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MacHale R, Ffrench C, McGuire B. The experiences and views of adults with intellectual disabilities accessing digital mental health interventions: A qualitative systematic review and thematic synthesis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:448-457. [PMID: 36781378 DOI: 10.1111/jar.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Technology is ubiquitous in all aspects of daily life and research interest in the topic of digital mental health interventions (DMHI) for people with intellectual disabilities is growing. In addition, the COVID-19 pandemic has accelerated technology use in delivering mental health supports. METHOD This review used a qualitative systematic literature review methodology with the aim of collating the views and experiences of adults with intellectual disabilities accessing DMHI. The electronic databases MEDLINE, PsycINFO, CINAHL and SCOPUS were searched in March 2022. RESULTS Five studies were selected in this review, and three major narrative themes were generated, each with sub-themes: (1) User experience with DMHI (personal experience, digital experience); (2) Relationships fostered through technology (interpersonal support, relating to virtual characters, computer as skilled helper); (3) Psychological benefits (new skills development, personal autonomy development). CONCLUSION This review highlights that, although there is a diversity of views and experiences of people with intellectual disabilities, the evidence suggests that DMHI has potential to support this population given the right opportunities. Findings also point to the benefit of technology as a complement to therapy, but not necessarily as a replacement to in-person therapeutic encounters.
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Affiliation(s)
| | - Cathal Ffrench
- School of Psychology, University of Galway, Galway, Ireland
| | - Brian McGuire
- School of Psychology, University of Galway, Galway, Ireland
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Kulnazarova G, Namazbaeva Z, Butabayeva L, Tulepova L. Cognitive Therapy for Children with Intellectual Disabilities: A New Look at Social Adaptation Skills and Interpersonal Relationships. Occup Ther Int 2023; 2023:6466836. [PMID: 37051114 PMCID: PMC10085646 DOI: 10.1155/2023/6466836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/26/2023] [Accepted: 03/04/2023] [Indexed: 04/05/2023] Open
Abstract
The purpose of the study is to consider the factors influencing the development of the culture of interpersonal relationships and the effectiveness of the influence of cognitive therapy on improving social adaptation skills. The method of cognitive therapy included several types of activities. The first type of activities included group sessions, during which the weaknesses of the interaction and their correction were identified. The second type was conducted in the format of teaching standard models of interaction between people. The third type of activity aimed to teach children to build a dialogue with each other and express their desires and emotions. Classes were held 3 times a week throughout the year. The study was attended by pupils of 5-7 grades of Zhanuya boarding school and special correctional boarding school No. 7 for children with intellectual disabilities. The results of a randomized study demonstrated an increase in the indicators of teamwork skills, self-control, emotional stability, and independent decision-making. The indicators of cheerfulness, openness, sociability, and logical thinking also improved. But the factor of antisocial behavior decreased. All of these indicators directly affect socialization. This strategy can be applied in practice in various specialized boarding schools and schools for children with intellectual disabilities.
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Affiliation(s)
- Gulnaz Kulnazarova
- Department of Special Education, Abai Kazakh National Pedagogical University, Almaty 050010, Kazakhstan
| | - Zhamiliya Namazbaeva
- Department of Special Education, Abai Kazakh National Pedagogical University, Almaty 050010, Kazakhstan
| | - Laura Butabayeva
- Department of Special Education, Abai Kazakh National Pedagogical University, Almaty 050010, Kazakhstan
| | - Lazzat Tulepova
- Department of Special Education, Abai Kazakh National Pedagogical University, Almaty 050010, Kazakhstan
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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: 0] [Impact Index Per Article: 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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Torra Moreno M, Canals Sans J, Colomina Fosch MT. Behavioral and Cognitive Interventions With Digital Devices in Subjects With Intellectual Disability: A Systematic Review. Front Psychiatry 2021; 12:647399. [PMID: 33927655 PMCID: PMC8076520 DOI: 10.3389/fpsyt.2021.647399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/17/2021] [Indexed: 01/01/2023] Open
Abstract
In recent years, digital devices have been progressively introduced in rehabilitation programs and have affected skills training methods used with children and adolescents with intellectual disabilities (ID). The objective of this review is to assess the effects of the use of digital devices on the cognitive functions and behavioral skills in this population, and to acknowledge their potential as a therapeutic tool. Electronic databases were analyzed until February 2020 using search formulas with free terms related to ID and the use of digital systems with children or adolescents. The risk of bias in randomized controlled trials was assessed by means of the modified Cochrane Collaboration tool and the quality level of the non-randomized studies was assessed using the Newcastle-Ottawa Scale. Forty-four studies were analyzed, most of which were categorized as low quality. Of the executive function studies analyzed, 60% reported significant improvements, most commonly related to working memory. Within the cognitive skills, 47% of the studies analyzed reported significant improvements, 30% of them in language. Significant improvements in the social (50%) and behavioral domains (30%) were also reported. These results suggest that digital interventions are effective in improving working memory and academic skills, and positively affect both the social and behavioral domains. Little information has been published regarding the duration of the effects, which could be limited in time. Further research is necessary to assess long-term effectiveness, the influence of comorbidities, and the effects on subjects with severe ID. The inclusion of smartphones and special education centers is also necessary.
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Affiliation(s)
- Marta Torra Moreno
- Jeroni de Moragas Private Fundation, Tarragona, Spain
- Jeroni de Moragas Association, Tarragona, Spain
| | - Josefa Canals Sans
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Rovira i Virgili University, Tarragona, Spain
| | - Maria Teresa Colomina Fosch
- Department of Psychology, Research Center for Behavioral Assessment (CRAMC), Rovira i Virgili University, Tarragona, Spain
- Research Group in Neurobehavior and Health (NEUROLAB), Tarragona, Spain
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Gosens LCF, Otten R, Didden R, Poelen EAP. Evaluating a personalized treatment for substance use disorder in people with mild intellectual disability or borderline intellectual functioning: A study protocol of a multiple baseline across individuals design. Contemp Clin Trials Commun 2020; 19:100616. [PMID: 32743120 PMCID: PMC7387771 DOI: 10.1016/j.conctc.2020.100616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/19/2020] [Accepted: 07/12/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of substance use disorder (SUD) in people with Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF) is high. However, an effective personalized treatment for people with MID-BIF and SUD is lacking. This paper describes the study protocol of the effectiveness study of Take it Personal!+, a personalized treatment for people with MID-BIF and SUD. METHODS The effectiveness of Take it Personal!+ in decreasing substance use will be assessed in a non-concurrent multiple baseline across individuals design comprising ten participants with MID-BIF and SUD. The participants with MID-BIF and SUD will be randomly allocated to one of the five baseline lengths (7-11 days). Substance use, will be assessed during baseline, intervention, and post-treatment phase using a daily diary method. DISCUSSION If this study shows that Take it Personal!+ is effective in decreasing substance use, the gap in treatment for people with MID-BIF and SUD will be filled. TRIAL REGISTRATION The study is registered in the Netherlands Trial Register (Trial NL4935, registered July 2, 2019).
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Affiliation(s)
- Lotte C F Gosens
- Research and Development, Pluryn, P.O. Box 53, 6500, AB, Nijmegen, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands
| | - Roy Otten
- Research and Development, Pluryn, P.O. Box 53, 6500, AB, Nijmegen, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands
- REACH Institute, Arizona State University, Tempe, USA
| | - Robert Didden
- Behavioral Science Institute, Radboud University, Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands
- Trajectum, Zwolle, the Netherlands
| | - Evelien A P Poelen
- Research and Development, Pluryn, P.O. Box 53, 6500, AB, Nijmegen, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands
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Thought-feeling discrimination in people with dementia: adaptation and preliminary validation of the first dementia-specific measure. Int Psychogeriatr 2020; 32:87-96. [PMID: 31030701 PMCID: PMC7025873 DOI: 10.1017/s1041610219000322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is emerging evidence that cognitive behavioral therapy (CBT) can be effective for treating anxiety and depression in people living with dementia (PLWD). Discriminating between thoughts and feelings is a critical element of CBT and also of relevance to emotional understanding more generally. The aim of the present study was the structured adaptation and preliminary validation of an existing measure of thought-feeling discrimination for use in PLWD. METHODS/DESIGN The Behavior Thought Feeling Questionnaire (BTFQ) was adapted via expert and service-user consultation for use in PLWD. One hundred two PLWD and 77 people aged over 65 years who did not have measurable cognitive impairments completed the adapted measure along with two measures of emotional recognition and reasoning. The factor structure of this measure was examined and the measure reduced. RESULTS Factor analysis suggested a two-factor solution with thought and feeling items loading on separate factors. The behavior items were not included in scoring due to high cross-loading and ceiling effects, leaving a 14-item measure with two subscales. Thus, an adapted measure was created (named the BTFQ-D), which showed moderate convergent validity in the PLWD but not the older adult sample. Both thought and feeling subscales showed good internal consistency. CONCLUSIONS The BTFQ-D showed preliminary validity as a measure of thought-feeling discrimination in PLWD. It may have utility in measuring readiness for CBT as part of clinical assessment. Further validation is required.
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Vereenooghe L, Westermann K. Feasibility and Acceptability of an Interactive Mental Well-Being Intervention for People With Intellectual Disabilities: Pilot Mixed Methods Study. JMIR Form Res 2019; 3:e15190. [PMID: 31724954 PMCID: PMC6914282 DOI: 10.2196/15190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/06/2019] [Accepted: 08/17/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The availability of both digital and traditional mental well-being interventions is rising, but these interventions typically do not consider people with intellectual disabilities as potential users. OBJECTIVE The study aimed to explore the acceptability and feasibility of a new digital intervention, developed with and for people with intellectual disabilities, to improve their subjective well-being. METHODS Using a single-group pre-post design, participants with intellectual disabilities and their caregivers completed the 4-week intervention. Mixed methods questionnaires assessed the acceptability of the intervention, in addition to self-report and proxy-report measures of subjective well-being and behavioral problems. RESULTS A total of 12 men with mild to moderate intellectual disabilities enrolled in and completed the study alongside 8 caregivers. Participant acceptability of the intervention was high, and feedback covered multiple aspects of the intervention, including (1) program concept and design, (2) program content, and (3) intervention usage. Self-rated mood barometers indicated mood improvements for 5 participants, deteriorations for 2 participants, and no observed changes for the remaining participants. Statistical analyses yielded no difference from pretest (median=79; range 39-86) to posttest (median=79; range 21-96) for subjective well-being in people with intellectual disabilities (W=10.5; P=.17) and for behavioral problems (W=14; P=.05). CONCLUSIONS People with intellectual disabilities and their caregivers are receptive to using digital well-being interventions, and this research shows such interventions to be feasible in routine practice. Given the acceptability of the intervention, its potential efficacy can now be evaluated in people with intellectual disabilities and symptoms of reduced mental well-being.
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Affiliation(s)
- Leen Vereenooghe
- Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Kristian Westermann
- Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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Clarke A, Dagnan D, Smith IC. How service-users with intellectual disabilities understand challenging behaviour and approaches to managing it. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1203-1215. [PMID: 31066173 DOI: 10.1111/jar.12612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/20/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study explored understandings that service-users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well-being. METHODS Eight participants (three female, five male) partook in individual semi-structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. RESULTS Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long-term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day-to-day life was perceived to reduce challenging behaviour in the long term. CONCLUSIONS Implications for practice are discussed.
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Affiliation(s)
- Aoife Clarke
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Dave Dagnan
- Cumbria Partnership NHS Foundation Trust, Workington, UK
| | - Ian C Smith
- Division of Health Research, Lancaster University, Lancaster, UK
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Watfern C, Heck C, Rule C, Baldwin P, Boydell KM. Feasibility and Acceptability of a Mental Health Website for Adults With an Intellectual Disability: Qualitative Evaluation. JMIR Ment Health 2019; 6:e12958. [PMID: 30920378 PMCID: PMC6458530 DOI: 10.2196/12958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Electronic mental health (e-mental health) programs for people with an intellectual disability are currently underexplored but may provide a way of mitigating some of the barriers that this population faces in accessing appropriate mental health services. OBJECTIVE The aim of this study was to examine the feasibility and acceptability of Healthy Mind, an e-mental health program for adults with an intellectual disability developed by the Black Dog Institute, focusing on the design and implementation of the website. METHODS A qualitative research design was used, which involved semistructured interviews and focus groups with people with an intellectual disability, support workers, and allied health professionals. People with an intellectual disability were also observed while using the website. A thematic analysis was used to interrogate the interview transcripts and observational field notes. RESULTS Participants found the content of the website informative and appreciated the many ways that the website had been made accessible to users. Participants voiced some differing requirements regarding the way information should be presented and accessed on the website. Acknowledging different types of support needs was identified as an important issue for website dissemination. CONCLUSIONS The Healthy Mind website promises to provide an excellent tool for people with ID and their supporters. This research has pragmatic implications for the future development and implementation of the program, while contributing to knowledge in the broader fields of e-mental health and inclusive design for people with an intellectual disability.
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Affiliation(s)
- Chloe Watfern
- Black Dog Institute, Sydney, Australia.,University of New South Wales Art & Design, Sydney, Australia
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Cooney P, Jackman C, Tunney C, Coyle D, O'Reilly G. Computer-assisted cognitive behavioural therapy: The experiences of adults who have an intellectual disability and anxiety or depression. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1032-1045. [PMID: 29722919 DOI: 10.1111/jar.12459] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite its evidence base in the general population, computerized cognitive behavioural therapy (cCBT) has not yet been adapted for use with people with intellectual disability. This study aimed to explore the experiences of adults with an intellectual disability who played a cCBT program. METHOD Twenty-four adults (with a mild or moderate intellectual disability and clinically significant anxiety or depression) who were in the treatment arm of a pilot randomized controlled trial evaluating the cCBT program were individually interviewed. Thematic analysis was used to analyse and report themes within the data. RESULTS Participants found playing the program to be an enjoyable and novel experience and that it was challenging and helpful. It allowed them to develop and reflect on relationships and increased their awareness of thoughts, feelings and behaviours. CONCLUSIONS Combining technology with CBT is an effective way to reduce barriers to accessing mental health interventions and technology for this population.
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Affiliation(s)
- Patricia Cooney
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Conall Tunney
- School of Psychology, University College Dublin, Dublin, Ireland
| | - David Coyle
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Gary O'Reilly
- School of Psychology, University College Dublin, Dublin, Ireland
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Roberts L, Kwan S. Putting the C into CBT: Cognitive challenging with adults with mild to moderate intellectual disabilities and anxiety disorders. Clin Psychol Psychother 2018; 25:662-671. [DOI: 10.1002/cpp.2196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Lynette Roberts
- Centre for Disability Studies; affiliate of the University of Sydney; New South Wales Australia
| | - Sophia Kwan
- School of Psychology; UNSW Sydney; New South Wales Australia
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A case series to examine whether people with learning disabilities can learn prerequisite skills for cognitive behavioural therapy. COGNITIVE BEHAVIOUR THERAPIST 2018. [DOI: 10.1017/s1754470x1700023x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAlthough cognitive behavioural therapy (CBT) is recommended for the treatment of a number of mental disorders among the general population, the ability of individuals with learning disabilities (LD) to understand CBT concepts and engage in CBT has been questioned. Aims: To examine whether specific prerequisite skills for CBT can be taught to people with LD using a newly developed training intervention and to investigate the acceptability of the intervention. Method: The study adopted a within-subjects case series research design. Quantitative assessment methods were used to evaluate the CBT skills of six adults with mild to moderate LD pre-intervention, following intervention and at 1-week follow-up. Participants were also asked to provide some qualitative feedback about how they had experienced the intervention. Results: The cognitive mediation skills and the ability of most participants to link activating events to emotions increased following intervention training and this improvement was maintained for four of them at follow-up. The feedback of participants regarding the process and content of the task demands was positive. Conclusions: The findings suggest that people with LD can learn some of the skills considered necessary to participate in CBT, such as cognitive mediation. However, further and more robust research is required to substantiate these findings.
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Kouimtsidis C, Scior K, Baio G, Hunter R, Pezzoni V, Hassiotis A. Development and evaluation of a manual for extended brief intervention for alcohol misuse for adults with mild to moderate intellectual disabilities living in the community: The EBI-LD study manual. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30 Suppl 1:42-48. [PMID: 28875511 DOI: 10.1111/jar.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extended brief interventions for alcohol misuse are effective in the general population. The process of manualising the first ever such intervention for people with mild to moderate intellectual disabilities in the UK is the focus of this study. METHODS The manual was an adaptation of existing manuals based on Motivational Enhancement and Cognitive Behaviour Therapy and was used in a feasibility randomized controlled trial, the EBI-LD study. The sessions were recorded and scored using an adapted version of the Yale Adherence and Competence Scale (YACS II). Feedback was provided by therapists. The trial is closed. Registered: isrctn.com; ISRCTN58783633. RESULTS The quality of the sessions provided was rated as good. Therapists were able to cover all topics within each session. Main challenges included session duration and homework task completion. CONCLUSIONS We recommend the duration of the sessions to be extended to 40 min to accommodate carers in the session and to enhance their support in homework task completion.
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Affiliation(s)
| | - Katrina Scior
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health Research, University College London, London, UK
| | - Vittoria Pezzoni
- Hertfordshire Partnership NHS Foundation Trust, Saint Albans, UK
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Cooney P, Jackman C, Coyle D, O'Reilly G. Computerised cognitive-behavioural therapy for adults with intellectual disability: randomised controlled trial. Br J Psychiatry 2017; 211:95-102. [PMID: 28596245 DOI: 10.1192/bjp.bp.117.198630] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 11/23/2022]
Abstract
BackgroundDespite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.
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Affiliation(s)
- Patricia Cooney
- Patricia Cooney, BA, School of Psychology, University College Dublin; Catherine Jackman, MPsychSc, Cheeverstown House, Dublin; David Coyle, PhD, School of Computer Science, University College Dublin; Gary O'Reilly, PhD, School of Psychology, University College Dublin, Ireland
| | - Catherine Jackman
- Patricia Cooney, BA, School of Psychology, University College Dublin; Catherine Jackman, MPsychSc, Cheeverstown House, Dublin; David Coyle, PhD, School of Computer Science, University College Dublin; Gary O'Reilly, PhD, School of Psychology, University College Dublin, Ireland
| | - David Coyle
- Patricia Cooney, BA, School of Psychology, University College Dublin; Catherine Jackman, MPsychSc, Cheeverstown House, Dublin; David Coyle, PhD, School of Computer Science, University College Dublin; Gary O'Reilly, PhD, School of Psychology, University College Dublin, Ireland
| | - Gary O'Reilly
- Patricia Cooney, BA, School of Psychology, University College Dublin; Catherine Jackman, MPsychSc, Cheeverstown House, Dublin; David Coyle, PhD, School of Computer Science, University College Dublin; Gary O'Reilly, PhD, School of Psychology, University College Dublin, Ireland
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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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Stott J, Charlesworth G, Scior K. Measures of readiness for cognitive behavioural therapy in people with intellectual disability: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:37-51. [PMID: 27886587 DOI: 10.1016/j.ridd.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Cognitive behavioural therapy (CBT) is a promising treatment for mental health problems in people with intellectual disabilities but some may not be suited or ready. This review critically evaluates the quality and utility of measures of CBT readiness in people with intellectual disabilities. METHODS AND PROCEDURES Twelve studies of six measures based on three aspects of CBT readiness were identified through systematic review. OUTCOMES AND RESULTS Across measures, measurement quality was largely poor or un-assessed. Only one study evaluated measurement change over the course of CBT. Not all participants with intellectual disabilities could 'pass' readiness measures and performance may be affected by levels of language and cognitive functioning. There was some evidence that CBT readiness is trainable with brief interventions. CONCLUSIONS AND IMPLICATIONS Before using readiness measures in a clinical context, further work is needed to extend initial evidence on recognising cognitive mediation as a CBT readiness ability. Given the lack of consensus as to the definition of CBT readiness and the heterogeneity of CBT interventions, future research could also focus on developing readiness measures using a bottom up approach, developing measures within the context of CBT interventions themselves, before further refining and establishing their psychometric properties. WHAT THIS PAPER ADDS 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.
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Affiliation(s)
- Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom.
| | - Georgina Charlesworth
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Katrina Scior
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
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