Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature (original) (raw)
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Cognitive Behavior Therapy with Adults with Intellectual Disabilities: A Systematic Review
2017
A small but significant portion of the population has a diagnosis of an intellectual disability, defined as cognitive deficits that impact a person’s daily functioning. Adults with intellectual disabilities struggle with psychopathology at four times the rate as the general population, yet only 10% receive psychotherapy. There is very little existing research into the use of psychotherapy for adults with intellectual disabilities, the majority of which has been published in niche publications that most practitioners have limited access to. Therefore, this systematic review answered the question “What are the known outcomes of Cognitive Behavior Therapy (CBT) for adults with intellectual disabilities?” A total of 19 articles were reviewed. Of the 16 quantitative studies reviewed, all 16 found statistically significant improvement on at least one outcome measure, with the majority of studies (13 of 16) finding statistically significant improvement on at least half of the outcome measu...
Journal of Affective Disorders, 2013
Background: Evaluation of complex interventions, including standardisation of the intervention, types of outcomes selected and measures of change, is a fairly novel concept in the field of intellectual disabilities. Our aim was to explore these issues in a feasibility study of Manualised Individual Cognitive Behaviour Treatment (M-iCBT) compared to the treatment as usual alone (TAU). Methods: Service users with mild to moderate intellectual disability experiencing a mood disorder or symptoms of depression and/or anxiety (mini PAS-ADD total score 4 10 or 7 respectively) were randomly assigned to either. Results: In total, 32 participants were randomly assigned to 16 sessions of M-iCBT (n ¼16) in addition to TAU or TAU alone (n ¼ 16). We explored recruitment and accrual rates, willingness to participate, acceptability of the intervention and suitability of assessment tools. Mean change (95% CI) in the Beck Depression Inventory-Youth (BDI-Y) score from baseline to the 16 week endpoint (primary variable) was 0.10 (95% CI: −8.56, 8.76) and in the Beck Anxiety Inventory-Youth (BAI-Y) 2.42 (95% CI: −5.27, 10.12) in favour of TAU. However, there was a clear trend in favour of CBT in depressed participants with or without anxiety. Limitations: The intervention targeted both depression and anxiety following a transdiagnostic model. This may have impacted the anticipated size of change in the primary outcome. The precise impact of cognitive limitations on ability to use therapy effectively is not fully understood.
Research in developmental disabilities, 2013
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 e...
Research in Developmental Disabilities, 2008
The prevalence of co-morbid depression in people with intellectual disability (ID) provides a strong rationale for the early identification and treatment of individuals at risk. The aim of this study was to evaluate a staff-administered group CBT program for the treatment of depression in people with mild ID. A sample of 13 staff employed at two community-based disability agencies were trained to deliver the program to 47 individuals with mild ID and symptoms of depression. A wait list control group comprised of 27 individuals subsequently completed the program. Compared to the control group, individuals who had participated in the treatment program showed lower depression scores, and fewer automatic negative thoughts. Furthermore, these changes were maintained at a 3-month follow-up. The results indicate that staff can be trained to deliver a CBT program within community settings that is effective in the reduction of depression symptomatology in people with mild ID.
Journal of Intellectual Disabilities, 2011
The aim of this review is to identify and analyse the published evidence base and wider literature in relation to psychological interventions for adults with intellectual disabilities. The review suggests that the evidence base regarding psychological interventions is sparse yet growing, and if the therapeutic approaches are modified and adapted to meet the distinct needs of people with intellectual disabilities these may be life enhancing. The lack of access to psychotherapies for people with intellectual disabilities has led to their exclusion from mainstream research, thereby limiting the evidence base on effective interventions and treatment approaches. This has significant implications for research, policy, education and clinical practice and is an area requiring strategic and local attention and development in the future.
Research in Developmental Disabilities, 2017
This paper is the first to systematically review measures of skills thought necessary to be ready for cognitive behavioural therapy in intellectual disabilities. The findings suggest that while readiness skills may be trainable with brief interventions, the available measures of these skills have not been fully evaluated for quality. Levels of functioning on these measures have yet to be established relative to those without intellectual disabilities and critically, there is very little evidence as to whether these skills are important in cognitive behavioural therapy process and outcome. We suggest that future research could focus on those constructs where there is preliminary evidence for utility such as recognising cognitive mediation and also on developing the concept of readiness perhaps by developing measures within the context of specific CBT interventions. Until this is done, clinicians should exercise caution in using these measures to assess readiness for cognitive behavioural therapy in people with intellectual disabilities. abilities to discriminate among thoughts, feelings and behaviours. Behaviour Research and Therapy, 42(3), 343-356. Reed, J., & Clements, J. (1989). Assessing the understanding of emotional states in a population of adolescents and young adults with mental handicaps.
Journal of intellectual disability research : JIDR, 2014
Important work has been carried out adapting cognitive behavioural therapy for people with intellectual disabilities. However, there is a lack of alternative psychological therapies available for people with intellectual disabilities and emotional difficulties. Behavioural activation for depression is less reliant on verbal communication and focuses on increasing purposeful activity and reducing avoidance. This feasibility study involved the development and piloting of an adapted manual of behavioural activation for people with intellectual disabilities. The intervention consisted of 10-12 sessions and a key adaptation was that the therapist worked with the clients alongside a significant other in their life, either a paid carer or family member. Baseline, post-intervention (3 months after entering the study) and 6-month quantitative follow-up data were obtained. Primary outcome data were gathered, concerning depressive symptoms, participants' levels of activity and general well...
Journal of Applied Research in Intellectual Disabilities, 2013
Background The role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated. Method To explore their views and expectations of cognitive behaviour therapy (CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were recruited and interviewed before the CBT sessions commenced for their service users and nine took part in the second interview that took place after nine sessions. Results Thematic Analysis of the interview transcripts indicates that staff members do not perceive CBT as a long-term solution for psychological problems have little knowledge of CBT and do not feel included in the process. Nevertheless, after nine sessions, most participants reported improved psychological well-being for their service users and expressed a wish for longerterm involvement of the therapist. Conclusions The results suggest that for CBT to be effective in the longer term, the therapist is required to consider a wider systemic approach including staff training and supervision, staff and management consultancy and creating a delicate balance between confidentiality and sharing the psychological formulation with 'significant others' to ensure maintenance and generalisation of improved psychological well-being.