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Doing more, feeling better: a behavioural approach to helping a woman overcome low mood and anxiety
- Authors:
- STUART Simon, GRAHAM Christopher D., BUTLER Sarah
- Journal article citation:
- British Journal of Learning Disabilities, 42(4), 2014, pp.328-335.
- Publisher:
- Wiley
A substantial body of literature exists concerning the adaptation of cognitive behavioural therapy for people with learning disabilities. However, it is possible that cognitive approaches have been prioritised at the expense of behavioural techniques that are simpler and more effective. This case conceptualisation considers a behaviourally focused approach to helping a woman with a mild learning disability who was experiencing low mood and anxiety, delivered by a trainee clinical psychologist working within a multidisciplinary team. (Edited publisher abstract)
Cognitive behavioural therapy and the impact of internalised societal discourses in people with intellectual disabilities: a case example
- Authors:
- GERRY Louise, CRABTREE Jason
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(1), 2013, pp.59-65.
- Publisher:
- Emerald
Cognitive behaviour therapies (CBT) are being seen as the treatment of choice for people with intellectual disabilities. And, the authors suggest, as the focus of national services change, more people with learning disabilities are likely to access mainstream health services such as Improving Access to Psychological Therapies in which CBT is often the primary mode of therapy. With this in mind they describe a cautionary case that demonstrates some of the potential dilemmas and challenges that can be experienced when working with clients with intellectual disabilities. The challenges stem from using an approach that locates problems within people rather than as being generated and maintained through social relations and social discourses. The case describes work with Mark, a young man with intellectual disabilities who accessed services for support with his low mood. It appears from this case example that there is the potential for therapeutic techniques used in CBT to promote questions that invite, generate and reinforce feelings of incompetence and inability in people with intellectual disabilities. The authors discuss the use of narrative techniques as a means of avoiding locating the problem as being within clients with intellectual disabilities; the implications that this has for the use of CBT with this client group are considered.
Treatment of erotomania using cognitive behavioural psychotherapy approaches
- Author:
- HURLEY Anne Desnoyers
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 6(2), 2012, pp.76-81.
- Publisher:
- Emerald
Erotomania is a delusional disorder in which the person believes that another loves him or her although there has been no evidence to encourage this belief. Erotomania is a rare disorder that occurs in people with intellectual disability and can last for many years. The cause of erotomania is believed to be loneliness as it occurs most frequently in socially isolated people. This article presents a case report illustrating successful treatment of a woman with erotomania and intellectual disability. Pharmacotherapy assessment suggested its ineffectiveness and medicines were slowly reduced and discontinued. Cognitive behavioural psychotherapy provided a venue to discuss personal issues and work on solutions. The community support system was enlisted to approach the problem using 2 main psychotherapeutic strategies: eliminating social attention for the delusion; and increasing social relationships. This treatment resulted in great improvement, and within 3 years the individual returned to previous functioning with no symptoms of the delusional disorder.
A cognitive behavioural intervention for dental anxiety for people with learning disabilities: a case study
- Authors:
- PRANGNELL Simon J., GREEN Karen
- Journal article citation:
- British Journal of Learning Disabilities, 36(4), December 2008, pp.242-248.
- Publisher:
- Wiley
Very little work has been done to investigate effective non-medical approaches for supporting people with a learning disability and dental anxiety to access dental care. Using a case study, this paper demonstrates that a simple cognitive behavioural intervention can be effective in reducing dental anxiety, and offer a more meaningful choice of treatment options. This paper is limited in that no formal assessment measures were used, and was evaluated through client feedback. It is possible that this intervention could be applied by other practitioners to increase the accessibility of dental health services.
The influence of anger-arousal level on attribution of hostile intent and problem solving capability in an individual with a mild intellectual disability and a history of difficulties with aggression
- Authors:
- MacMAHON Kenneth M.A., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.99-107.
- Publisher:
- Wiley
Recent studies have suggested that cognitive biases may play an important mediating role in aggressive outbursts from people with mild intellectual disabilities (IDs). Essentially, some individuals may frequently perceive other people as acting towards them in a hostile fashion. This biased perception may develop through repeated adverse experiences, and may make them more likely to respond, likewise, in an aggressive manner. These studies have led to the development of a cognitive behavioural model of aggression, incorporating factors both intrinsic and extrinsic to the individual. This study aimed to explore one facet of this model: a putative relationship between anger-arousal level, problem-solving ability and perception of hostile intent in others. Single-case methodology was utilized, and a 44-year-old man with a mild ID and a history of difficulties with aggression participated. A series of vignettes, containing potentially provocative social interactions, were read to the participant. His perception of hostile intent, and suggestions of possible behavioural responses were recorded as dependent variables. Anger-arousal was manipulated, through autobiographical recall, as a dependent variable. Although not conclusive, results indicate that anger-arousal may act in an interactive fashion to increase perception of hostile intent. No effect of anger-arousal was observed on problem-solving ability; however, floor-effects in the task used may provide an explanation for this. A high level of anger-arousal may exacerbate the probability of a frequently aggressive individual perceiving others as acting in a hostile manner. However, future research should take the limitations of this study into account, and continue development of a cognitive model of frequent aggression in those with a mild ID.
Readiness for cognitive therapy in people with intellectual disabilities
- Authors:
- WILNER Paul, MORGANNWG Bro
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.5-16.
- Publisher:
- Wiley
Cognitive therapies are increasingly being offered by clinical psychologists to people with intellectual disabilities. This paper reviews some of the factors that influence people's readiness to engage in cognitive therapy. Limited verbal ability, psychological-mindedness (particularly in relation to the understanding of emotions and the mediating role of cognitions), and self-efficacy, are all likely to present significant barriers. There may also be motivational barriers to treatment, including the functionality of some psychological presentations, maladaptive beliefs promoting resistance to change, the intellectually challenging nature of cognitive therapy, and external factors such as inappropriate settings. Engagement with therapy can be promoted by involving carers to support the therapy, but carers may themselves display a range of limitations of ability and motivation similar to those displayed by clients, which need to be recognized, and where possible addressed, in order for their involvement to be effective. If barriers to treatment are recognized, significant steps can be taken to increase accessibility. In addition to simplifying the delivery of therapy, there is also scope to simplify the model; this point is illustrated by case examples, and some principles for formalizing modifications to standard procedures are suggested. As barriers to treatment can often be surmounted, a decision whether or not to offer cognitive therapy should be derived from a comprehensive formulation, and should never be based solely on a client's performance on tests of cognitive ability.
Developing a logic model to guide evaluation of impact for learning disability projects: the case of the Positive Behavioural Support (PBS) Academy
- Authors:
- SCOTT Suzi J., DENNE Louise D., HASTINGS Richard P.
- Journal article citation:
- Tizard Learning Disability Review, 23(3), 2018, pp.125-132.
- Publisher:
- Emerald
Purpose: Measuring “impact” is an important aspect of the dissemination of evidence-based practice and relevant to all disciplines. However, it has only recently become a focus of enquiry and is not commonly directly researched within the learning disabilities field. The purpose of this paper is to describe the process of developing a logic model for the UK Positive Behavioural Support (PBS) Academy as part of an evaluation and impact study of its work to date. Design/methodology/approach: Logic models are a visual representation of the relationship between a project’s resources, activities and outputs and identified outcomes, in relation to key stakeholder groups. This representation allows for key impact measures to be identified and can be a useful tool for evaluation purposes. The authors used the process outlined by McLaughlin and Jordan (1998) to develop a bespoke logic model for the PBS Academy. Findings: The model was particularly helpful in making clear the distinction between output and impact, identifying impact criteria differentiated by stakeholder group and across time scales, and highlighting areas of activity that are needed to increase the impact of the work of the PBS Academy in the longer term. Originality/value: In the absence of any generalised impact evaluation frameworks in the learning disabilities field, the authors suggest that logic models may provide a useful framework for evaluating the impact of policy, practice, and research interventions. (Edited publisher abstract)
Acceptance and commitment therapy (ACT) with a learning disabled young person experiencing anxious and obsessive thoughts
- Authors:
- BROWN Freddy Jackson, HOOPER Sian
- Journal article citation:
- Journal of Intellectual Disabilities, 13(3), September 2009, pp.195-201.
- Publisher:
- Sage
- Place of publication:
- London
This case study, of a young person (Sarah) with moderate to severe learning disabilities who was experiencing obsessive and anxious thoughts, illustrates how the Acceptance and Commitment Therapy (ACT) model, a type of Cognitive Behavioural Therapy (CBT), can be individually adapted to help people with learning disabilities. Using ACT-based experimental activities, including mindfulness and defusion exercises, Sarah learned to notice her thoughts, distance herself from their literal content, remain calmer, become more socially confident and return to a part-time college course. The activity-based nature of ACT is concluded to be more suited for people with learning disabilities than the verbal reasoning skills utilised traditionally in CBT. The authors call for further work as both techniques require adaptation and individualisation for each client and are dependent on both the extent of a person’s learning disabilities and how well their language and cognitive skills allow engagement with the therapeutic process.
Cognitive-behavioural therapy for command hallucinations and intellectual disability: a case study
- Author:
- BARROWCLIFF Alastair L.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 21(3), May 2008, pp.236-245.
- Publisher:
- Wiley
This paper reports a case study documenting the successful application of CBT targeting the treatment of command hallucinations for mild intellectual disability. A range of measures (including positive and negative syndrome scale, beliefs about voices questionnaire and psychotic symptom rating scale for auditory hallucinations) collected at pre- and post-intervention indicates successful reduction in positive symptoms, with 3- and 6-month follow-up data indicating maintenance of improvements. Critically, positive clinical changes in core beliefs regarding the power of the hallucinatory voice are also observed. Concludes that cognitive-behavioural therapy for command hallucinations can be successfully adapted and applied to people with a mild disability.
Treating chronic nightmares of sexual assault survivors with an intellectual disability - two descriptive case studies
- Authors:
- KROESE Biza Stenfert, THOMAS Gail
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.75-80.
- Publisher:
- Wiley
Imagery rehearsal therapy for people who suffer from recurring nightmares has been shown to be a successful intervention. Very little research has been conducted on post-traumatic nightmare sufferers with learning disabilities. This paper presents two case studies to illustrate the application of an adapted form of imagery rehearsal therapy to adults with learning disabilities. Both descriptive cases indicated that the intervention resulted in significant reductions in distress because of nightmares and provided some evidence that these positive results were generalized into waking life. As a short and simple method, imagery rehearsal therapy appears to be very suitable for people with learning disabilities.