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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
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.
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)
From denial to acceptance of sexually offending behaviour: a psychodynamic approach
- Author:
- BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.293-299.
- Publisher:
- Emerald
Purpose: Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted probation with a condition of treatment. However, when he attended treatment he denied the offence. Thus do those providing treatment send them back into the criminal justice system or work with them try and help them accept what they have done and provide appropriate treatment to help them reduce future risk of offending. Design/methodology/approach: In this case study the assimilation model was used to understand the process of change and monitor change through exploratory psychotherapy. The psychotherapeutic model was psychodymnamic. Findings: The client demonstrated gains through the stages of the model toward acceptance of his problematic behaviour and continued to work on this through further psychotherapy. Originality/value: The assimilation model offers a useful approach to monitor change in psychotherapy; but especially when the client does not accept the problem the rest of the world feels they have. (Publisher abstract)
Service user satisfaction with individual psychotherapy for people with intellectual disabilities
- Authors:
- KHAN Mahbub Munir, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.277-283.
- Publisher:
- Emerald
Purpose: Psychological therapies are increasingly being made available to adults with intellectual disabilities. However, little is known about service user satisfaction with this type of intervention. The aim was to ascertain quantitative and qualitative data on user satisfaction with the psychological therapy they had received. Design/methodology/approach: In total, 20 recipients of psychological therapy completed the Satisfaction with Therapy and Therapist Scale – Revised (STTS-R; Oei and Shuttleword, 1999) and the Experience of Service Questionnaire (Commission for Health Improvement, 2002). The scales were adapted for language and administered in an assisted completion format by an independent researcher after a course of psychological therapy had been completed. Descriptive statistics were used to analyse the quantitative data and thematic analysis was used to analyse the qualitative data. Findings: Generally, recipients were highly satisfied with their therapist and the therapy they received. Originality/value: The results confirm previous findings from two small-scale qualitative studies. Service user satisfaction is a key quality outcome measure and can be collated in routine practice for people with intellectual disabilities. The collation of qualitative responses in addition to quantitative measures is important to enable the expression of dissatisfaction and greater detail in order to inform service improvement. (Publisher abstract)