Cognitive behavioural therapy for people with learning disabilities: focus on anger

The Effectiveness of a Recreational Behavioural Programme in Reducing Anger among Children with Intellectual Disabilities at the Primary Stage

This study aimed to investigate the impact of a recreational behavioural programme on reducing the degree of anger among children with intellectual disabilities (ID) in the primary stage. The study was implemented with 24 children who were randomly divided into two groups: an experimental group (n = 12, age = 10.80 ± 1.03 years, IQ = 63.10 ± 4.43 scores, ASW = 55.50 ± 1.51 scores) and a control group (n = 12, age = 10.80 ± 0.92 years, IQ = 63.00 ± 4.16 scores, ASW = 56.00 ± 1.15 scores). We used the PROMIS anger scale with a modification that was used to measure the degree of anger, and the recreational behavioural programme was implemented three times per week for six weeks. The results of the research showed that the improvement percentages for Anger Triggers (AT), Inner Anger (IA), and External Anger (EA) were 9.73%, 9.04%, and 9.60%, respectively, and the Anger scale as a whole (ASW) rate was 9.46%. r = (0.89-0.91). The experimental group using the recreational behavioural programme also outperformed the control group, as the results indicated a decrease in the intensity of anger in the direction of the experimental group. The differences in the improvement percentages for Anger Triggers (AT) Inner Anger (IA), and External Anger (EA) were 32.97%, 31.03%, and 26.63%, respectively, and the Anger scale as a whole (ASW) rate was 30.09%, r = (0.82-0.86). The results of the study confirmed the effectiveness of the recreational activity programme in developing social interaction among children with intellectual disabilities, which indicates the success of the recreational behavioural programme in reducing the degree of anger among children with IDs. Therefore, the recreational behavioural programme had a positive effect in terms of reducing the degree of anger among children with IDs in the primary stage.

Impacts of cognitive behavior therapy on occupational stress among science and social science education facilitators in open and distance learning centers and its implications for community development: A randomized trial group

BACKGROUND

Extensive review of literature showed that no available study in Nigeria has explored the impact of cognitive behavior therapy (CBT) on the management of occupational stress among open and distance learning (ODL) centers science and social science education facilitators. Thus, this study determined the impacts of CBT on the management of occupational stress among science and social science education facilitators in ODL centers in South-South Nigeria.

METHODS

A randomized controlled trial experimental design was adopted for the study with a sample size of 68 science and social science education facilitators in ODL centers in South-South states, Nigeria. Perceived stress scale (PSS) and Occupational stress index (OSI) were used for data collection. Using Cronbach alpha method, internal consistency reliability indices of 0.81 and 0.85 for PSS and OSI respectively were obtained in the Nigerian context. A 12-week cognitive behavior therapy intervention was conducted after which the participants in both the intervention group and the non-intervention group were administered posttest, while a follow-up assessment was administered after 2 months. Data collected were analyzed using mixed-design repeated-measures analysis of variance for the within-groups and between-groups effects.

RESULTS

It was found that CBT intervention led to a significant decrease in the occupational stress among science and social science education facilitators in ODL in the South-South region of Nigeria.

CONCLUSION

Cognitive behavior therapy is effective in the management of occupational stress among science and social science education facilitators in distance learning centers.

Adapting Psychological Therapies for Autism - Therapist Experience, Skills and Confidence

BACKGROUND

Psychological interventions informed by cognitive behavioural theory have proven efficacy in treating mild-moderate anxiety and depression. They have been successfully adapted for autistic children and adults who experience disproportionately high rates of co-occurring emotional problems. There has been little research into the perspectives and experience of psychological therapists adapting cognitive behavioural therapy (CBT) as part of routine clinical practice. We surveyed therapist skills, experience and confidence in working psychologically with autistic people, in order to highlight gaps and needs, as well as strengths in terms of therapist skills when working with this group.

METHOD

Fifty therapists attending a training event completed a survey about their experience of adapting CBT for autistic clients, alongside a measure of therapist confidence.

RESULTS

Almost all therapists reported making adaptations to CBT practice when working with autistic clients. Key challenges identified were rigidity in thinking and pacing sessions appropriately. Therapists were relatively confident about core engagement and assessment skills but reported less confidence in using their knowledge to help this group. Therapist confidence was not associated with years of practice or number of adaptations made, but was positively associated with level of therapy training received.

CONCLUSIONS

This study highlights a need for training and ongoing supervision to increase therapist confidence in and ability to make appropriate adaptations to CBT treatment protocols for autistic people.

Development of a scale to measure fidelity to manualized group-based cognitive behavioural interventions for people with intellectual disabilities

The context for the present study was a cluster-randomized controlled trial of a group-based anger-management intervention, delivered by day-service staff. We aimed to develop a scale to measure the fidelity of manualized cognitive-behavioural therapy (CBT) delivered to adults with intellectual disabilities in group-based settings. A 30-item monitoring instrument (the MAnualized Group Intervention Check: MAGIC) was adapted from an existing fidelity-monitor instrument for individual CBT. Two sessions for 27 groups were observed by pairs of monitors who had no other contact with the intervention. 16 observers participated, in 15 unique pairings. Observers recorded high levels of inter-rater reliability and the scale had good internal consistency. Fidelity ratings predicted two key outcomes of the intervention, and were themselves predicted by the therapists' clinical supervisors.

Access all areas: creative adaptations for CBT with people with cognitive impairments – illustrations and issues

Policy and legislation requires clinicians and services to address diversity and equalities including disability. Currently, practice, training and research do not do this adequately. This paper outlines why adapted CBT is important and presents some evidence to increase accessibility for people who have cognitive impairments, learning disabilities and/or neurodevelopmental disorders. It demonstrates how CBT can be made accessible through clinical examples using traditional, adapted and personalized assessment and intervention materials. Implications and recommendations are identified.

Anger management for people with mild to moderate learning disabilities: study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff

BACKGROUND

Cognitive behaviour therapy (CBT) is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision.

METHODS/DESIGN

This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis.

DISCUSSION

This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have very significant benefits in relation to the current policy of improving access to psychological therapies, in addition to addressing more effectively an important and often unmet need of this vulnerable client group. The economic analysis will identify the direct and indirect costs (and/or savings) of the intervention and consider these in relation to the range of observed effects. The qualitative analyses will enhance the interpretation of the quantitative data, and if the study shows positive results, will inform the roll-out of the intervention to the wider community.

TRIAL REGISTRATION

ISRCTN: ISRCTN37509773.

CBT for People with Intellectual Disabilities: Emerging Evidence, Cognitive Ability and IQ Effects

Historically people with intellectual disabilities have not been offered or received cognitive behavioural interventions that have been shown to be effective for mental health and emotional problems experienced by those without such disabilities. This is despite many people with intellectual disabilities having life experiences that potentially result in them having an increased risk to such problems. This paper discusses whether such therapeutic disdain is justified based on the evidence that is available and emerging concerning the application of cognitive behavioural interventions for this population. Issues concerning access to services, the ability of people with intellectual disabilities to engage in and benefit from the cognitive components of CBT, and the effect of cognitive abilities and IQ level on treatment effectiveness are explored in relation to this question.