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“I don’t wanna be mad and sad”: using individual systemic therapy to help manage anger and low mood in an adult with a learning disability
- Author:
- BIRDSEY Nicola
- Journal article citation:
- British Journal of Learning Disabilities, 49(2), 2021, pp.179-190.
- Publisher:
- Wiley
People with learning disabilities have historically been overlooked in research investigating the efficacy of therapeutic interventions, despite the increased prevalence of mental health difficulties among this population. As it is not uncommon for individuals with learning disabilities to be part of different relational systems (including access to a range of services), it seems logical to consider wider systems when seeking to understand difficulties that individuals may experience. While it is encouraging that there is growing interest in the use of systemic interventions for people with learning disabilities, there is limited peer-reviewed research exploring psychological difficulties from a systemic lens. This paper seeks to address the gap in literature by presenting a case where individual systemic therapy is used to help an adult with a learning disability to manage low mood and anger. The paper documents the therapist's clinical decision-making and learning from this case, with the hope that it encourages others to consider systemic interventions for people with learning disabilities in future. (Edited publisher abstract)
Psychological interventions for anger and aggression in people with intellectual disabilities in forensic services
- Author:
- BROWNE Claire
- Journal article citation:
- Aggression and Violent Behavior, 39, 2018, pp.1-14.
- Publisher:
- Elsevier
This systemic review investigates the current evidence for the effectiveness of anger and/or aggression interventions for people with intellectual disabilities (ID) in receipt of forensic mental health services. Due to the prevalence within this population of difficulties with anger and aggression, and the associated substantial individual and societal consequences, the provision of psychological interventions has become increasingly common. However, no critical synthesis of the empirical evidence relating to their effectiveness has previously been conducted. Sixteen peer-reviewed controlled trials or case series designs published between 2001 and 2016 met the inclusion criteria. The results highlight an emerging evidence base for the use of CBT in improving anger regulation, and for a range of psychological therapies in reducing aggressive behaviour. However, consistent methodological shortcomings limit the generalisability of findings and currently preclude firm conclusions on effectiveness. Recommendations are made for future research to address these shortcomings, including clearly-defined adaptations, adequately powered sample sizes, carefully designed baselines and follow-up periods. Despite the current status of evidence, the review provides an accessible and objective foundation to inform decision-making by service commissioners and clinicians providing anger and aggression interventions to people with ID. (Publisher abstract)
Say it with flowers
- Author:
- HOPKINS Graham
- Journal article citation:
- Community Care, 17.4.03, 2003, pp.44-45.
- Publisher:
- Reed Business Information
Looks at how horticultural therapy has been helping a women with learning difficulties deal with her aggression and challenging behaviour.
Adapting dialectical behaviour therapy in forensic learning disability services: a grounded theory informed study of “what works”
- Authors:
- BROWNE Claire, BROWN Gill, SMITH Ian C.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 32(4), 2019, pp.792-805.
- Publisher:
- Wiley
Background: Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about “what works” facilitating engagement and change. Methods: Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. Results: The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra‐/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants’ motivation, beliefs about safety and ability to change, and interactions with staff. Conclusion: Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness. (Edited publisher abstract)
Narrative therapy in a learning disability context: a review
- Author:
- MCPARLAND James
- Journal article citation:
- Tizard Learning Disability Review, 20(3), 2015, pp.121-129.
- Publisher:
- Emerald
Purpose: Narrative therapy is aligned with government priorities for learning disabilities as it promotes inclusion and seeks to empower. While research on narrative therapy in learning disability services is emerging, it has not been critically evaluated. This paper aims to identify, summarise and critique the extant literature that has explored narrative therapy for adults with learning disabilities, and to consider the implications for research and clinical practice. Design/methodology/approach: A literature search identified seven relevant case studies that described individual narrative therapy interventions for adults with learning disabilities. A qualitative review of these studies was carried out. Findings: Overall, the reviewed studies offer tentative evidence for the short-term usefulness of narrative therapy for difficulties with anger and qualitative benefits for ritualistic behaviour, social anxiety and stealing behaviour. Research limitations/implications: A number of methodological issues are identified, particularly concerning the use of outcome measures and the generalisability of findings. The research is limited due to a reliance on case study evidence and outcome measures that lack validity and reliability. Both larger scale and more robust research, and high quality practice-based evidence, are required. Originality/value: This paper provides an up-to-date, comprehensive review of the literature on narrative therapy for people with learning disabilities that will be of use to clinicians providing therapeutic support and to people commissioning such services. (Edited publisher abstract)
Resetting the balance: from despair to self-determination
- Authors:
- HALL Ian, CROSSLEY Brenda, MERCER Mark
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 4(3/4), 2013, pp.70-76.
- Publisher:
- Emerald
Purpose: A case study approach to highlight the use of cognitive neurological rehabilitation in the therapeutic management of two service users who have a diagnosis of learning disability and who have exhibited the extremes of aggressive and challenging behaviour. The purpose of this paper is to explore the remarkable progress made by two service users for whom services seemed to be at a loss as to how to meet all but there basic needs. Their journeys from hopelessness to optimism and recovery are both attributable to the cognitive neurological rehabilitation model and how staff and service users worked together to gradually regain control. Design/methodology/approach: A case study approach highlighting the value of training, team working and a therapeutic model and the impact this has made on service users who, in the past, where labelled as highly disruptive and potentially untreatable. Findings: That the cognitive neurological approach is effective in managing service users who have certain cognitive deficits in a structured and supportive way that allows positive progress towards recovery. Practical implications – A very practical intervention that can be taught and supported. An intervention that appears to achieve excellent clinical results. Originality/value – Very original and effective approach to care and treatment of service users with diagnosis of learning disability living in conditions requiring security. (Publisher abstract)
Therapeutic progressions of client and therapist throughout a course of psychodynamic therapy with a man with mild learning disabilities and anger problems
- Author:
- ALIM Nadja
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 4(1), March 2010, pp.42-49.
- Publisher:
- Emerald
Anger problems, coupled with challenging behaviour in people with learning disabilities is an area of growing concern both clinically and economically within the NHS. Although there is a long history of psychodynamic therapy with people with learning disabilities and anger problems, there is little evidence that suggests that this approach is effective. This paper outlines a case study exploring 18 psychodynamic therapy sessions with a 34 year old adult male with mild learning disabilities and anger problems. It investigated therapy outcomes and progress along a nine-stage Malan model, as well as analysing therapeutic interactions leading to therapy progression. The case study patient’s progression along Malan stages was explored by a thematic analysis matching therapy sessions to the Malan model. The investigation of therapeutic interactions was achieved by discourse analysis of those therapy sessions indicative of Malan-Stage progression. In conclusion, the author suggests that people with learning disabilities and anger problems may benefit from short-term psychodynamic therapy interventions.
Using specific approaches for individual problems in the management of anger and aggression
- Authors:
- LINDSAY William R., et al
- Journal article citation:
- British Journal of Learning Disabilities, 26(2), 1998, pp.44-50.
- Publisher:
- Wiley
This article investigates treatment for anger and aggression using a variety of methods in people with learning difficulties. Treatment approaches include two forms of relaxation (BRT and APR), discussions and exercises on the understanding of emotion, role-plays to develop skills for dealing with feelings of anger, and exercises in the way in which individuals construe various situations.
The effectiveness of painting therapy program for the treatment of externalizing behaviors in children with intellectual disability
- Authors:
- BEH‐PAJOOH Ahmad, ABDOLLAHI Abbas, HOSSEINIAN Simin
- Journal article citation:
- Vulnerable Children and Youth Studies, 13(3), 2018, pp.221-227.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Externalizing behaviours are prevalent among children with intellectual disability (ID). This study was conducted to identify the effectiveness of painting therapy program in alleviating the externalizing behaviours of male children with ID. In a randomized clinical trial, 60 children with ID were separated into intervention group and control group. The intervention group received the painting therapy program (12 weeks; two sessions per week), while the control group did not receive any program. The questionnaires were completed by their parents in order to evaluate the externalizing behaviours of children at the beginning and at the end of the painting therapy program. A two-way repeated-measure Analysis of Variance showed that the mean levels of externalizing behaviours in the intervention group decreased after the painting therapy program. In addition, the analysis showed that the mean levels of externalizing behaviours between the intervention group and the control group were significantly different. The findings revealed that painting therapy program could alleviate the externalizing behaviours of children with ID. (Edited publisher abstract)