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Journal article

Cognitive behavioural treatment for anger in adults with intellectual disabilities: a systematic review and meta-analysis

Authors:
NICOLL Matthew, BEAIL Nigel, SAXON David
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 26(1), 2013, pp.47-62.
Publisher:
Wiley-Blackwell

An evidence base for the use of cognitive behavioural treatment (CBT) for adults with intellectual disabilities is emerging. The aim of this paper is to systematically review the current literature on the effectiveness of CBT for anger in adults with intellectual disabilities and provide a meta-analysis of the findings. A literature search found 12 studies published since 1999 eligible for the quality appraisal (10 conducted in the UK and 2 conducted in Australia). Nine of these provided sufficient data to be included in the meta-analysis. The results from the review reveal an emerging evidence base for cognitive behavioural anger interventions in adults with intellectual disabilities. The quality appraisal revealed that studies are now utilising reliable and valid measurements of the anger construct. Furthermore, the quality appraisal revealed a good level of methodological rigour, especially in the studies that were entered into the meta-analysis. The meta-analysis revealed large uncontrolled effect sizes for the treatment of anger in adults with intellectual disabilities, but is viewed with caution due to low sample sizes. Overall, the literature is limited by concatenated data, a lack of comparative control groups and small study samples.

Journal article

Service user views of long-term individual psychodynamic psychotherapy

Authors:
MERRIMAN Charlotte, BEAIL Nigel
Journal article citation:
Advances in Mental Health and Learning Disabilities, 3(2), June 2009, pp.42-47.
Publisher:
Emerald

Long-term psychodynamic psychotherapy is a costly service to provide, but many clinicians believe it is of benefit for people who have learning disabilities and psychological problems. There is also now some evidence for its effectiveness. However, the views of recipients is unknown. In this study, recipients of more than two years of psychodynamic psychotherapy were interviewed about their experiences and views. Themes emerged about the referral process, the experience and the outcome. Areas of strength were identified, as well as areas for improvement. The findings concur with previous findings on group therapy and help inform current and future provision of long-term psychodynamic psychotherapy.

Journal article

Empathy and theory of mind in offenders with intellectual disability

Authors:
PROCTOR Tracey, BEAIL Nigel
Journal article citation:
Journal of Intellectual and Developmental Disability, 32(2), June 2007, pp.82-93.
Publisher:
Informa Healthcare

Little research has been carried out on empathy and theory of mind in offenders with intellectual disability (ID) and these concepts are often poorly defined.  Various models of empathy and theory of mind are discussed and scores on 2 empathy and 3 theory of mind tasks are compared for 25 offenders with ID and 25 non-offenders with ID (all male). Differences were found in empathy and theory of mind performance of offenders and non-offenders with ID. Offenders performed better than non-offenders on a second order theory of mind task and on emotion recognition. They required fewer prompts to mention emotions, and gave empathic/caring responses more often than non-offenders when observing happiness (but not sadness or anger). Results suggest that offenders with ID may have better, rather than poorer, empathy and theory of mind abilities than non-offenders, and that empathy training is therefore not indicated for this group.

Journal article

Monitoring change in psychotherapy with people with intellectual disabilities: the application of the Assimilation of Problematic Experiences Scale

Authors:
NEWMAN David W., BEAIL Nigel
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 15(1), 2002, pp.48-60.
Publisher:
Wiley-Blackwell

The assimilation model and the assimilation of problematic experiences scale (APES), provide a structured account of changes occurring within psychotherapy. The model proposes that the clients assimilate their problematic experience through the development of schema observable in the psychotherapeutic setting. The model provides a way of describing change in psychotherapy independent of affiliation to a single theoretical school. This paper aims to demonstrate the application of APES methodology to psychotherapy with people with intellectual disabilities. An innovative research procedure is implemented, utilizing transcript and rating procedures in relation to a client and therapist dialogue within psychodynamic psychotherapy. Outcome data is collected from psychometric questionnaires. Quantitative data and qualitative methods are combined to portray results in the format of a single case study. The presented case illustrates assimilation achieved by a client with intellectual disabilities within and across psychotherapy sessions. Outcome data is also provided. This study provides a newly obtained information on the applicability of psychotherapy and the assimilation model in relation to this client group. The outcome data acts as a point of reference with which to examine the nature and validity of APES findings. The present authors argue that process research has a significant role in advancing our understanding of psychotherapy with the people with intellectual disabilities.

Journal article

Evaluation of a psychodynamic psychotherapy service for adults with intellectual disabilities: rationale, design and preliminary outcome data

Authors:
BEAIL Nigel, WARDEN Sharon
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 9(3), 1996, pp.223-228.
Publisher:
Wiley-Blackwell

The debate concerning the provision of psychotherapy services for people with intellectual disabilities has moved on from issues of 'relevance' through 'equity' to the current issue of 'effectiveness'. The latter is hard to prove from the available research and clinical literature. Reports on preliminary results from an evaluation of a psychodynamic psychotherapy service for adults with intellectual disabilities. Presents the rationale and design, including details of process and outcome measures, and preliminary results. Issues concerning operationalisation of such a study in normal clinical practice are discussed.

Journal article

Psychological therapies and people who have ID: a report from the Royal College of Psychiatrists and British Psychological Society

Author:
BEAIL Nigel
Journal article citation:
Advances in Mental Health and Intellectual Disabilities, 11(1), 2017, pp.24-26.
Publisher:
Emerald

Purpose: Over a decade ago “Psychotherapy and learning disabilities” was published by the UK Royal College of Psychiatrists. It was decided by the Royal College and British Psychological Society’s faculties for people who have ID to revise and update this report. The paper aims to discuss these issues. Design/methodology/approach: Experts in the field were invited to make a contribution on their approach covering method, adaptations, service user views and outcomes. Findings: A great deal has changed in the last decade in terms of service development and research resulting in a much wider range of therapies being made available and there being a growing evidence base. Research limitations/implications: Further work needs to be carried out to make such information accessible to carers and service users. Practical implications: The report is a useful resource for professionals involved in the support of the mental health and emotional needs of people who have ID. (Edited publisher abstract)

Journal article

The use of mechanical restraint with people who engage in severe self-injurious behaviour: impact on support staff

Authors:
BETHEL Nichola, BEAIL Nigel
Journal article citation:
Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.312-318.
Publisher:
Emerald

Purpose: There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices, there is very limited literature looking at the impact the use of mechanical restraints has upon service users and support staff using them. The aim of this study was to ascertain the experiences of support staff who apply the restraints to the people they support. Design/methodology/approach – Qualitative methodology was utilised. A semi-structured interview was conducted with nine support workers who: directly worked with a client with intellectual disabilities who engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and they had to have been directly involved in the application and removal of the mechanical restraints in the last week. Content analysis utilising emergent coding was used to analyse the data. Findings: All participants described using mechanical restraints as having a negative impact upon them. Participants said they manage the negative impact by reframing, inhibiting their emotions, following support plans closely and gaining support from other staff. Participants described concerns and unmet needs regarding whether they were applying the restraints correctly, the responsibility of teaching others to use restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints is not talked about. Recommendations for practice are made. Originality/value: This is the first study to explore the views of care staff who are required to use mechanical restraint. It provides insight on the impact of this on them. (Publisher abstract)

Journal article

Assessing components of empathy in sex-offenders with intellectual disabilities

Authors:
RALFS Sonya, BEAIL Nigel
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 25(1), January 2012, pp.50-59.
Publisher:
Wiley-Blackwell

Aiming to examine empathy in sex offenders with intellectual disabilities because of a lack of previous research, this study focused on the components outlined in the 4 stage process model of empathy (emotion recognition, perspective taking, emotion replication, and response decision). 21 male sex offenders with intellectual and developmental disability and 21 male non-offenders with intellectual disabilities completed the Test of Emotional Perception, and the responses were compared. The study found that there were no significant differences between the 2 groups across the components of empathy, but that sex offenders who had received treatment performed better on tasks of emotion recognition, emotion replication and response decision than the non-offenders. The authors conclude that further research is needed to understand empathy in sex offenders with intellectual disabilities.

Journal article

Self-harm among people with intellectual disabilities living in secure service provision: a qualitative exploration

Authors:
BROWN Jessica, BEAIL Nigel
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 22(6), November 2009, pp.503-513.
Publisher:
Wiley-Blackwell

This study explored the experiences and understanding of self-harm among people with intellectual disabilities living in secure accommodation. Interventions associated with this behaviour were also explored. Semi-structured interviews were carried out with nine people who self harm, had intellectual disabilities and had been placed in secure accommodation. Interpretative Phenomenological Analysis yielded three master themes. The first related to the interpersonal context of self-harm and included sub themes relating to past experiences of abuse and loss, and current issues of control and protection. The second master theme related to the emotional experience of self-harm, which varied throughout the process of self-harm and was characterized by anger, frustration, hopelessness, relief, guilt and regret. The third master theme related to the management of self-harm. Participants had experience of helpful individual and collaborative strategies, as well as interventions that were experienced as controlling, unhelpful or ridiculing. The emerging themes are considered in relation to the wider-self-harm literature and current psychotherapeutic models. A number of limitations to the study are noted and the use of this methodology with people with intellectual disabilities was discussed.

Journal article

The experience of detention under the Mental Health Act (1983)

Authors:
McNALLY Carolyn, BEAIL Nigel, KELLETT Stephen
Journal article citation:
Advances in Mental Health and Learning Disabilities, 1(4), December 2007, pp.47-53.
Publisher:
Emerald

This study explored the experiences of detention under the Mental Health Act (1983) of people with learning disabilities. Seven semi-structured one-to-one interviews were analysed using interpretative phenomenological analysis. Participants had mild learning disabilities and had been detained under the Mental Health Act in England for compulsory assessment and treatment within a two-year period prior to the study. A number of valuable insights emerged, including: the impact of perceived lack of control over self, experiences of vulnerability/powerlessness/victimisation (both prior to and following detention), participant's sense of care versus punishment; the development of 'role' within the mental health system and attribution of blame.

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