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Adapting individual psychotherapy for adults with intellectual disabilities: a comparative review of the cognitive-behavioural and psychodynamic literature
- Authors:
- WHITEHOUSE Richard M., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.55-65.
- Publisher:
- Wiley
Historically, adults with intellectual disabilities have had little access to individual psychotherapy. Over the last 20 years an increasing body of literature has described psychotherapy with adults with intellectual disabilities and reported methods for adapting traditional psychotherapeutic techniques. This review identified the frequency of adaptations suggested by Hurley et al. (1998) [Journal of Developmental and Physical Disabilities, vol. 10, pp. 365–386] within cognitive behavioural and psychodynamic studies with adults with intellectual disabilities. Twenty-five studies were reviewed, 10 cognitive–behavioural and 15 psychodynamic. A total of 94 adaptations were identified. Within cognitive behavioural therapy (CBT) studies, flexibility in method was the most frequently considered adaptation whilst transference and counter transference issues were most frequently considered within psychodynamic studies. Across the two approaches, disability and rehabilitation issues were given the least consideration. Implications for practitioners and services are highlighted along with recommendations for future research.
Individual cognitive-behavioural anger treatment for people with mild-borderline intellectual disabilities and histories of aggression: a controlled trial
- Authors:
- TAYLOR John L., et al
- Journal article citation:
- British Journal of Clinical Psychology, 44(3), September 2005, pp.367-382.
- Publisher:
- Wiley
Approximately forty detained patients with mild-borderline intellectual disabilities and histories of serious aggression were allocated to specially modified cognitive-behavioural anger treatment (AT group) or to routine care waiting-list control (RC group) conditions. AT group participants received 18 sessions of individual treatment. The AT and RC groups were assessed simultaneously at 4 time points: screen, pre- and post-treatment, and at 4-month follow-up using a range of self- and staff-rated anger measures. The effectiveness of the treatment was evaluated using ANCOVA linear trend analyses of group differences on the main outcome measures. The AT group's self-reported anger scores on a number of measures were significantly lower following treatment, compared with the RC wait-list condition, and these improvements were maintained at follow-up. Limited evidence for the effectiveness of treatment was provided by staffs' ratings of patient behaviour post-treatment. The results suggest that detained men with mild-moderate intellectual disabilities and histories of severe aggression can successfully engage in, and benefit from, an intensive individual cognitive-behavioural anger treatment that also appears to have beneficial systemic effects.
Community dialectical behaviour therapy for emotionally dysregulated adults with intellectual disabilities
- Authors:
- BAILLIE Aubrey, SLATER Sean
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(3), 2014, pp.165-173.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group. Design/methodology/approach: A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served. Findings: Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research. Research limitations/implications: This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions. Practical implications: The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently. Originality/value: The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for. (Publisher abstract)
The views of carers about support for their family member with an intellectual disability: with a focus on positive behavioural approaches
- Authors:
- MCKENZIE Karen, et al
- Journal article citation:
- Health and Social Care in the Community, 26(1), 2018, pp.e56-e63.
- Publisher:
- Wiley
This qualitative study explored the views of family carers about the support that their adult children with an intellectual disability had received in relation to their behaviour that challenged. There was a particular focus on positive behavioural support (PBS), although some participants spoke more generally in terms of positive approaches. Semi-structured interviews with eight family carers were analysed using inductive thematic analysis. Four key themes were identified. Good support, of which PBS was an example, was seen as both having reduced behaviours that challenged and having a wider positive impact on the quality of life of the individual and their families. Key features highlighted were: technical knowledge and skill; a strong value base of warmth, acceptance and respect; a collaborative, consistent approach; open communication; and the extension of support to the family carer when needed. It was recognised that there is a need for broad systemic change and for the application of a workforce development model that takes account of the needs of staff, carers and those working in wider systems that have contact with people with an intellectual disability. (Publisher abstract)
Computerised cognitive-behavioural therapy for adults with intellectual disability: randomised controlled trial
- Authors:
- COONEY Patricia, et al
- Journal article citation:
- British Journal of Psychiatry, 211(2), 2017, pp.95-102.
- Publisher:
- Cambridge University Press
Background: Despite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability. Aims: To evaluate the utility of a CBT computer game for adults who have an intellectual disability. Method: A 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis. Results: A significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU. Conclusions: As the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population. (Publisher abstract)
Positive behaviour support and supported employment for adults with severe disability
- Authors:
- WEST Elizabeth A., PATTON Holly Ann
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 35(2), June 2010, pp.104-111.
- Publisher:
- Taylor and Francis
Functional assessments and supported employment procedures have the potential to enhance quality of life factors for adults who have historically been isolated. This project addressed the needs of 4 adults with a history of challenging behaviour. The participants attended a community service organisation, were not considered for supported employment services, and were in jeopardy of termination from the programme because of the severity of their challenging behaviour. It was hypothesised that, if meaningful life opportunities were provided, the challenging behaviours would decrease. Functional assessments and supported employment procedures were used to assist the 4 participants to achieve community access and employment. Hypothesis-driven interventions were used to decrease problem behaviours and increase access to job-related activities in the community. All the participants met the criterion on task analysed job performance. When they were involved in community settings and job training, an immediate and complete absence of problem behaviour occurred within those settings. The findings emphasise the importance of positive behavioural supports and community access in the lives of adults who have historically been isolated.
Behavioral treatment of challenging behaviors in individuals with mild mental retardation: meta-analysis of single-subject research
- Authors:
- DIDDEN Robert, et al
- Journal article citation:
- American Journal on Mental Retardation, 111(4), July 2006, pp.290-298.
- Publisher:
- American Association of Mental Retardation
A meta-analytic study of the effectiveness of behavioural and psychotherapeutic treatments for challenging behaviours in individuals with mild learning disabilities is reported. For each of 133 comparisons in 80 studies, two effect sizes were calculated: PND (percentage of non-overlapping data) and PZD (percentage of zero data). Overall, behavioural interventions were shown to be effective (PND = 75%; PNZ = 35%). Studies with experimental designs and methods of experimental functional analysis produced significantly larger PNDs than those using less methodologically rigorous designs and descriptive methods. However, the review is limited because the majority of studies referred to children and adolescents in residential settings, and the applicability of the findings to adults and to different settings is in doubt.
Elicited imitation in children and adults with autism: is there a deficit?
- Authors:
- BEADLE-BROWN Julie D., WHITTEN Andrew
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 29(2), June 2004, pp.147-163.
- Publisher:
- Taylor and Francis
It has been proposed that an early deficit in imitation, together with a cascade of developmental disorders in emotion sharing and theory of mind, could be important in understanding autism, but the research on deficits in imitation is not conclusive. Using a Do-As-I-Do procedure, the present study tested the existence of a deficit in elicited imitation in a group of individuals with autism aged from 4 to 34 years and compared their performance to that of typically developing children and to children with mild to moderate intellectual disabilities. On a large battery of tasks, the majority of children and adults with autism had few problems relative to controls, although certain actions did seem more difficult, especially for the youngest children. Taking into consideration the reasonably small sample sizes, which advise cautious interpretation, implications for both theory and practice are discussed.
Advancing psychological therapies research in Northern Ireland
- Authors:
- IRVINE Mandy, et al
- Publisher:
- Public Health Agency
- Publication year:
- 2011
- Pagination:
- 191p.
- Place of publication:
- Belfast
One of a series of rapid research reviews following the Bamford Review to contribute to a needs led research programme for psychological therapies. First the paper reviews existing national and international literature regarding psychological therapies. It then outlines the findings of a regional survey into the current provision of psychological therapies and research programmes being delivered across statutory and third sector services in Northern Ireland. The findings of the presented by the four main client groups of: adults; older adults; children and young people; and learning disabilities. Conditions covered include: depression, anxiety, post traumatic stress disorder, suicide, Autistic Spectrum Disorders, Attention Deficit Hyperactivity Disorder, schizophrenia, bipolar disorder, and challenging behaviour. Finally the authors offer a model for prioritising future needs-led research in the psychological therapies in Northern Ireland.