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Cognitive-behavioural intervention for people with intellectual disability and anxiety disorders
- Authors:
- DAGHAN Dave, JAHODA Andrew
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.91-97.
- Publisher:
- Wiley
Distinct cognitive models and treatments have been developed for people without intellectual disability with a wide range of anxiety disorders. However, these have not been reported as applied to people with intellectual disabilities. In fact, much of the cognitive therapy literature for people with intellectual disabilities does not distinguish between different presentations of anxiety. The authors take the particular example of social phobia and describe the specific cognitive model and associated intervention developed for people without intellectual disabilities. They then consider research on the social context of people with intellectual disability and research on developmental factors predictive of anxiety and make suggestions for adaptation of treatment approaches. It is suggested that such an approach would be useful to apply to other anxiety presentations and to identify areas for further clinical and research development.
Depression, social context and cognitive behaviour therapy for people who have intellectual disabilities
- Authors:
- JAHODA Andrew, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.81-89.
- Publisher:
- Wiley
This paper examines how the life experience of people with intellectual disabilities may influence the nature of their self-perceptions and their vulnerability to depression. In addition to considering the impact of experience on the content of participants' self-perceptions, evidence concerning the mediating role played by cognitive factors in the genesis and maintenance of depression is also reviewed. These strands of research are discussed in the light of existing CBT models of depression, along with potential adaptations of interventions for people with intellectual disabilities.
Therapy expectations: preliminary exploration and measurement in adults with intellectual disabilities
- Authors:
- KILBANE Amy L., JAHODA Andrew
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 24(6), November 2011, pp.528-542.
- Publisher:
- Wiley
This study began with the hypothesis that certain characteristics of people with intellectual disabilities and their pathway to psychological interventions may make their expectations of therapy and motivation to attend sessions particularly significant influences on the therapy process and outcomes. This preliminary exploration measured therapy (CBT) expectancy in adults with intellectual disabilities through the development and psychometric evaluation of the therapy expectation measure (TEAM). Six adults with intellectual disabilities took part in semi-structured interviews about therapy expectancy and motivation to identify TEAM items. A further 22 participants living in the Glasgow area piloted the measure. This study confirmed that the TEAM has acceptable test–retest reliability and internal consistency. There was a strong positive relationship with a measure of general self-efficacy. Client expectations of therapy were largely positive and congruent with therapy as a goal-oriented process in which they would be an active participant. However, a number of individuals were unclear about the reason for referral and felt a low level of involvement. Client and carer perceptions of referral were significantly different. The authors conclude that the TEAM instrument may help clinicians to identify potential barriers to engagement in therapy and find ways of enhancing the therapeutic experience of adults with an intellectual disability. Further evaluation of the TEAM with larger samples is required.
Talking about real-life events: an investigation into the ability of people with intellectual disabilities to make links between their beliefs and emotions within dialogue
- Authors:
- HEBBLETHWAITE Amy, JAHODA Andrew, DAGNAN Dave
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 24(6), November 2011, pp.543-553.
- Publisher:
- Wiley
This study explored how adults with mild-moderate intellectual disabilities talk about emotive real-life experiences and whether they identify and make links between events, beliefs and emotions within their narratives. A cognitive-emotive interview was used to assist 19 adults with intellectual disabilities from the west of Scotland and 19 adults without disabilities to generate an account of an emotive, interpersonal event. Participants (mean age 42-43 years, 23 women in total) also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Between-group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive-emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within-group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. The authors conclude that because participants with intellectual disabilities had more difficulties in talking about events, beliefs and emotions they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors.
The balance of power in therapeutic interactions with individuals who have intellectual disabilities
- Authors:
- JAHODA Andrew, et al
- Journal article citation:
- British Journal of Clinical Psychology, 48(1), March 2009, pp.63-77.
- Publisher:
- Wiley
Establishing a collaborative relationship is a cornerstone of cognitive behavioural therapy (CBT). Increasingly CBT is being offered to people with intellectual disabilities who may have problems with receptive and expressive communication, and a history of disadvantage or discrimination in their relationships with those in positions of power. Consequently, they may have difficulty establishing a collaborative interaction with their therapist. This paper uses a novel method of interactional analysis to examine if collaboration increases as therapy progresses. Fifteen participants with borderline to mild intellectual disabilities and significant problems of depression, anxiety and anger were recruited from specialist clinical services to participate in this study. Verbatim transcripts of therapy sessions 4 and 9 were coded using an initiative-response method of analysing power distribution in dialogue, to investigate collaboration at the level of therapeutic interaction. The initiative response scores indicated that power was relatively equally distributed between clients and therapists. On this measure there was no significant increase in collaboration as therapy progressed, as the dialogues were relatively equal from session 4. Analyses of the pattern of interaction showed that whilst the therapists asked most questions, the clients contributed to the flow of the analysis and played an active part in dialogues. The implications of these findings are discussed, along with the possible uses of such interactional analyses in identifying barriers to communication and ways of establishing effective therapeutic dialogue.