Whether in the justice or healthcare systems or even staff and corporate wellness, there is a familiar challenge in treatment settings: participants do not always fully commit and engage in their treatment and self-care [1][2]. Behavior that is often labeled as treatment-resistant, disengaged, or burned out is more accurately seen as a nervous system operating in survival mode.
Across justice settings, mental health and substance use challenges are far more common among incarcerated people than in the general population [3]. Among youth in custody, nearly 66 percent live with at least one mental health condition [4] compared with an estimated 9 to 22 percent of the general youth population. Yet these high needs do not translate into increased participation by individuals. A classic meta-analysis estimates that roughly 40 to 50% of patients discontinue psychotherapy prematurely, a widely cited benchmark for engagement challenges across care settings [5]. This clearly underscores the importance of approaches that support readiness, self-regulation, and the ability to participate effectively in treatment.
This dynamic is not limited to the incarcerated. It extends to the staff delivering care. A 2022 U.S. correctional study reported that 57% of correctional officers and 47% of healthcare workers reported burnout symptoms [6], conditions known to impair emotional regulation, decision-making, and engagement.
This is where regulation-first treatments like the Heal intervention matter, increasing readiness so people can better engage in their treatment and wellness for the long run.
Regulation Should Come Before Insight
Modern neuroscience has clarified something clinicians have long observed: when the nervous system is dysregulated, recovery is compromised. Trauma, chronic stress, and addiction negatively affect the autonomic nervous system (ANS). For individuals in this state, reflection and verbal processing, core requirements of traditional talk therapy, become difficult or impossible.
In high-acuity correctional settings, hyperarousal and emotional shutdown become common survival responses. In moderate-acuity settings like outpatient and reentry programs, individuals may appear functional yet struggle with emotional dysregulation, relapse triggers, and sustained engagement. In lower-acuity environments, including clinical settings, healthcare systems, staff wellness, and workplaces, the same physiology shows up as burnout, poor focus, irritability, and declining productivity.
This constant heightened state of agitation has quietly become the new normal, corroding engagement, learning, and the capacity for change. When survival becomes the baseline, it stops being recognized as distress and starts being mistaken for normal functioning. Systems adapt around it, and in doing so, make meaningful engagement harder for the incarcerated, staff, and everyone involved.
Different settings. Same nervous system. Same outcomes regardless of acuity.
Research consistently shows that practices supporting self-regulation, including slow breathing, sound and music therapy, somatic practices, and mindfulness, reduce stress and restore emotional control and cognitive flexibility [7]. These approaches address the body first, allowing the mind to follow. Yet most treatments reverse the order, by asking people to think their way into calmness.
The Heal intervention is designed to flip this sequence.
Bridging the Body to the Mind
Heal’s approach starts with a simple premise: self-regulation should come first, connecting directly to whatever comes next, whether therapy, group work, reentry planning, or your workday.
The Heal intervention uses a distraction-free space called the Healpod where individuals spend five minutes in a multi-sensory experience. The sound, gentle vibrations, ambient lighting, breath guidance, and mindfulness prompts work to downshift physiological arousal. The resulting neurological realignment helps guide the nervous system into a more restful state in preparation for talk therapy.
What sets the Heal intervention apart is not only that it regulates the body, mind and emotions, but that it carries the experience into treatment. Heal converts a somatic state into a therapeutic signal through journaling. Participants write or draw what their body, emotions, and attention are communicating, turning regulation into language that the therapist can work with. By focusing on emotions, the journal becomes the bridge. In justice and clinical settings, this process feeds directly into CBT, DBT, or counseling. In reentry and community programs, it supports reflection, coping, and planning. In workplace settings, it destigmatizes mental health disorders and sharpens focus and productivity.
Decades of research on expressive writing have shown that journaling supports emotional regulation, improves cognitive/executive function, and helps integrate meaning into experience[8]. The journaling translates a regulated body state into usable therapeutic insight for the therapist.
Significance in Justice Settings
Dr. Deanna Dwenger, PsyD, Lead Mental Health Designer for Elevatus, has spent over 15 years in corrections and justice reforms. She provides a useful graphic (main image top of page) to illustrate the significance of self-regulation in the justice environment. She describes a feedback loop in which an overwhelmed, fatigued officer snaps at an inmate (Point 1). Under sustained stress, the officer’s self-regulation has broken down, leading to negative interactions that escalate tension among patients, other staff, and the entire unit (“pod” in the figure above). Without an intervention to restore regulation, the self-reinforcing cycle increases strain throughout the system.
Heal has demonstrated outcomes consistent with Dr. Dwenger’s feedback loop in an independently conducted, four-year innovation pilot study in the San Luis Obispo (SLO) County Behavioral Health Agency [9]. The project worked with county court diversion programs, treatment courts, reentry programs, probation services, and community-supervised mental health and addiction programs. Data from that study show that many incarcerated individuals struggle to verbalize their emotions, are non-verbal in talk therapy sessions, distrust authority, or fear vulnerability.
The Heal integration workflow changes this dynamic. Patients’ nervous system regulation happens in a safe, non-confrontational space where expression begins on paper prior to engaging with their therapist. After the short Heal intervention, the patient is calmer, more present, already engaged and more ready for treatment. Therapists in the SLO County program reported significantly better outcomes for patients, including improved emotional regulation, therapeutic alignment, and coping skills.
Based on the success of the initial work with the SLO County Behavioral Health Agency, Heal is extending its assessment of the Heal intervention for incarcerated youth at the SLO County Juvenile Hall. In this second program, Heal is conducting a clinical trial to assess outcomes, including the impact on emotional regulation, therapeutic engagement, stress, anxiety, and depression.
Designing for the Long Term
The relevance of these findings does not stop at the justice facility gate. Such environments and interventions can work together to support safety, rehabilitation, dignity, and effectiveness at the point of society reentry.
Self-regulation is portable. A person who learns how to downshift their nervous system while in custody can use that same skill in the future, making self-regulation not just a treatment tool, but a reintegration skill.
The same principle applies beyond justice settings. In workplaces, healthcare, and community environments, improved self-regulation supports resilience and reduces burnout. The common thread is clear: when regulation is supported, people function better and outcomes improve.
Therapy Elevated
If we want better outcomes, from improving relapse rates and reducing recidivism to making workplaces healthier, we need to start earlier in the process. We need to regulate before we rehabilitate, calm before we coach, and engage before we problem-solve.
Heal is built on this simple idea: when people can regulate themselves, everything works better. Across youth and adults. Across custody and community. Across crisis care and everyday workplaces.
Heal is not only built as an elevated therapy modality. It is built on good foundational, integrated treatment design.
Harriet Ullman is Director of Marketing and Communications for SoundHeal, Inc.; she can be reached at harriet@heal.mx
Citations
- Zaccaro A, Piarulli A, Laurino M, Garbella E, Menicucci D, Neri B, Gemignani A. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Front Hum Neurosci. 2018 Sep 7;12:353. doi: 10.3389/fnhum.2018.00353. PMID: 30245619; PMCID: PMC6137615.
- Brittany Landrum, Danica K. Knight, Patrick M. Flynn, The impact of organizational stress and burnout on client engagement, Journal of Substance Abuse Treatment, Volume 42, Issue 2, 2012,
- U.S. Department of Justice, Bureau of Justice Statistics, Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011–12 (June 22, 2017), https://www.bjs.ojp.gov/content/pub/pdf/imhprpji1112.pdf
- U.S. Department of Health and Human Services. (n.d.). Youth involved with the juvenile justice system. Youth.gov. https://youth.gov/youth-topics/juvenile-justice/youth-involved-juvenile-justice-system
- Kullgard N, Holmqvist R, Andersson G. Premature Dropout From Psychotherapy: Prevalence, Perceived Reasons and Consequences as Rated by Clinicians. Clin Psychol Eur. 2022 Jun 30;4(2):e6695. doi: 10.32872/cpe.6695. PMID: 36397946; PMCID: PMC9667417.
- Burhanullah MH, Rollings-Mazza P, Galecki J, Van Wert M, Weber T and Malik M (2022) Mental Health of Staff at Correctional Facilities in the United States During the COVID-19 Pandemic. Front. Psychiatry 12:767385. doi: 10.3389/fpsyt.2021.767385
- Dixon LB, Holoshitz Y, Nossel I. Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry. 2016 Feb;15(1):13-20. doi: 10.1002/wps.20306. Erratum in: World Psychiatry. 2016 Jun;15(2):189. doi: 10.1002/wps.20372. PMID: 26833597; PMCID: PMC4780300.
- Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial. JMIR Ment Health. 2018 Dec 10;5(4):e11290. doi: 10.2196/11290. PMID: 30530460; PMCID: PMC6305886.
- Arrington N, Benton K, Pitlick C (August 2024) MHSA Innovation Projects Evaluation SoundHeal Progress Report.
The Heal integration workflow. Photo Credit: SoundHeal
