad. Actually I started to walk around the landscape and started implementing a few things and trying to figure out where I could go and what I could do to make things better. Yeah it was ok! (p1)
Non-participants survey responses (Numbers in parenthesis = withdrawers) Strongly disagree Disagree Neither Agree Strongly agree I did not like the look of the ProReal 2 (1) 2 0 (1) 0 software I was not clear what I had to do 1 (2) 1 0 2 0 I did not think it would be of benefit 1 (1) 1 2 0 0 to me It was too much. There is already a (1) 1 3 0 (1) 0 lot of therapy going on in the TC I do not like using computers (2) 3 1 0 0 I was concerned about what it might 3 (1) 0 1 (1) 0 bring up I did not want to share my personal 0 (1) 3 (1) 1 0 0 experiences with other residents I did not want to share my personal (2) 3 1 0 0 experiences with staff It took too long to start the project (2) 2 1 1 0
Evaluation Outcomes Feasible to implement and acceptable to staff and participants Experienced as helpful in developing insight and empathy Indications of helpfulness in reducing distress
Recommendations Cautious support for implementation and further testing More structure to the interventions Longer period of therapy with longer sessions Further development of software