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Experiences of running an anxiety management group for people with a learning disability using a cognitive behavioural intervention
- Authors:
- DOUGLASS Sarah, PALMER Katherine, O'CONNOR Chris
- Journal article citation:
- British Journal of Learning Disabilities, 35(4), December 2007, pp.245-252.
- Publisher:
- Wiley
An anxiety management group utilizing a cognitive behavioural intervention, of 12 weeks duration, for six people with mild to moderate learning disabilities is described. A number of techniques to assist in developing clients’ understanding of their anxiety, cognitive and behavioural coping strategies and maximizing generalizability of skills learnt were implemented. Outcome measures demonstrated that two participants showed a clinically significant reduction in anxiety levels. Qualitative feedback from both participants and carers suggested that all group members developed coping strategies. Measures also indicated that carers demonstrated a better understanding of the individual's difficulties and were able to support them more effectively. Adopting a cognitive behavioural approach proved valuable and recommendations for future interventions are made.
Low self-esteem: group cognitive behaviour therapy
- Authors:
- WHELAN Anne, et al
- Journal article citation:
- British Journal of Learning Disabilities, 35(2), June 2007, pp.125-130.
- Publisher:
- Wiley
This article describes a self-esteem cognitive behavioural therapy group run with adults with learning disabilities. The aim is to show how a group of this nature can be organized and run, using theory to inform practice. An introduction to the concept of self esteem will be given and then explored in relation to adults with learning disabilities. Details of the group, including how people were selected, will then be discussed. Some basic background information on group members and a cognitive behavioural formulation will follow. Then contents of sessions and the use of an adapted outcome measure will be mentioned, followed by some final reflections on the group.
The provision of psychological therapy to people with intellectual disabilities: an investigation into some of the relevant factors
- Author:
- MASON J.
- Journal article citation:
- Journal of Intellectual Disability Research, 51(3), March 2007, pp.244-249.
- Publisher:
- Wiley
Five factors are proposed as important in influencing the provision of psychological therapy to people with intellectual disabilities (IDs): the perceived effectiveness of psychological therapy, individual clinician competence, service resources (number of trained clinicians), the level of the client's disability and the diagnostic overshadowing bias. A prospective questionnaire design was used. A survey style questionnaire was sent out to clinical psychologists (n = 412) and psychiatrists (n = 274) working in ID services in the UK. Responses were received from 133 psychologists and 90 psychiatrists. Perceived competence, the level of the client's disability and the diagnostic overshadowing bias all appeared to be important factors. The perceived effectiveness of psychological therapy with this client group and service resources appeared less important than hypothesized. Whereas the debates in research publications tend to focus on broad issues of effectiveness, clinicians themselves appear more concerned with their personal skill levels. The issue of the appropriateness of psychological therapies for people with more severe levels of disability remains largely unresearched.
Cognitive-behavioural treatment for men with intellectual disabilities and sexually abusive behaviour: a pilot study
- Authors:
- MURPHY Glynis, et al
- Journal article citation:
- Journal of Intellectual Disability Research, 51(11), November 2007, pp.902-912.
- Publisher:
- Wiley
A pilot study providing group cognitive behavioural therapy (CBT) for two groups of male sex offenders with ID in the south-east of England is described. Measures of change in sexual knowledge, victim empathy and cognitive distortions were collected, together with a log of further sexually abusive behaviour. Fifteen men were offered treatment but some dropped out and some declined to take part in the research. The results for the eight men who consented to the research and completed treatment showed significant positive changes in sexual knowledge and victim empathy (two men completed both groups, making 10 sets of data in all). Cognitive distortions showed significant change on only one of the two measures. Some men showed further sexually abusive behaviour either during or after the treatment group (all had been previously diagnosed as on the autistic spectrum). The authors call for a larger multi-site trial of treatment with a broad set of measures and the ability to analyse who benefits from such treatments and who does not.
Generalization of anger-coping skills from day-service to residential settings
- Authors:
- WILLNER Paul, TOMLINSON Sarah
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(6), November 2007, pp.553-562.
- Publisher:
- Wiley
This study aimed to evaluate the extent to which anger management training provided within a learning disabilities day service generalizes to residential settings. Eleven day-service users participated in one of two anger management groups. Treatment was delivered by day-service staff and an assistant psychologist, using a standard cognitive-behavioural therapy (CBT) package shown to be effective in earlier studies. Evaluation was by the Provocation Index and the Profile of Anger-Coping Skills, which measure, respectively, the potential to react in an angry manner, and the utilization of eight different anger-coping skills. Participants showed a decrease in anger and an increase in anger-coping skills, which was maintained at 6-month follow-up. Similar changes were reported by day-service key-workers and by residential carers (and by the participants themselves). At the level of the group, key-workers and home carers did not differ significantly, at any time, in their ratings of anger, aggregate coping skills or individual coping skills. Within each setting, profiles of coping skills differed between individuals but were relatively stable across the 6-month follow-up period. However, there was no significant correlation between the profiles of coping skills reported for individual service users in the two settings. The results confirm that group-based CBT is an effective treatment for people with learning disabilities and anger management problems. Therapeutic gains are maintained for at least 6 months and generalize across settings. Different anger-coping skills may be used by different people, or by the same person in different environments.
The Life Skills group - an introductory multi-modular group programme in forensic learning disability
- Authors:
- HEARNE S., et al
- Journal article citation:
- British Journal of Forensic Practice, 9(2), July 2007, pp.3-13.
- Publisher:
- Emerald
This article describes an innovative, multi-modular group therapy programme based on cognitive-behavioural principles and psycho-education. It introduces participants to strategies and skills to assist with deficits such as poor social skills, low self-esteem, poor emotional regulation and problematic inter-personal relationships. The manual-based format enables members to be introduced to working in a group, and enables facilitators to obtain qualitative information about group members to promote existing skills in future treatment programmes. The programme can also be used for clients with learning disability and offending behaviours who are resident in the community.
Group treatment for men with intellectual disability and sexually abusive behaviour: service user views
- Authors:
- HAYS Sarah-Jane, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 32(2), June 2007, pp.106-116.
- Publisher:
- Taylor and Francis
Men with intellectual disability (ID) and sexually abusive behaviour are a disempowered and marginalised group. Nevertheless, as service users, they can be consulted and involved in a variety of different ways, including ascertaining their views of the services they receive. A group of 16 men with ID and sexually abusive behaviour were interviewed to ascertain their views approximately 2 months after completing a 1-year group cognitive behavioural treatment (CBT) for sexual offending. Two raters independently reviewed interview transcripts and participant responses were summarised. The most salient components of treatment recalled by participants were: sex education; legal and illegal behaviours and their consequences; and discussions about specific sexual assaults. Only 3 of the 16 participants stated that they had problems with sexual offending, and only 1 identified that he had learnt about victim empathy, although this is an important component of treatment. Having support, the knowledge that they had the same problems as other group members, and talking through problems, were appreciated as some of the "best things" about the group, while the "worst things" were generally person-specific. Participants had mixed views on talking about their own offences during group sessions and, overall, viewed the experience as difficult but helpful. Valuable insights into the aspects of treatment that group members found useful were explored. Such insights are often not captured by studies that assess the efficacy of treatment models using treatment-specific measures only, and these are important in defining the quality of services provided.
Cognitive behavioural therapy for people with learning disabilities: focus on anger
- Author:
- WILNER Paul
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 1(2), June 2007, pp.14-21.
- Publisher:
- Emerald
Cognitive behavioural therapy (CBT) is being used increasingly with people with learning disabilities. The evidence base to support these developments comes from uncontrolled trials of CBT in a variety of psychological disorders and eight to nine controlled trials of CBT for anger (plus a single controlled study for depression). This article reviews the evidence for the effectiveness of group-based anger management and the acquisition of anger coping skills, and the effectiveness of individual anger treatment, with some discussion of the status of CBT for other indications and the difficulties of conducting outcome research in this area.
Successful multi-disciplinary and multi-treatment working for a person with learning disability who experienced major depressive disorder
- Authors:
- MACKAY Fiona, WILSON Claire
- Journal article citation:
- Tizard Learning Disability Review, 12(3), July 2007, pp.39-47.
- Publisher:
- Emerald
Janette is a young women with both mild intellectual disability and moderate physical disabilities who experienced a major depressive disorder at a stage of her life when many young adults leave home. This case study highlights the success of a multi-disciplinary, multi-agency and multi-element intervention for severe depression in relation to the task of adolescence. The impact of a combination of treatments (including attendance at an assessment day unit, electro-compulsive therapy (ECT) and cognitive behaviour therapy (CBT)) on Janette's mood has been assessed regularly using the Glasgow Depression Inventory - Learning Disability scale. In this case these multiple inputs have had the desired effect of greatly improving mood, which has been sustained via outpatient follow-up and tailoring of day and respite services.
Comparing sexual offender treatment efficacy: mainstream sexual offenders and sexual offenders with special needs
- Authors:
- KEELING Jenny A., ROSE John L., BEECH Anthony R.
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 32(2), June 2007, pp.117-124.
- Publisher:
- Taylor and Francis
This paper investigates the efficacy of a treatment program for sexual offenders with special needs in comparison to treatment outcomes for mainstream sexual offenders in Australia. Follow-up data is also presented for the group of offenders with special needs. Participants from the two groups were matched on four variables (risk category, sex of victim, type of offence and age). All participants completed an assessment battery pre- and post-treatment and the scores on these tests were analysed for each group. Change on these measures was also compared between the two groups. Follow-up data for the special needs cohort were collected from an offender database. Overall, both groups made few significant changes on the tests post-treatment, however individual results demonstrated that some offenders in both groups had achieved reliable change. In comparing treatment results between the two groups, the sexual offenders with special needs differed only on progress relating to "avoidant" relationship styles. The results also indicated that social desirability bias played a significant role in self-report assessment for both groups. Follow-up data for the group with special needs identified that none of the offenders had committed further sexual offences, after an average release time of 16 months. There are a number of limitations to this study, particularly as a result of the experimental design and the small number of participants, and these should be considered as a major limitation on the conclusions drawn from the results. However, it is suggested that the program had some positive effects for some offenders, with little difference in progress detected between the two groups. Possible explanations for the varied outcomes are discussed.