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Taylor JL, Novaco RW. Cognitive behavioural anger treatment for adults with intellectual disabilities: effects of therapist experience on outcome. Behav Cogn Psychother 2023; 51:533-542. [PMID: 37170761 DOI: 10.1017/s1352465823000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Anger has been shown to be associated with aggression and violence in adults with intellectual disabilities in both community and secure settings. Emerging evidence has indicated that cognitive behavioural anger treatment can be effective in reducing assessed levels of anger and violent behaviour in these patient populations. However, it has been suggested that the effectiveness of these types of interventions is influenced by the experience and training of the therapists. METHOD In this service evaluation study, the pre- and post-treatment and 12-month follow-up assessment scores of 88 detained in-patient adults with intellectual disabilities and forensic histories who received cognitive behavioural anger treatment were examined in order to investigate whether participants' responsiveness to treatment was associated with treatment being delivered by qualified versus unqualified therapists. RESULTS Overall significant reductions in self-reported measures of anger disposition and anger reactivity were found with no significant time × therapist experience interaction effects. However, the patients treated by qualified therapists improved significantly on measures of anger control compared with those allocated to unqualified therapists. CONCLUSIONS Male and female detained patients with intellectual disabilities and forensic histories can benefit from an individual cognitive behavioural anger treatment intervention delivered by qualified and unqualified therapists, but therapist experience may be important in supporting patients to develop more complex anger control coping skills.
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Affiliation(s)
- John L Taylor
- Northumbria University and Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
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Elsayed AR, Hassan AK. The Effectiveness of a Recreational Behavioural Programme in Reducing Anger among Children with Intellectual Disabilities at the Primary Stage. Eur J Investig Health Psychol Educ 2023; 13:948-963. [PMID: 37366776 DOI: 10.3390/ejihpe13060072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
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.
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Affiliation(s)
- Ahmed R Elsayed
- Department of Special Education, College of Education, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Ahmed K Hassan
- Department of Physical Education, College of Education, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Department of Team Sports and Racket Games, Faculty of Physical Education, Minia University, Minya 61519, Egypt
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Tapp K, Vereenooghe L, Hewitt O, Scripps E, Gray KM, Langdon PE. Psychological therapies for people with intellectual disabilities: An updated systematic review and meta-analysis. Compr Psychiatry 2023; 122:152372. [PMID: 36724728 DOI: 10.1016/j.comppsych.2023.152372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities. METHOD A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group-based to individually delivered psychotherapy. RESULTS Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [-0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [-0.10, 0.85], N = 216, after outliers were removed. CONCLUSIONS Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions.
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Affiliation(s)
- Katherine Tapp
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Leen Vereenooghe
- v. Bodelschwinghsche Stiftungen Bethel, Psychologischer Dienst, proWerk, Nazarethweg 4, 33617 Bielefeld, Germany
| | - Olivia Hewitt
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Berkshire Healthcare NHS Foundation Trust, Learning Disabilities Service, Erlegh House, Earley Gate, Whiteknights Road, Reading, Berkshire RG6 6BZ, United Kingdom
| | - Emma Scripps
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Department of Psychiatry, School of Clinical Health Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, Birmingham B37 5RY, United Kingdom; Herefordshire and Worcestershire Health and Care NHS Trust, 2 Kings Way, Charles Hastings Way, Worcester WE5 1JR, United Kingdom; Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry CV4 7AL, United Kingdom.
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Prior D, Win S, Hassiotis A, Hall I, Martiello MA, Ali AK. Behavioural and cognitive-behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities. Cochrane Database Syst Rev 2023; 2:CD003406. [PMID: 36745863 PMCID: PMC9901280 DOI: 10.1002/14651858.cd003406.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Outwardly directed aggressive behaviour in people with intellectual disabilities is a significant issue that may lead to poor quality of life, social exclusion and inpatient psychiatric admissions. Cognitive and behavioural approaches have been developed to manage aggressive behaviour but the effectiveness of these interventions on reducing aggressive behaviour and other outcomes are unclear. This is the third update of this review and adds nine new studies, resulting in a total of 15 studies in this review. OBJECTIVES To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly directed aggressive behaviour compared to usual care, wait-list controls or no treatment in people with intellectual disability. We also evaluated enhanced interventions compared to non-enhanced interventions. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was March 2022. We revised the search terms to include positive behaviour support (PBS). SELECTION CRITERIA We included randomised and quasi-randomised trials of children and adults with intellectual disability of any duration, setting and any eligible comparator. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were change in 1. aggressive behaviour, 2. ability to control anger, and 3. adaptive functioning, and 4. ADVERSE EFFECTS Our secondary outcomes were change in 5. mental state, 6. medication, 7. care needs and 8. quality of life, and 9. frequency of service utilisation and 10. user satisfaction data. We used GRADE to assess certainty of evidence for each outcome. We expressed treatment effects as mean differences (MD) or odds ratios (OR), with 95% confidence intervals (CI). Where possible, we pooled data using a fixed-effect model. MAIN RESULTS This updated version comprises nine new studies giving 15 included studies and 921 participants. The update also adds new interventions including parent training (two studies), mindfulness-based positive behaviour support (MBPBS) (two studies), reciprocal imitation training (RIT; one study) and dialectical behavioural therapy (DBT; one study). It also adds two new studies on PBS. Most studies were based in the community (14 studies), and one was in an inpatient forensic service. Eleven studies involved adults only. The remaining studies involved children (one study), children and adolescents (one study), adolescents (one study), and adolescents and adults (one study). One study included boys with fragile X syndrome. Six studies were conducted in the UK, seven in the USA, one in Canada and one in Germany. Only five studies described sources of funding. Four studies compared anger management based on cognitive behaviour therapy to a wait-list or no treatment control group (n = 263); two studies compared PBS with treatment as usual (TAU) (n = 308); two studies compared carer training on mindfulness and PBS with PBS only (n = 128); two studies involving parent training on behavioural approaches compared to wait-list control or TAU (n = 99); one study of mindfulness to a wait-list control (n = 34); one study of adapted dialectal behavioural therapy compared to wait-list control (n = 21); one study of RIT compared to an active control (n = 20) and one study of modified relaxation compared to an active control group (n = 12). There was moderate-certainty evidence that anger management may improve severity of aggressive behaviour post-treatment (MD -3.50, 95% CI -6.21 to -0.79; P = 0.01; 1 study, 158 participants); very low-certainty evidence that it might improve self-reported ability to control anger (MD -8.38, 95% CI -14.05 to -2.71; P = 0.004, I2 = 2%; 3 studies, 212 participants), adaptive functioning (MD -21.73, 95% CI -36.44 to -7.02; P = 0.004; 1 study, 28 participants) and psychiatric symptoms (MD -0.48, 95% CI -0.79 to -0.17; P = 0.002; 1 study, 28 participants) post-treatment; and very low-certainty evidence that it does not improve quality of life post-treatment (MD -5.60, 95% CI -18.11 to 6.91; P = 0.38; 1 study, 129 participants) or reduce service utilisation and costs at 10 months (MD 102.99 British pounds, 95% CI -117.16 to 323.14; P = 0.36; 1 study, 133 participants). There was moderate-certainty evidence that PBS may reduce aggressive behaviour post-treatment (MD -7.78, 95% CI -15.23 to -0.32; P = 0.04, I2 = 0%; 2 studies, 275 participants) and low-certainty evidence that it probably does not reduce aggressive behaviour at 12 months (MD -5.20, 95% CI -13.27 to 2.87; P = 0.21; 1 study, 225 participants). There was low-certainty evidence that PBS does not improve mental state post-treatment (OR 1.44, 95% CI 0.83 to 2.49; P = 1.21; 1 study, 214 participants) and very low-certainty evidence that it might not reduce service utilisation at 12 months (MD -448.00 British pounds, 95% CI -1660.83 to 764.83; P = 0.47; 1 study, 225 participants). There was very low-certainty evidence that mindfulness may reduce incidents of physical aggression (MD -2.80, 95% CI -4.37 to -1.23; P < 0.001; 1 study; 34 participants) and low-certainty evidence that MBPBS may reduce incidents of aggression post-treatment (MD -10.27, 95% CI -14.86 to -5.67; P < 0.001, I2 = 87%; 2 studies, 128 participants). Reasons for downgrading the certainty of evidence were risk of bias (particularly selection and performance bias); imprecision (results from single, often small studies, wide CIs, and CIs crossing the null effect); and inconsistency (statistical heterogeneity). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that cognitive-behavioural approaches such as anger management and PBS may reduce outwardly directed aggressive behaviour in the short term but there is less certainty about the evidence in the medium and long term, particularly in relation to other outcomes such as quality of life. There is some evidence to suggest that combining more than one intervention may have cumulative benefits. Most studies were small and there is a need for larger, robust randomised controlled trials, particularly for interventions where the certainty of evidence is very low. More trials are needed that focus on children and whether psychological interventions lead to reductions in the use of psychotropic medications.
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Affiliation(s)
- David Prior
- Forensic Intellectual and Neurodevelopmental Disabilities (FIND) Community Team South London Partnership, Oxleas NHS Foundation Trust, London, UK
| | - Soe Win
- Services for People with Learning Disabilities (Luton), East London NHS Foundation Trust, London, UK
| | | | - Ian Hall
- Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Michele A Martiello
- More Ward, Goodmayes Hospital, North East London NHS Foundation Trust, London, UK
| | - Afia K Ali
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
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Bourne J, Harrison TL, Wigham S, Morison CJ, Hackett S. A systematic review of community psychosocial group interventions for adults with intellectual disabilities and mental health conditions. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:3-23. [PMID: 34337837 DOI: 10.1111/jar.12919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities have a high risk of developing mental ill-health. Treatment is often neglected and diagnosis is misattributed to a person's disability. Standard psychosocial interventions can improve a person's well-being. This review aimed to understand what interventions are being delivered, any benefits, and future recommendations. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review registered with PROSPERO-CRD42020160254. Databases searched included: MEDLINE, Embase, and PsycINFO. A framework synthesis approach was used to present the findings. RESULTS There are limited psychosocial interventions offered for this population. When groups are delivered having a creative element, multiple activities over a short period of time, with breaks and group rules outcomes can be improved. CONCLUSIONS Adaptations and reasonable adjustments should be used specifically to a person's ability. A mixed-method design allows people to share their experiences alongside quantitative data that provides clinical information.
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Affiliation(s)
- Jane Bourne
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
| | - Toni Leigh Harrison
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
| | - Sarah Wigham
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cindy-Jo Morison
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
| | - Simon Hackett
- Arts Therapies Department, Cumbria Northumberland Tyne & Wear NHS Foundation Trust, Northgate Hospital, Morpeth, UK
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Scott K, Hatton C, Knight R, Singer K, Knowles D, Dagnan D, Hastings RP, Appleton K, Cooper SA, Melville C, Jones R, Williams C, Jahoda A. Supporting people with intellectual disabilities in psychological therapies for depression: A qualitative analysis of supporters' experiences. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:323-335. [PMID: 30264419 DOI: 10.1111/jar.12529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/13/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. METHOD Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. RESULTS Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. CONCLUSIONS The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.
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Affiliation(s)
- Katie Scott
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Chris Hatton
- Centre for Disability Research, Lancaster University, Lancaster, UK
| | - Rosie Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Kevanne Singer
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Dawn Knowles
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Centre for Disability Research, Lancaster University, Lancaster, UK.,Cumbria Partnership NHS Foundation Trust, Workington, UK
| | - Richard P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Kim Appleton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rob Jones
- Betsi Cadwaladr University Health Board, Porthmadog, UK.,School of Psychology, Bangor University, Bangor, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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7
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Kurtek P. Prosocial vs antisocial coping and general life satisfaction of youth with mild intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:581-592. [PMID: 29682853 DOI: 10.1111/jir.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/14/2017] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The purpose of this study was to find differences in general life satisfaction in adolescents with mild intellectual disability (MID) with respect to exhibiting a prosocial or an antisocial coping style. According to the ecological approach, using the antisocial style in a competitive school environment (a zero-sum game) may increase personal satisfaction, while in the family, which operates on the principles of 'common good' or 'common failure' (a non-zero-sum game), the antisocial style may reduce general satisfaction of the individual. However, according to the self-regulatory approach, antisocial coping in interactions with parents and teachers in adolescence may increase life satisfaction as it heightens the individual's sense of autonomy. The differences between the two approaches in the hypothesised influence of a particular coping style on life satisfaction led us to conduct empirical research. METHOD A total of 151 students with MID were qualified for the final study (75 females and 76 males). The age of the examined group varied from 18 to 22 years. The study was conducted using the R-PDPI test, which is based on the Strategic Approach to Coping Scale by Hobfoll (). The test measures coping with domination and humiliation from parents and teachers as well as isolation and humiliation from peers (Kurtek ). Next, the Index of General Affect by Campbell et al. () was used to assess general life satisfaction. RESULTS Generally, a positive relationship between the indirect prosocial style and life satisfaction was found. Also, the results indicate that using the prosocial coping style to deal with humiliating acts of the mother and dominant acts of the father was connected with increased general life satisfaction, whereas the antisocial coping style employed in these situations - with a lower level of satisfaction. Moreover, it was found that general life satisfaction was positively related to passive and suppressive coping styles but negatively correlated with the antisocial coping style in situations of isolation and humiliation from peers. The paper ends with the discussion and interpretation of the results.
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Affiliation(s)
- P Kurtek
- Dept. of Pedagogy and Arts, Jan Kochanowski University in Kielce, Kielce, Poland
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8
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Cooney P, Tunney C, O'Reilly G. A systematic review of the evidence regarding cognitive therapy skills that assist cognitive behavioural therapy in adults who have an intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:23-42. [PMID: 28544303 DOI: 10.1111/jar.12365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is being increasingly adapted for use with people who have an intellectual disability. However, it remains unclear whether inherent cognitive deficits that are present in adults who have an intellectual disability preclude the use of cognitive-based therapies. This review aims to systematically examine "cognitive therapy skills" in adults who have an intellectual disability that assist engagement in CBT. METHOD Two authors independently reviewed titles and abstracts of articles located through electronic database searching. RESULTS Outcomes of the 18 studies selected for full-text review are mixed and limited by a moderately high risk of bias. CONCLUSIONS The authors suggest eleven findings from research areas of emotion recognition, cognitive mediation, discriminating between thoughts, feelings and behaviours, linking events and emotions that have implications for the design of CBT programmes and future research for this population.
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Affiliation(s)
- Patricia Cooney
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Conall Tunney
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Gary O'Reilly
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
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CBT in a Caribbean Context: A Controlled Trial of Anger Management in Trinidadian Prisons. Behav Cogn Psychother 2016; 45:1-15. [DOI: 10.1017/s1352465816000266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Anger causes significant problems in offenders and to date few interventions have been described in the Caribbean region. Aim: To evaluate a package of CBT-based Anger Management Training provided to offenders in prison in Trinidad. Method: A controlled clinical trial with 85 participants who participated in a 12-week prison-based group anger management programme, of whom 57 (67%: 16 control, 41 intervention) provided pretrial and posttrial outcome data at Times 1 and 2. Results: Intervention and control groups were not directly comparable so outcome was analysed using t-tests. Reductions were noted for state and trait anger and anger expression, with an increase in coping skills for the intervention group. No changes were noted in the control group. The improvements seen on intervention were maintained at 4 month follow-up for a sub-group of participants for whom data were available. Several predictors of outcomes were identified.
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Abstract
BACKGROUND Interventions for anger represent the largest body of research on the adaptation of cognitive behavioural therapy (CBT) for people with intellectual disabilities. The extent to which the effectiveness of these interventions reflects the behavioural or cognitive components of CBT is uncertain. This arises in part because there are few measures of anger-related cognitions. METHOD The Profile of Anger-related Cognitions (PAC) is built around interpersonal scenarios that the participant identifies as personally anger-provoking, and was designed as an extension of the Profile of Anger Coping Skills (PACS). A conversational presentational style is used to approach ratings of anger experienced in those situations and of four relevant cognitive dimensions: attribution of hostile intent, unfairness, victimhood, and helplessness. The PAC, and other measures, including the PACS, was administered to (i) people with ID identified as having problems with anger control (n = 12) and (ii) university students (n = 23); its psychometric properties were investigated and content analyses were conducted of participants' verbal responses. In a third study, clinicians (n = 6) were surveyed for their impression of using the PAC in the assessment of clients referred for help with anger problems. RESULTS The PAC had good consistency and test-retest reliability, and the total score on the four cognitive dimensions correlated significantly with anger ratings but not with impersonal measures of anger disposition. The predominant cognitions reported were perceptions of unfairness and helplessness. People with ID and university students were in most respects very similar in both the psychometric analyses and the content analyses of their verbal responses. The PAC had high acceptability both to people with ID and to clinicians. CONCLUSIONS The PAC may be a useful instrument for both clinical and research purposes. Personal relevance and the conversational mode of administration are particular strengths.
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Ali A, Hall I, Blickwedel J, Hassiotis A. Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with intellectual disabilities. Cochrane Database Syst Rev 2015; 2015:CD003406. [PMID: 25847633 PMCID: PMC7170213 DOI: 10.1002/14651858.cd003406.pub4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Outwardly-directed aggressive behaviour is a significant part of problem behaviours presented by people with intellectual disabilities. Prevalence rates of up to 50% have been reported in the literature, depending on the population sampled. Such behaviours often run a long-term course and are a major cause of social exclusion. This is an update of a previously published systematic review (see Hassiotis 2004; Hassiotis 2008). OBJECTIVES To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly-directed aggressive behaviour in people with intellectual disabilities when compared to standard intervention or wait-list controls. SEARCH METHODS In April 2014 we searched CENTRAL, Ovid MEDLINE, Embase, and eight other databases. We also searched two trials registers, checked reference lists, and handsearched relevant journals to identify any additional trials. SELECTION CRITERIA We included studies if more than four participants (children or adults) were allocated by random or quasi-random methods to either intervention, standard treatment, or wait-list control groups. DATA COLLECTION AND ANALYSIS Two review authors independently identified studies and extracted and assessed the quality of the data. MAIN RESULTS We deemed six studies (309 participants), based on adult populations with intellectual disabilities, suitable for inclusion in the current version of this review. These studies examined a range of cognitive-behavioural therapy (CBT) approaches: anger management (three studies (n = 235); one individual therapy and two group-based); relaxation (one study; n = 12), mindfulness based on meditation (one study; n = 34), problem solving and assertiveness training (one study; n = 28). We were unable to include any studies using behavioural interventions. There were no studies of children.Only one study reported moderate quality of evidence for outcomes of interest as assessed by the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We judged the evidence for the remaining studies to be of very low to low quality. Most studies were at risk of bias in two or more domains: one study did not randomly allocate participants and in two studies the process of randomisation was unclear; in one study there was no allocation concealment and in three studies this was unclear; blinding of assessors did not occur in three studies; incomplete outcome data were presented in one study and unclear in two studies; there was selective reporting in one study; and other biases were present in one study and unclear in four studies.Three of the six studies showed some benefit of the intervention on improving anger ratings. We did not conduct a meta-analysis, as we considered the studies too heterogeneous to combine (e.g. due to differences in the types of participants, sample size interventions, and outcome measures).Follow-up data for anger ratings for both the treatment and control groups were available for two studies. Only one of these studies (n = 161) had adequate long-term data (10 months), which found some benefit of treatment at follow-up (continued improvement in anger coping skills as rated by key workers; moderate-quality evidence).Two studies (n = 192) reported some evidence that the intervention reduces the number of incidents of aggression and one study (n = 28) reported evidence that the intervention improved mental health symptoms.One study investigated the effects of the intervention on quality of life and cost of health and social care utilisation. This study provided moderate-quality evidence, which suggests that compared to no treatment, behavioural or cognitive-behavioural interventions do not improve quality of life at 16 weeks (n = 129) or at 10 months follow-up (n = 140), or reduce the cost of health service utilisation (n = 133).Only one study (n = 28) assessed adaptive functioning. It reported evidence that assertiveness and problem-solving training improved adaptive behaviour.No studies reported data on adverse events. AUTHORS' CONCLUSIONS The existing evidence on the effectiveness of behavioural and cognitive-behavioural interventions on outwardly-directed aggression in children and adults with intellectual disabilities is limited. There is a paucity of methodologically sound clinical trials and a lack of long-term follow-up data. Given the impact of such behaviours on the individual and his or her support workers, effective interventions are essential. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes that include reduction in outward-directed aggressive behaviour, improvement in quality of life, and cost effectiveness.
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Affiliation(s)
- Afia Ali
- University College LondonUCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EY
| | - Ian Hall
- Mile End HospitalCommunity Learning Disability ServiceBeaumont HouseBancroft RoadLondonUKE1 4DG
| | - Jessica Blickwedel
- University College LondonUCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EY
| | - Angela Hassiotis
- University College LondonUCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EY
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Felce D, Cohen D, Willner P, Rose J, Kroese B, Rose N, Shead J, Jahoda A, MacMahon P, Lammie C, Stimpson A, Woodgate C, Gillespie D, Townson J, Nuttall J, Hood K. Cognitive behavioural anger management intervention for people with intellectual disabilities: costs of intervention and impact on health and social care resource use. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:68-81. [PMID: 24404992 DOI: 10.1111/jir.12112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Anger and aggression among adults with intellectual disability (ID) are associated with a range of adverse consequences for their well-being and that of their family or staff carers. The aims were to evaluate the effectiveness of an anger management intervention for adults with mild to moderate ID and to evaluate the costs of the intervention and its impact on health and social care resource use. This paper is concerned with the latter aim. METHODS A cluster-randomised controlled trial was conducted involving day services for adults with ID in Scotland, England and Wales. Incremental costs of delivering the intervention and its impact on subsequent total health and social care package costs were calculated. Full data comparing costs between baseline and follow-up 10 months later were collected for 67 participants in the intervention arm and 62 participants in the control arm. Cost differences between the groups at follow-up, adjusted for baseline levels, were calculated using non-parametric bootstrapping controlling for clustering. RESULTS The mean hourly excess cost of intervention over treatment as usual was £12.34. A mean adjusted cost difference of £22.46 per person per week in favour of the intervention group was found but this was not statistically significant. CONCLUSIONS The baseline-adjusted cost difference at follow-up would result in a fairly immediate compensation for the excess costs of intervention, provided the difference is not a statistical artefact. Further research is needed to clarify the extent to which it might represent a real saving in service support costs.
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Affiliation(s)
- D Felce
- Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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McWilliams J, de Terte I, Leathem J, Malcolm S. An evaluation of an emotion regulation programme for people with an intellectual disability. THERAPEUTIC COMMUNITIES 2014. [DOI: 10.1108/tc-02-2014-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to examine the effectiveness of the Transformers programme on individual's use of appropriate emotion regulation strategies.
Design/methodology/approach
– Five people with an intellectual disability participated in the Transformers programme and took part in the current study. The intervention was evaluated using the Profile of Anger Coping Skills (PACS) and incident reports. The PACS was completed by participants and their caregivers.
Findings
– The majority of participants demonstrated increases in self- and caregiver-reported use of appropriate emotion regulation strategies following their involvement in the Transformers programme. However, treatment gains were not always maintained at follow-up. Three of the participants also exhibited fewer incidents of challenging behaviour after taking part in the programme.
Originality/value
– Overall, the results provide preliminary support for the continued use of the Transformers programme with people with an intellectual disability who have emotion regulation difficulties. It is recommended that further research be carried out with a larger sample size, a control group, and a longer follow-up period.
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Jahoda A, Willner P, Rose J, Kroese BS, Lammie C, Shead J, Woodgate C, Gillespie D, Townson J, Felce D, Stimpson A, Rose N, MacMahon P, Nuttall J, Hood K. Development of a scale to measure fidelity to manualized group-based cognitive behavioural interventions for people with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4210-4221. [PMID: 24077070 DOI: 10.1016/j.ridd.2013.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 06/02/2023]
Abstract
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.
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Affiliation(s)
- Andrew Jahoda
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
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Vereenooghe L, Langdon PE. Psychological therapies for people with intellectual disabilities: a systematic review and meta-analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4085-4102. [PMID: 24051363 DOI: 10.1016/j.ridd.2013.08.030] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/16/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to evaluate the efficacy of psychological therapies for people with intellectual disabilities (IDs) through a systematic review and meta-analysis of the current literature. A comprehensive literature search identified 143 intervention studies. Twenty-two trials were eligible for review, and 14 of these were subsequently included in the meta-analysis. Many studies did not include adequate information about their participants, especially the nature of their IDs; information about masked assessment, and therapy fidelity was also lacking. The meta-analysis yielded an overall moderate between-group effect size, g=.682, while group-based interventions had a moderate but smaller treatment effect than individual-based interventions. Cognitive-behaviour therapy (CBT) was efficacious for both anger and depression, while interventions aimed at improving interpersonal functioning were not effectual. When CBT was excluded, there was insufficient evidence regarding the efficacy of other psychological therapies, or psychological therapies intended to treat mental health problems in children and young people with IDs. Adults with IDs and concurrent mental health problems appear to benefit from psychological therapies. However, clinical trials need to make use of improved reporting standards and larger samples.
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Affiliation(s)
- Leen Vereenooghe
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Willner P, Rose J, Jahoda A, Kroese BS, Felce D, Cohen D, Macmahon P, Stimpson A, Rose N, Gillespie D, Shead J, Lammie C, Woodgate C, Townson J, Nuttall J, Hood K. Group-based cognitive-behavioural anger management for people with mild to moderate intellectual disabilities: cluster randomised controlled trial. Br J Psychiatry 2013; 203:288-96. [PMID: 23520220 DOI: 10.1192/bjp.bp.112.124529] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements. AIMS To evaluate the effectiveness of a cognitive-behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities. METHOD A cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773). RESULTS The intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% CI -1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour. CONCLUSIONS The intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.
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Affiliation(s)
- Paul Willner
- Paul Willner, DSc, Psychology Department, Swansea University, Swansea and Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; John Rose, PhD, School of Psychology, University of Birmingham, Birmingham and Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; Andrew Jahoda, PhD, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow; Biza Stenfert Kroese, PhD, School of Psychology, University of Birmingham, Birmingham; David Felce, PhD, Welsh Centre for Learning Disabilities, Psychological Medicine and Neurology, Cardiff University, Cardiff; David Cohen, PhD, Health Economics and Policy Research Unit, University of Glamorgan, Pontypridd; Pamela MacMahon, DClinPsy, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Aimee Stimpson, DClinPsy, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; Nicola Rose, DClinPsy, Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; David Gillespie, BSc, South East Wales Trials Unit, Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University, Cardiff; Jennifer Shead, MSc, Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; Claire Lammie, BSc, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Christopher Woodgate, MSc, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; Julia Townson, BA, Jacqueline Nuttall, BSc, Kerenza Hood, PhD, South East Wales Trials Unit, Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University, Cardiff, UK
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Rose J, Willner P, Shead J, Jahoda A, Gillespie D, Townson J, Lammie C, Woodgate C, Stenfert Kroese B, Felce D, MacMahon P, Rose N, Stimpson A, Nuttall J, Hood K. Different Factors Influence Self-Reports and Third-Party Reports of Anger by Adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 26:410-9. [DOI: 10.1111/jar.12037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- John Rose
- School of Psychology; University of Birmingham; Birmingham UK
- Black Country Foundation Partnership Trust; Stourbridge UK
| | - Paul Willner
- Psychology Department; College of Human and Health Sciences; Swansea University; Swansea UK
- Directorate of Learning Disability Services; Abertawe Bro Morgannwg University Health Board; Neath UK
| | - Jennifer Shead
- Black Country Foundation Partnership Trust; Stourbridge UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing; College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow UK
| | - David Gillespie
- South East Wales Trials Unit; Institute of Primary Care & Public Health; School of Medicine; Cardiff University; Cardiff UK
| | - Julia Townson
- South East Wales Trials Unit; Institute of Primary Care & Public Health; School of Medicine; Cardiff University; Cardiff UK
| | - Claire Lammie
- Institute of Health and Wellbeing; College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow UK
| | - Christopher Woodgate
- Directorate of Learning Disability Services; Abertawe Bro Morgannwg University Health Board; Neath UK
| | | | - David Felce
- Psychological Medicine and Neurology; School of Medicine; Cardiff University; Cardiff UK
| | - Pamela MacMahon
- Institute of Health and Wellbeing; College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow UK
| | - Nikki Rose
- Black Country Foundation Partnership Trust; Stourbridge UK
| | - Aimee Stimpson
- Directorate of Learning Disability Services; Abertawe Bro Morgannwg University Health Board; Neath UK
| | - Jacqueline Nuttall
- South East Wales Trials Unit; Institute of Primary Care & Public Health; School of Medicine; Cardiff University; Cardiff UK
| | - Kerenza Hood
- South East Wales Trials Unit; Institute of Primary Care & Public Health; School of Medicine; Cardiff University; Cardiff UK
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Pierce LL, Pierce SW, Gies CE. Choices: anger and anger management in rehabilitative care. Rehabil Nurs 2013; 38:80-7. [PMID: 23529946 DOI: 10.1002/rnj.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Violent acts are on rise and rehabilitation providers as caregivers may encounter anger on a daily basis. The purpose of this article is to discuss anger and describe anger management strategies based on behavioral interventions grounded in Choice Theory. CHOICE THEORY Applying choice theory to anger is the belief that people are internally, not externally motivated, and that outside events do not make people do anything. Thus, what drives people's anger behaviors are internally developed notions of what is important and satisfying for them. CLINICAL RELEVANCE AND CONCLUSION Anger becomes a choice along with its management. Choosing strategies to manage anger are key to reducing the potential for angry emotions to escalate to the point of aggressive and violent acts that threaten caregivers and clients safety. Anger-free environments promote mental/physical health and establish elements of safe living and working environments in a variety of rehabilitative care settings.
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Affiliation(s)
- Linda L Pierce
- College of Nursing, University of Toledo, Toledo, OH 43614, USA.
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19
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Nicoll M, Beail N, Saxon D. Cognitive Behavioural Treatment for Anger in Adults with Intellectual Disabilities: A Systematic Review and Meta-analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2012; 26:47-62. [PMID: 23255378 DOI: 10.1111/jar.12013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Nicoll
- Men's Personality Disorder Service; Rampton Hospital; Nottinghamshire Healthcare Trust; Retford UK
| | - Nigel Beail
- South West Yorkshire Partnership NHS Foundation Trust; Department of Psychology; University of Sheffield; Sheffield UK
| | - David Saxon
- Centre for Psychological Services Research; ScHARR; University of Sheffield; Sheffield UK
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Stimpson A, Kroese BS, MacMahon P, Rose N, Townson J, Felce D, Hood K, Jahoda A, Rose J, Willner P. The Experiences of Staff Taking on the Role of Lay Therapist in a Group-Based Cognitive Behavioural Therapy Anger Management Intervention for People with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2012; 26:63-70. [DOI: 10.1111/jar.12006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Aimée Stimpson
- Directorate of Learning Disability Services; Abertawe Bro Morgannwg University Health Board; Bridgend UK
| | | | - Pamela MacMahon
- Institute of Health and Wellbeing; College of Medical; Veterinary and Life Sciences; University of Glasgow; Glasgow UK
| | - Nicola Rose
- Black Country Foundation Partnership Trust; Dudley UK
| | - Julia Townson
- South East Wales Trials Unit; Department of Primary Care & Public Health; School of Medicine Cardiff University; Cardiff UK
| | - David Felce
- Psychological Medicine and Neurology; School of Medicine; Cardiff University; Cardiff UK
| | - Kerenza Hood
- South East Wales Trials Unit; Department of Primary Care & Public Health; School of Medicine Cardiff University; Cardiff UK
| | - Andrew Jahoda
- Institute of Health and Wellbeing; College of Medical; Veterinary and Life Sciences; University of Glasgow; Glasgow UK
| | - John Rose
- School of Psychology; University of Birmingham; Birmingham UK
- Black Country Foundation Partnership Trust; Dudley UK
| | - Paul Willner
- Psychology Department; College of Human and Health Sciences; Swansea University; Swansea UK
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Willner P, Jahoda A, Rose J, Stenfert-Kroese B, Hood K, Townson JK, Nuttall J, Gillespie D, Felce D. 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. Trials 2011; 12:36. [PMID: 21306624 PMCID: PMC3045902 DOI: 10.1186/1745-6215-12-36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 02/09/2011] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Paul Willner
- Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, and Dept of Psychology, Swansea University, UK.
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Down R, Willner P, Watts L, Griffiths J. Anger Management groups for adolescents: a mixed-methods study of efficacy and treatment preferences. Clin Child Psychol Psychiatry 2011; 16:33-52. [PMID: 20223794 DOI: 10.1177/1359104509341448] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the efficacy of, and adolescents' preferences for, a Cognitive Behavioural (CBT) and Personal Development (PD) Anger Management (AM) group. The CBT group aimed to help adolescents develop skills to manage predominantly reactive aggression. The PD group aimed to enhance motivation to develop less aggressive identities with less use of proactive aggression. Eighteen adolescents were randomly allocated to a 10-session CBT or PD AM Group; seven additional adolescents formed a control group. They completed pre- and post-intervention questionnaires to assess anger expression and control, use of AM coping skills (also completed by carers) and self-image. Participants were also interviewed pre- and post-intervention; transcripts were subjected to Interpretive Phenomenological Analysis. Both treatment groups demonstrated significant improvements in anger coping and self-esteem, relative to the control group. Participants' age was significantly correlated with self-image and anger control outcomes in the CBT group. Qualitative analysis identified factors associated with improved outcomes, particularly regarding participants' age, motivation and readiness to change, engagement in the therapeutic process, group dynamics and emotional expressiveness. Our ability to interpret data clinically was enhanced by the use of a mixed quantitative-qualitative methodology. The results help us to better match interventions to clients.
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Hassiotis AA, Hall I. Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities. Cochrane Database Syst Rev 2008:CD003406. [PMID: 18677776 DOI: 10.1002/14651858.cd003406.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours often run a long term course and are a major cause of social exclusion. OBJECTIVES To determine the efficacy of behavioural and cognitive behavioural interventions for outwardly-directed aggressive behaviour for people with learning disabilities. SEARCH STRATEGY The Cochrane Library (CENTRAL) 2007 (Issue 1), MEDLINE 1966 to February 2007, EMBASE 1980 to February 2007, PsycINFO 1872 to February 2007 and Dissertation Abstracts late 1960s to February 2007 were searched. Where appropriate, research filters were used. SELECTION CRITERIA Studies were selected if more than four participants, children or adults, were allocated by random or quasi-random methods to either intervention or standard treatment/wait list. DATA COLLECTION AND ANALYSIS References identified by electronic searches, examinations of bibliography and personal contacts were screened against inclusion criteria by two independent reviewers. Two reviewers independently extracted and entered data into RevMan (Cochrane Collaboration software). MAIN RESULTS Four studies based on adult populations with learning disabilities were deemed to be suitable for inclusion in the current version of this review. Data were only available in a form suitable for meta-analysis in three studies, but due to heterogeneity of populations and interventions, meta-analysis was not performed. Direct interventions based on cognitive-behavioural methods (modified relaxation, assertiveness training with problem solving, and anger management) appear to have some impact on reduction of aggressive behaviour at the end of treatment and in some studies also at follow up (up to six months). AUTHORS' CONCLUSIONS The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwardly directed aggression in children and adults with learning disabilities is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.
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Affiliation(s)
- Angela A Hassiotis
- Department of Mental Health Sciences, University College of London, Charles Bell House, 67-73 Riding House Street, London, UK, W1W 7EY.
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Willner P, Tomlinson S. Generalization of Anger-Coping Skills from Day-Service to Residential Settings. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2007. [DOI: 10.1111/j.1468-3148.2007.00366.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Willner P. Cognitive behavioural therapy for people with learning disabilities: focus on anger. ACTA ACUST UNITED AC 2007. [DOI: 10.1108/17530180200700015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Willner P. The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical overview. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:73-85. [PMID: 15634314 DOI: 10.1111/j.1365-2788.2005.00633.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Historically, people with learning disabilities have had little or no access to psychotherapeutic interventions, although there are signs that, over the past decade, this situation has seen some gradual improvement. This paper provides an overview of the evidence for the effectiveness of psychodynamic, cognitive-behavioural and cognitive therapies in this client group. The available data support the position that all three approaches can be effective in people with mild learning disabilities and in a proportion of people with more severe conditions. However, the literature reporting outcomes of psychotherapeutic interventions in people with learning disabilities is extremely limited, and there is a conspicuous and unjustified poverty of randomized controlled trials. There is also very little evidence regarding either the importance of specific components of therapeutic packages, or the optimal manner of delivering these interventions to people with learning disabilities.
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Affiliation(s)
- P Willner
- Department of Psychology, Learning Disabilities Directorate, Bro Morgannwg NHS Trust, and University of Wales Swansea, Swansea, UK.
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