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Adapted dialectical behaviour therapy for male offenders with learning disabilities in a high secure environment: six years on
- Authors:
- MORRISSEY Catrin, INGAMELLS Bridget
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(1), January 2011, pp.8-15.
- Publisher:
- Emerald
Dialectical behaviour therapy (DBT) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. Standard DBT is an integrated model combining a range of cognitive and behavioural approaches with aspects of Eastern philosophy, including mindfulness meditation, and has several treatment modes. The model has previously successfully been used to address violence and aggression in a forensic setting. The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning disabilities in 2004, and the programme has been developed over a period of 6 years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain. It concludes that adapted DBT is a promising approach to address self-harm and aggression in hospitalised forensic populations with learning disability and personality disorder, but much creativity and adaptation is necessary. Manualised approaches need to serve as a guidance rather than being rigidly prescriptive.
Behavioural interventions for self injurious behaviour: a review of recent evidence (1998–2008)
- Author:
- PRANGNELL Simon
- Journal article citation:
- British Journal of Learning Disabilities, 38(4), December 2010, pp.259-270.
- Publisher:
- Wiley
This study provides an update to a review by Emerson published in 2001 on behavioural interventions for self injurious behaviour (SIB) for people with learning disabilities. A systematic search of peer reviewed journals and the ‘grey’ literature identified 34 relevant documents published between 1998 and 2008, the majority of which were single case studies. These papers tended to report only on changes in the frequency of SIB during the intervention; therefore conclusions cannot be made about the long term efficacy and generalisability of these approaches. Reductions in SIB were highly variable, often produced in controlled environments and with the use of aversive interventions. This study presents implications for research and clinical practice and highlights the need for more research reporting on the effectiveness of new interventions such as positive behavioural support.
A case study demonstrating the effectiveness of an adapted-DBT program upon increasing adaptive emotion management skills, with an individual diagnosed with mild learning disability and emotionally unstable personality disorder
- Authors:
- ASHWORTH Sarah, MOONEY Paul, TULLY Ruth J.
- Journal article citation:
- Journal of Forensic Psychology Research and Practice, 17(1), 2017, pp.38-60.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
The effectiveness of an adapted-DBT (dialectical behavioural therapy) program upon adaptive emotion management is reviewed. This case study focuses upon a male forensic inpatient diagnosed with mild learning disabilities and emotionally unstable personality disorder who presented with behavioural difficulties including self-harm and aggression. Following development of a psychological formulation, informed by an initial psychological assessment process, the client was referred for the “I Can Feel Good” program (Ingamells & Morrissey, 2014), which is designed to reduce difficulties managing emotions and resulting problematic behaviours. This was in addition to supplementary individual sessions designed to support and reinforce skills developed within the group. The effectiveness of this intervention was assessed using a combination of approaches including a range of self- and staff-report psychometrics and observational data. Findings demonstrated an effect upon some secondary treatment targets (namely an increase in use of mindfulness techniques and adaptive coping strategies) but no overall reduction of the primary treatment target of emotional management or associated emotional and psychological problems. Reflection upon the initial formulation in light of findings is discussed. Methodological difficulties and issues of evaluation are reviewed. Future adaptation of the “I Can Feel Good” program is considered. (Edited publisher abstract)
Self-injurious behaviour: what do we know and where are we going
- Author:
- MURPHY Glynis
- Journal article citation:
- Tizard Learning Disability Review, 4(1), January 1999, pp.5-12.
- Publisher:
- Emerald
Self-injurious behaviour can become an intransigent difficulty, reduce people's quality of life and lead to hospital admissions or other restrictive outcomes. Over the last 15 years there have been some important developments in the treatment of severe self-injury, but the evidence is that these are making little impact on most people's lives. The reasons why this might be are discussed, and it is proposed that it is time for a radical new approach to interventions for self-injurious behaviour.