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Langdon PE, Apanasionok MM, Scripps E, Barrowcliff A, Biswas A, Bunning K, Burbidge C, Byron-Daniel K, Cookson A, Croom S, Filipczuk M, Gillespie D, Hastings RP, Jahoda A, McNamara R, Patterson L, Rai D, Steward R, Gray KM. Behavioural interventions to treat anxiety in adults with autism and moderate to severe intellectual disabilities: The BEAMS-ID feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13282. [PMID: 39074852 DOI: 10.1111/jar.13282] [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: 03/20/2024] [Revised: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The aim of this feasibility study was to adapt and model a behavioural intervention for anxiety with autistic adults with moderate to severe intellectual disabilities. METHOD Twenty-eight autistic adults with moderate or severe intellectual disabilities, 37 carers, and 40 therapists took part in this single-group non-randomised feasibility study designed to test intervention feasibility and acceptability, outcome measures, and research processes. RESULTS The intervention was judged as feasible and acceptable by autistic adults with intellectual disabilities, carers, and therapists. Minor intervention revisions were suggested. Carers completed 100% of outcome measures and the missing data rate was low. Complying with legislation governing the inclusion of participants who lack capacity to decide whether they wanted to take part in this study led to an average 5-week enrolment delay. CONCLUSION The intervention and associated study processes were judged to be feasible and acceptable and should now be tested within a larger randomised trial.
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Affiliation(s)
- Peter E Langdon
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Magdalena M Apanasionok
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - Emma Scripps
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | | | - Asit Biswas
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - Karen Bunning
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Cheryl Burbidge
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | | | - Sarah Croom
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Malwina Filipczuk
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - David Gillespie
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Richard P Hastings
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - Andrew Jahoda
- Psychological Medicine, University of Glasgow, Glasgow, UK
| | - Rachel McNamara
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Dheeraj Rai
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Robyn Steward
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - Kylie M Gray
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
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Huynh TN, Delagrammatikas CG, Chiriatti L, Panfili A, Ventarola K, Menke LA, Tartaglia M, Huisman SA, Priolo M. Natural history in Malan syndrome: survey of 28 adults and literature review. Orphanet J Rare Dis 2024; 19:282. [PMID: 39075508 DOI: 10.1186/s13023-024-03288-6] [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: 10/25/2023] [Accepted: 07/14/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Malan syndrome (MALNS), previously referred to as "Sotos syndrome 2" due to its resemblance to Sotos syndrome (SS), is an ultra-rare neurodevelopmental disorder characterized by overgrowth, typical craniofacial features, intellectual disability (ID), and a range of psychobehavioral, musculoskeletal, vision and neurological signs. As MALNS and SS partly overlap, it is essential to more accurately profile their clinical presentations and highlight their differences in order to improve syndrome specific management. An increasing number of individuals with MALNS reach adult-age though the natural history of the disorder is poorly characterized due to the small number of adult individuals described so far. As a consequence, current guidelines are limited to the pediatric population. Further delineation of MALNS is essential to optimize care in adulthood. RESULTS A mixed approach based on cross-sectional data collection with a survey disseminated to caregivers of adults with molecularly confirmed MALNS and literature review was conducted. Twenty-eight caregivers completed the survey. Clinical presentation in adulthood is multisystemic and defined by psychobehavioral comorbidities (96%), musculoskeletal involvement (96%), vision impairment (96%) and neurological complications (86%). The most common signs were anxiety (79%), hypotonia (75%), movement difficulty (75%), scoliosis (64%), problems with coordination (61%), strabismus (57%), constipation (54%), breastbone abnormalities (54%) and advanced bone age during childhood (54%). Impaired vision was complicated by vision decline (36%) and optic atrophy (32%). We report some previously unidentified features, including high pain threshold (46%), incontinence (25%), tremors (21%), muscle hypoplasia (18%) and tics (18%). CONCLUSIONS This survey in the adult population has allowed a more complete description of the natural history of MALNS. Our findings will contribute to the development and improvement of standards of care for adults with MALNS to assure optimal health monitoring and treatment of evolutive complications. We propose additional recommendations to the previous dataset of clinical evaluations specifically applied to adults. The comparison of MALNS and SS adult presentation highlights significant differences in terms of prevalence and severity of ID, behavioral issues, and vision problems, confirming that a proper differential diagnosis between the two conditions is indispensable to guide physicians and mental health professionals to syndrome specific management.
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Affiliation(s)
- T N Huynh
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - L Chiriatti
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, Viale di San Paolo 15, 00146, Rome, Italy
| | - A Panfili
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Medical Genetics Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K Ventarola
- Malan Syndrome Foundation, Old Bridge, NJ, USA
| | - L A Menke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Tartaglia
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino Gesù, IRCCS, Viale di San Paolo 15, 00146, Rome, Italy
| | - S A Huisman
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Zodiak, Prinsenstichting, 1444 JE, Purmerend, The Netherlands.
| | - M Priolo
- Operative Unit of Medical Genetics and Laboratory of Genetics, AORN A.Cardarelli, Via Cardarelli 9, 80131, Naples, Italy.
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Hronis A, Hao J, Roberts R, Roberts L, Shires A, Kneebone I. A case series evaluation of the Fearless Me! © program for children with intellectual disabilities and anxiety. J Clin Psychol 2024. [PMID: 38781683 DOI: 10.1002/jclp.23709] [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: 07/15/2022] [Revised: 03/25/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Children and adolescents with intellectual disabilities (ID) have high rates of mental health disorders, particularly anxiety disorders. Cognitive behavior therapy (CBT) has largely remained unexamined as a treatment option for this population. Fearless Me! © is an adapted CBT treatment program specifically designed for children and adolescents with ID. METHOD Eleven children, aged between eight and 17, completed 10 therapy sessions. Measures of anxiety were completed pre and posttreatment and at 3 and 12-month follow-ups by both the children and parents. RESULTS Six children reported significant reductions in anxiety, with all showing significant reductions in parent-reported child anxiety at either posttreatment assessment, 3-month follow-up, or 12-month follow-up. Results varied across the six children as all parents reported heightened anxiety, but not all children reported high levels of anxiety for themselves. CONCLUSION Overall, this evaluation provides a sound basis for continued investigation and research into the use of the Fearless Me! © modified CBT program to treat children with ID and anxiety.
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Affiliation(s)
- Anastasia Hronis
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Jichun Hao
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Rachel Roberts
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Lynette Roberts
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Alice Shires
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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Gillooly A, Dagnan D, Hastings R, Hatton C, McMeekin N, Baines S, Cooper SA, Crawford L, Gillespie D, Miller J, Jahoda A. Behavioural activation for depressive symptoms in adults with severe to profound intellectual disabilities: Modelling and initial feasibility study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13197. [PMID: 38356379 DOI: 10.1111/jar.13197] [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: 04/02/2023] [Revised: 11/06/2023] [Accepted: 01/01/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Almost no research has been published reporting on evaluations of the effectiveness of psychological interventions for people with severe to profound intellectual disabilities and depression. This paper describes the development and initial feasibility testing of an adapted Behavioural Activation therapy (BeatIt2) for this population. METHOD Phase 1 of the study examined participant recruitment and willingness to be randomised in the context of a planned Randomised Controlled Trial (RCT). Phase 2 examined the feasibility of delivering the intervention. RESULTS Twenty adults with a severe or profound intellectual disability and clinically significant depression were recruited to Phase 1 of the study. In Phase 2, there was 100% participant retention for those recruited to the study at 6-month follow-up. The BeatIt2 therapy was reported to be acceptable for participants. CONCLUSION COVID disruption meant that it was not possible to complete the planned feasibility RCT. The positive findings suggest that additional evaluation of BeatIt2 is warranted.
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Affiliation(s)
- Amanda Gillooly
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Community Learning Disability Services, Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Workington, UK
| | - Richard Hastings
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
| | - Chris Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - Nicola McMeekin
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susie Baines
- Division of Health Reserach, University of Lancaster, Lancaster, UK
| | - S-A Cooper
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lucy Crawford
- Learning Disabilty Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Jenny Miller
- Promoting a More Inclusive Society (PAMIS), Dundee, UK
| | - Andrew Jahoda
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Mercier A, Dorris L. A systematic review of psychosocial interventions for children and young people with epilepsy. Eur J Paediatr Neurol 2024; 49:35-44. [PMID: 38364750 DOI: 10.1016/j.ejpn.2024.02.002] [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: 10/06/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Epilepsy is a lifelong neurological disorder that has a profound impact on the lives of millions of children and young people throughout the world, and is linked with mental ill-health and a poorer quality of life. Psychosocial interventions have showed promise for children and young people with epilepsy (CYPE), however there is an absence of large-scale RCT's that would add robustness to the evidence base. The present systematic review provides an update and extension of findings from an earlier review by Corrigan et al. to assess the state of the literature in 2023. METHODS The present systematic review carried out a search of six electronic databases. Forward and backward chaining was carried out on review articles as well as the studies returned through the search to source additional studies. In total, ten articles were included in this review and appraised for quality using the Crowe Critical Appraisal Tool (CCAT). RESULTS Forty percent (4/10) of the included studies were rated as high quality according to the CCAT, which represents a significant proportional increase since Corrigan et al.'s review. A meta-analysis of results was not possible due to significant methodological heterogeneity, and the variability of outcome measures, however effect sizes were reported or calculated for the majority of studies (7/10), which facilitated comparison. Despite the issues of relatively small samples, there are promising findings with regard to psychosocial interventions increasing epilepsy knowledge, coping strategies, self-efficacy, and quality of life markers. CONCLUSIONS There is a growing evidence base supporting the efficacy of psychosocial interventions for children and young people with epilepsy. This evidence base is also increasing in quality. Particular components of treatment that prove to be effective include psychoeducation, components based on cognitive behavioural therapy principles, as well as mindfulness techniques. This aligns with the evidence-based recommendations for adult populations. Intervention goals centre around improving quality of life, reducing symptom distress, and increasing knowledge and skills. The instruments used to measure these outcomes are predominantly standardised, however remain heterogeneous between studies which impacts the overall robustness of the evidence base.
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Affiliation(s)
| | - Liam Dorris
- School of Health and Wellbeing, University of Glasgow, UK; Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.
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Dell'Armo K, Tassé MJ. Diagnostic Overshadowing of Psychological Disorders in People With Intellectual Disability: A Systematic Review. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:116-134. [PMID: 38411245 DOI: 10.1352/1944-7558-129.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/15/2024] [Indexed: 02/28/2024]
Abstract
Diagnostic overshadowing is a bias in which symptoms of a psychological disorder are falsely attributed to a known diagnosis of intellectual disability. This systematic review evaluated all research on diagnostic overshadowing conducted to date, including dissertations and peer-reviewed journal articles. In total, 25 studies were included in this review. Findings suggest diagnostic overshadowing may not be as ubiquitous as originally believed, with one third of included studies finding no overshadowing. The quality of the evidence was graded as "Low" using the LEGEND tool, with common issues including outdated studies, analogue methodologies, small sample sizes and convenience samples, and inappropriate conducting or reporting of statistical analyses. Implications for the field and recommendations for future research are discussed.
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Affiliation(s)
- Kristin Dell'Armo
- Kristin Dell'Armo, Nationwide Children's Hospital and The Ohio State University
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Dunn Y, Summers SJ, Dagnan D. Facilitating transformative endings: Therapists' experience of ending therapy with people with intellectual disabilities-An interpretative phenomenological analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13162. [PMID: 37816696 DOI: 10.1111/jar.13162] [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] [Received: 04/03/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Endings in therapy are discussed widely in mainstream literature, however, there is only a small amount of research that considers endings in therapy for people with intellectual disabilities. METHODS Eight therapists were interviewed about their experience of ending therapy with people with intellectual disabilities. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS Four superordinate themes associated with endings that go well were identified: 'recognising', 'readying', 'reframing' and reflecting', with a fifth theme reflecting endings that were less successful. Participants worked hard to offer transformative experiences of endings and an overarching 'super-superordinate' theme of 'facilitating transformative endings' encompassed the findings. CONCLUSIONS Endings are a multi-faceted component of psychological therapy with people with intellectual disabilities and are significant for both client and therapist. We discuss implications for therapy adaptations and future research.
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Affiliation(s)
- Yasmine Dunn
- Doctorate in Clinical Psychology, Teesside University, Middlesbrough, Tees Valley, UK
| | - S J Summers
- Doctorate in Clinical Psychology, Teesside University, Middlesbrough, Tees Valley, UK
| | - Dave Dagnan
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust Community Learning, Disability Services Unit 9, Lillyhall Business Centre, Workington, CA, UK
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Keefer A, Perrin J, Singh V, Holingue C, Winchell S, Vasa RA. A pilot, single-arm feasibility study of an integrated cognitive-behavioral treatment for anxiety in young autistic children. J Pediatr Psychol 2024; 49:131-141. [PMID: 38216125 DOI: 10.1093/jpepsy/jsad093] [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: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Anxiety is prevalent in young autistic children under 7 years of age. Yet there is a paucity of empirically based interventions for this age group. DINO Strategies for Anxiety and Uncertainty Reduction (DINOSAUR) is an innovative cognitive behavioral intervention that seeks to optimize treatment response in young autistic children by targeting anxiety and the contributing mechanisms of intolerance of uncertainty and parental accommodation using a telehealth delivery model. This pilot, single-arm study examines the preliminary feasibility of DINOSAUR. METHODS Fourteen autistic children ages 4-6 years with average language and cognitive skills and their parents received the intervention. Quantitative and qualitative data pertaining to parent satisfaction and treatment outcomes were collected. RESULTS Attendance, retention, and parent satisfaction ratings offer preliminary support for the feasibility of the treatment model. Change in clinical severity ratings on a semi-structured parent interview of anxiety and parents' qualitative report suggests the potential to benefit young autistic children. CONCLUSIONS Results support future study of the DINOSAUR model in a larger, randomized controlled trial.
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Affiliation(s)
- Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
| | - Jeremy Perrin
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Sarah Winchell
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
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9
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Fynn G, Porter M, Borchard T, Kazzi C, Zhong Q, Campbell L. The effectiveness of cognitive behavioural therapy for individuals with an intellectual disability and anxiety: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:816-841. [PMID: 37291991 DOI: 10.1111/jir.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 02/16/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Individuals with intellectual disability (ID) are at higher risk of experiencing difficulties with anxiety than the general population. However, there are major barriers for individuals to receive appropriate services. There is a growing understanding of the importance of developing appropriate psychological interventions for this group. The objective of the current review was to systematically evaluate the findings of studies investigating the effectiveness of cognitive behavioural therapy (CBT) for individuals with ID and anxiety. Another aim was to explore which adaptions to CBT and treatment components were currently being utilised within the field. METHOD The electronic databases of CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection and Scopus were searched to identify relevant studies. The methodological quality of these studies was assessed using established quality assessment tools by the National Institutes of Health for pre and post studies and case series. RESULTS Nine studies were included in this systematic review, all of which reported improvements in anxiety severity for some participants (25%-100%; N = 60) following CBT. Only three studies reported moderate effect sizes for CBT interventions on anxiety for individuals with ID. DISCUSSION AND CONCLUSIONS There is emerging literature supporting the effectiveness of CBT for individuals with mild ID. Findings highlight that CBT for individuals with anxiety and mild ID, including cognitive components, may be feasible and tolerable. While the field is gradually receiving more attention, there are significant methodological flaws present, which limit the conclusions that can be drawn regarding the effectiveness of CBT for individuals with ID. However, there is emerging evidence for techniques such as cognitive restructuring and thought replacement and modifications such as visual aids, modelling and smaller groups based on this review. Future research is warranted to investigate whether individuals with more severe ID can benefit from CBT, as well as further exploring what are the necessary components and modifications.
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Affiliation(s)
- G Fynn
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - M Porter
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - T Borchard
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - C Kazzi
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Q Zhong
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - L Campbell
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia
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Kouroupa A, Hamza L, Rafiq A, Hassiotis A, Rapaport P, Jahoda A, Taggart L, Steed L, Cooper SA, Melville C, Marston L, Royston R, Ali A. Stakeholder views on the barriers and facilitators of psychosocial interventions to address reduction in aggressive challenging behaviour in adults with intellectual disabilities. NIHR OPEN RESEARCH 2023; 3:40. [PMID: 37881460 PMCID: PMC10593323 DOI: 10.3310/nihropenres.13437.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/27/2023]
Abstract
Background Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects, but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. Methods We conducted 42 semi-structured interviews with adults with intellectual disabilities and aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Results Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors of psychosocial interventions to address aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions addressing aggressive challenging behaviour in adults with intellectual disabilities. Conclusions Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions to reduce aggressive challenging behaviour in adults with intellectual disabilities.
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Affiliation(s)
- Athanasia Kouroupa
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Leila Hamza
- Assessment and Intervention Team, Barnet Enfield and Haringey Mental Health NHS Trust, London, England, UK
| | - Aisha Rafiq
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Angela Hassiotis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Penny Rapaport
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Andrew Jahoda
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Liz Steed
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, England, UK
| | - Sally-Ann Cooper
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Craig Melville
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Louise Marston
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, England, UK
| | - Rachel Royston
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, England, UK
| | - Afia Ali
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, England, UK
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11
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Longhurst P, Full W. Disabled people's perceptions and experiences of accessing and receiving counselling and psychotherapy: a scoping review protocol. BMJ Open 2023; 13:e069204. [PMID: 37339834 DOI: 10.1136/bmjopen-2022-069204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Evidence indicates that, compared with their non-disabled counterparts, disabled people are likely to face greater mental health challenges as well as significant inequalities in accessing appropriate therapeutic support. Currently, little is known about how disabled people perceive and experience counselling and psychotherapy, what barriers/facilitators to therapy delivery and/or therapy participation exist for disabled clients and whether clinicians sufficiently adapt their practice to meet the needs of this diverse but marginalised population. In this paper, we outline a proposal for undertaking a scoping review that aims to identify and synthesise current research relating to disabled individuals' perceptions of accessibility and experiences of counselling and psychotherapy. The review aims to identify current gaps in the evidence base and inform how future research, practice and policy may develop and foster inclusive strategies and approaches which will support the psychological well-being of disabled clients accessing counselling and psychotherapy. METHODS AND ANALYSIS The undertaking and reporting of the proposed scoping review will be guided by the framework outlined by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. Systematic searches of the PsycINFO, CINAHL, EMBASE, EBSCO and Cochrane Library electronic databases will be conducted. Reference lists of relevant studies will be reviewed to identify additional studies. Eligible studies will be limited to those published from 1 January 2010 to 31 December 2022 and in the English language. Empirical studies involving disabled individuals receiving and/or who have received a form of therapeutic intervention will be included. Data will be extracted, collated and charted, and will be summarised quantitatively through descriptive numerical analysis and qualitatively through a narrative synthesis. ETHICS AND DISSEMINATION The proposed scoping review of published research will not require ethical approval. Results will be disseminated through publication in a peer-reviewed journal.
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Affiliation(s)
- Phaedra Longhurst
- Anglia Ruskin University, Chelmsford, UK
- British Association for Counselling and Psychotherapy (BACP), Leicestershire, UK
| | - Wayne Full
- British Association for Counselling and Psychotherapy (BACP), Leicestershire, UK
- Projects, Fundraising and Research, British Psychotherapy Foundation, London, UK
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Jacinto M, Monteiro D, Oliveira J, Diz S, Frontini R, Matos R, Antunes R. The Effects of Physical Activity, Exercise, and Sports Programs on Depressive Symptoms in Individuals with Disabilities: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6134. [PMID: 37372720 DOI: 10.3390/ijerph20126134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Studies show that physical activity, exercise, or sport reduces depressive symptoms in the general population. However, little is known about its effects on individuals with disabilities. Thus, this systematic review with meta-analysis aims to verify the effects of this practice on depressive symptoms in individuals with disabilities. The Pubmed, Web of Science, Scopus, and SportDiscus databases were used, with several descriptors and Boolean operators. A total of 1509 studies were identified through searching the databases. Studies that met the eligibility criteria were subsequently assessed for their methodological quality (Downs and Black scale), and a meta-analysis was performed. The Z-values that were obtained to test the null hypothesis, which states that there is no difference in means, showed Z = -2.294 and a corresponding p-value = 0.022. We can, therefore, reject the null hypothesis in the sense that exercise seems to reduce depressive symptoms in individuals with disabilities. In sum, participants from the intervention group presented more probability of reducing depressive symptoms when compared to the control group (approximately -1.4 standard differences in means; 95% CI -2.602 to -0.204).
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Affiliation(s)
- Miguel Jacinto
- School of Education and Social Sciences (ESECS), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
| | - Diogo Monteiro
- School of Education and Social Sciences (ESECS), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Joana Oliveira
- School of Education and Social Sciences (ESECS), Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Susana Diz
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Roberta Frontini
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Rui Matos
- School of Education and Social Sciences (ESECS), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
| | - Raul Antunes
- School of Education and Social Sciences (ESECS), Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal
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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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Kazzi C, Campbell L, Porter M. Psychological therapies for anxiety in autistic individuals with co-occurring intellectual developmental disorder: A systematic review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AbstractThis systematic review aimed to evaluate the efficacy of psychological therapies for anxiety for people with autism and co-occurring intellectual developmental disorder (AUT + IDD). A systematic search identified 13 studies comprising 49 participants with AUT + IDD, aged between 5 and 41 years. Most studies were single-case experimental designs (n = 7) or case studies or case series (n = 4). Studies implemented cognitive behavioural therapy (n = 4) or exposure therapy techniques (n = 9). All studies reported a reduction in anxiety symptoms, as measured by either quantitative measures or defined as participants meeting end of treatment criterion. However, the conclusions are preliminary due to the methodological limitations of the current literature. The implications of these findings, as well as recommendations for future direction in the field, are discussed.
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15
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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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16
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Adapting cognitive behaviour therapy for people with intellectual disabilities: an overview for therapist working in mainstream or specialist services. COGNITIVE BEHAVIOUR THERAPIST 2023. [DOI: 10.1017/s1754470x22000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
This paper is an introduction to adaptations to make cognitive behaviour therapy (CBT) more accessible to people with intellectual disabilities. It is intended to inform therapists who may work with people with intellectual disabilities in mainstream services.
The paper describes adaptations that consider neuropsychological processes, such as memory, and executive functions, such as planning, problem solving and self-regulation, and identifies that these factors are not unique to people with intellectual disabilities. We describe adaptations based on a review of literature describing CBT for people with intellectual disabilities (Surley and Dagnan, 2019) and draw on clinical experience to give examples of adaptations where possible. The paper particularly emphasises the generalisability of adaptations used with people with intellectual disabilities to therapy with wider populations and suggests that CBT therapists working in mainstream services will have the skills to be able to adapt therapy for people with intellectual disabilities.
Key learning aims
(1)
To overview the evidence base supporting the use of CBT with people with intellectual disabilities.
(2)
To describe the epidemiology of intellectual disability and discuss its implications for the generalisability of adaptations discussed in this paper.
(3)
To describe a range of adaptations to make CBT more accessible people with intellectual disabilities.
(4)
To consider whether such adaptations are part of the skill set of CBT therapists mainly working with people without intellectual disabilities.
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17
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Lehman N, Trouillet R, Genevieve D. A single case experimental designed protocol to evaluate the effectiveness of anxiety therapy with a Smartphone application in Williams Beuren syndrome (Preprint). JMIR Res Protoc 2022; 12:e44393. [PMID: 37010888 PMCID: PMC10131632 DOI: 10.2196/44393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/10/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Williams syndrome (WS-OMIM 194050, orphaned number: Orpha 904) is a rare condition mostly associated with intellectual disability. People with Williams syndrome are 8 times more likely to have anxiety disorders than the general population. Therapeutic solutions to treat the anxiety remain limited, particularly nonpharmacological therapy. However, cognitive behavioral therapy (CBT) has been found efficacious in managing anxiety disorders and can be used for people with intellectual disability. OBJECTIVE This paper describes a protocol to assess the efficiency of a CBT program based on digital support for people with Williams syndrome and anxiety based on a research methodology designed for rare diseases. METHODS We will recruit 5 individuals with Williams syndrome and anxiety. They will participate in 9 CBT sessions. Participants will perform daily self-assessments of anxiety using a digital app, which will allow for ecological and repeated evaluation of their anxiety. This digital app will provide support for each therapy session. Anxiety and quality of life will be externally assessed before and after the program and at a 3-month follow-up. This is a single-case intervention research design with multiple baselines implying repeated measures of judgment criteria. The present protocol ensures high internal validity and will help identify encouraging contributions for later clinical trials. RESULTS Participant recruitment and data collection began in September 2019, and we project that the study findings will be available for dissemination by spring 2023. CONCLUSIONS This study will allow the assessment of the efficiency of a CBT program based on digital support to treat anxiety in people with Williams syndrome. Finally, the program could be used as an example of nonpharmacological therapy for rare diseases. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03827525; https://clinicaltrials.gov/ct2/show/NCT03827525. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44393.
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Affiliation(s)
- Natacha Lehman
- EA4556 Laboratoire Epsylon, Université Paul Valery Montpellier 3, Montpellier, France
- Genetic Department, Montpellier Hospital, Montpellier, France
| | - Raphaël Trouillet
- EA4556 Laboratoire Epsylon, Université Paul Valery Montpellier 3, Montpellier, France
| | - David Genevieve
- Genetic Department, Montpellier Hospital, Montpellier, France
- Institut National de la Santé et de la Recherche Médicale U1183, Montpellier University, Montpellier, France
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18
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Patterson CW, Golightly M. Adults with intellectual disabilities and third‐wave therapies: A systematic review and
meta‐ethnography. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:13-27. [DOI: 10.1111/jar.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/20/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Affiliation(s)
| | - Mark Golightly
- Peterborough Adult locality Team Adult Mental Health Peterborough UK
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19
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Harpazi S, Regev D, Snir S. What does the literature teach us about research, theory, and the practice of art therapy for individuals with intellectual developmental disabilities? A Scoping Review. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Hewitt OM, Steel C, Hales SA, Hayden N, Gundeslioglu H, Tapp K, Langdon P. A systematic review and narrative synthesis of mental imagery tasks in people with an intellectual disability: Implications for psychological therapies. Clin Psychol Rev 2022; 96:102178. [PMID: 35738164 DOI: 10.1016/j.cpr.2022.102178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/22/2022] [Accepted: 06/04/2022] [Indexed: 11/18/2022]
Abstract
Mental imagery is recognised for its role in both psychological distress and wellbeing, with mental imagery techniques increasingly being incorporated into psychological interventions. In this systematic review and narrative synthesis (PROSPERO 2021: CRD42021240930), we identify and evaluate the evidence base for the phenomenon and phenomenology of mental imagery in people with intellectual disabilities, to ascertain the applicability of such interventions for this population. Electronic searches of nine databases and grey literature identified relevant publications. Two reviewers independently assessed titles and abstracts of retrieved records (n = 8609) and full-text articles (n = 101) against eligibility criteria. Data were extracted and quality appraised. Forty-onepapers met our eligibility criteria. The quality and designs were variable. Mental imagery was facilitated through ensuring participants understood tasks, providing opportunity to rehearse tasks (including using concrete prompts) and using scaffolding to help participants elaborate their responses. People with intellectual disabilities can engage with mental imagery, with appropriate adaptations, although the associated phenomenology has not been thoroughly investigated. Mental imagery interventions may be useful for people with intellectual disabilities with appropriate modifications.
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Affiliation(s)
- Olivia Mary Hewitt
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK; Learning Disability Services, Berkshire Healthcare NHS Foundation Trust, 7-9 Cremyll Road, Reading RG1 8NQ, UK.
| | - Craig Steel
- xford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Headington, Oxford OX3 7JX, UK
| | - Susie A Hales
- Emotion and Mental Imagery Lab (EMIL), Department of Psychology, Uppsala University, Box 1225, 751 42, Sweden; Oxford Health NHS Foundation Trust, Littlemore Mental Health Centre, Sandford Road, Littlemore, Oxford OX4 4XN, UK
| | - Nikita Hayden
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK
| | - Hatice Gundeslioglu
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK
| | - Katherine Tapp
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK
| | - Peter Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, UK; Coventry and Warwickshire Partnership NHS Trust, Rainbow Unit, Brooklands Hospital, Marston Green, Birmingham B37 5RY, UK
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21
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Totsika V, Liew A, Absoud M, Adnams C, Emerson E. Mental health problems in children with intellectual disability. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:432-444. [PMID: 35421380 DOI: 10.1016/s2352-4642(22)00067-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022]
Abstract
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia; Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Ashley Liew
- Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; National & Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK; Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Colleen Adnams
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK; Centre for Disability Research & Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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22
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Byrne G. A Systematic Review of Treatment Interventions for Individuals With Intellectual Disability and Trauma Symptoms: A Review of the Recent Literature. TRAUMA, VIOLENCE & ABUSE 2022; 23:541-554. [PMID: 32969328 DOI: 10.1177/1524838020960219] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Individuals with intellectual disabilities (IDs) are at increased susceptibility to adverse life experiences and trauma sequelae. There is a disparate range of therapeutic interventions for post-traumatic stress disorder (PTSD) and associated symptoms. This systematic review aimed to appraise the effectiveness of both cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay. A systematic search, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of the PsychInfo, PubMed, Cochrane Database of Systematic Reviews, and MEDLINE databases were performed, and all relevant articles published between 2010 and March 2020 were included. A total of 11 articles were included, eight that focused on EMDR and three on CBT. The methodological quality of many of these articles was generally weak. Tentative findings suggest that EMDR and CBT are both acceptable and feasible treatment options among adults and children with varying levels of intellectual delay, but no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardized assessment, and a paucity of methodological rigorous treatment designs. This review highlights the continued use of therapeutic approaches with clients presenting with IDs and PTSD. It adds to the extant literature by providing an expansive and broad overview of the current effectiveness of both EMDR and CBT. Further high-quality research is needed to provide more conclusive findings regarding treatment effectiveness and modifications to treatment needed with this population.
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Affiliation(s)
- Gary Byrne
- Primary Care Psychology Department, Churchtown, Health Service Executive, Dublin, Ireland
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23
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Millar C, Greenhill B. Adapted remote cognitive behavioural therapy for comfort eating with a woman with intellectual disabilities: Case report. J Eat Disord 2022; 10:29. [PMID: 35193691 PMCID: PMC8862397 DOI: 10.1186/s40337-022-00537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic overshadowing can prevent the treatment of comfort eating in people with intellectual disabilities, and the published literature contains few therapeutic examples. This case study reports a relatively novel, promising, and accessible, remote cognitive behavioural intervention. CASE PRESENTATION This case study documents a therapeutic intervention for comfort eating with a client, Sarah, in a National Health Service adult Community Learning Disabilities Service. Sarah is a white, British woman in her late thirties, with a diagnosis of Down syndrome who experienced significant problems with comfort eating and subsequent weight management. Despite dieting and exercising, Sarah was clinically obese and experienced weight related pain and psychological distress. Systemic intervention between Sarah, her mother, and the therapist formulated Sarah's eating difficulties using a cognitive behavioural framework. This hypothesised how comfort-eating met her emotional needs and maintained her health difficulties. Remote cognitive behavioural therapy interventions included collaborative behavioural experiments, coping strategies, and homework tasks. CONCLUSIONS The Maslow Assessment of Needs Scale-Learning Disabilities, Glasgow Depression Scale for people with a Learning Disability, Glasgow Anxiety Scale for people with an Intellectual Disability, qualitative feedback from family, as well as frequency data showed significant improvement. Additionally, the case considers the evidence base, assessment, formulation and intervention, before reflecting on its various strengths and limitations. It reflects on the intersectionality of sexuality and intellectual disabilities, and the desire for romantic attachment, which was additionally complicated by the context of coronavirus and social isolation. The environmental influences on comfort eating regarding this case, and in general, the experiences of people with intellectual disabilities are also considered. The potential clinical impact of this case study includes exemplifying an effective comfort eating therapeutic intervention in an often overlooked client group.
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Affiliation(s)
- Chris Millar
- University of Liverpool, Liverpool, United Kingdom.
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Gómez LE, Navas P, Verdugo MÁ, Tassé MJ. Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability. World J Psychiatry 2021; 11:1039-1052. [PMID: 34888172 PMCID: PMC8613764 DOI: 10.5498/wjp.v11.i11.1039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/17/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.
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Affiliation(s)
- Laura E Gómez
- Department of Psychology, University of Oviedo, Oviedo 33011, Asturias, Spain
| | - Patricia Navas
- Department of Personality, Evaluation and Psychological Treatments, Institute on Community Integration, University of Salamanca, Salamanca 37005, Salamanca, Spain
| | - Miguel Ángel Verdugo
- Department of Personality, Evaluation and Psychological Treatments, Institute on Community Integration, University of Salamanca, Salamanca 37005, Salamanca, Spain
| | - Marc J Tassé
- Department of Psychology and Psychiatry, The Ohio State University Nisonger Center-UCEDD, Columbus, OH 43210-1257, United States
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Barney CC, Andersen RD, Defrin R, Genik LM, McGuire BE, Symons FJ. [Challenges in pain assessment and management among individuals with intellectual and developmental disabilities : German version]. Schmerz 2021; 36:49-58. [PMID: 34515871 DOI: 10.1007/s00482-021-00589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. OBJECTIVES This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. METHODS This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. RESULTS The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. CONCLUSION Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
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Affiliation(s)
- Chantel C Barney
- Gillette Children's Specialty Healthcare, 200 University Ave E., 55101, Saint Paul, MN, USA. .,Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Randi D Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norwegen
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine & Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Lara M Genik
- Department of Psychology, University of Guelph, Guelph, ON, Kanada
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Irland
| | - Frank J Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
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Treatment Approach and Sequence Effects in Cognitive Behavioral Therapy Targeting Emotion Regulation Among Adolescents with Externalizing Problems and Intellectual Disabilities. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Over the past years, it has become clear that adapted cognitive behavior therapy can be effective for adolescents with externalizing problems and mild intellectual disabilities or borderline intellectual functioning (MID–BIF). Most adapted treatment protocols consist, however, of a combined cognitive and behavioral approach, even though it is actually unclear which approach is most suitable for these adolescents. This experimental study aimed to examine which treatment approach (cognitive versus behavioral) and which treatment sequence (cognitive–behavioral versus behavioral–cognitive) is most effective.
Methods
Participating adolescents (N = 42, 50% boys, Mage = 15.52, SD = 1.43) consecutively received a cognitive and behavioral emotion regulation training module, but were randomly assigned to a different module sequence condition. Emotion regulation and externalizing problems were measured before and after the modules, and with continuing weekly assessments.
Results
Results indicated that the cognitive module, by itself, was more effective than the behavioral module. In addition, the results indicated that it is most effective to include behavioral exercises after (rather than before) cognitive training.
Conclusions
These findings highlight the importance of cognitive treatment approaches for adolescents with MID–BIF, and show that treatment approaches may have different effects, depending on the order in which they are presented.
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Tolentino-Castro JW, Raab M. Intellectual Disabilities Behavior Under the Lens of Embodied Cognition Approaches. Front Psychol 2021; 12:620083. [PMID: 34322048 PMCID: PMC8311120 DOI: 10.3389/fpsyg.2021.620083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Walter Tolentino-Castro
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil
| | - Markus Raab
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,School of Applied Sciences, London South Bank University, London, United Kingdom
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Oudshoorn CEM, Frielink N, Nijs SLP, Embregts PJCM. Psychological eHealth interventions for people with intellectual disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:950-972. [PMID: 33704872 PMCID: PMC8359285 DOI: 10.1111/jar.12877] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of eHealth, which has accelerated in the wake of the COVID-19 pandemic, could contribute to the access to tailor-made psychological interventions for people with intellectual disabilities. METHOD A scoping review was conducted on peer-reviewed studies between 1996-2019. RESULTS Thirty-three studies reported on the use of psychological eHealth interventions focused on mental health problems and/or challenging behaviour. The vast majority of these studies reported on interventions that were delivered at the individual level. The context in which these interventions were delivered varied, primarily ranging from the home setting to residential settings, as well as day or activity centres and schools. The studies described various types of interventions: telehealth interventions, computerized cognitive behavioural therapy, and interventions focused on (social) learning principles targeting challenging behaviour. CONCLUSIONS eHealth provides new opportunities for both therapists and lay-therapists to deliver psychological interventions. Future studies should focus on the effectiveness of psychological eHealth interventions.
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Affiliation(s)
- Cathelijn E. M. Oudshoorn
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - Noud Frielink
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Sara L. P. Nijs
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Petri J. C. M. Embregts
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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Cameron LA, Phillips K, Melvin GA, Hastings RP, Gray KM. Psychological interventions for depression in children and young people with an intellectual disability and/or autism: systematic review. Br J Psychiatry 2021; 218:305-314. [PMID: 33198825 DOI: 10.1192/bjp.2020.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children and young people with intellectual disability and/or Autism Spectrum Disorder (autism) experience higher rates of mental health problems, including depression, than their typically developing peers. Although international guidelines suggest psychological therapies as first-line intervention for children and young people, there is limited evidence for psychological therapy for depression in children and young people with intellectual disability and/or autism. AIMS To evaluate the current evidence base for psychological interventions for depression in children and young people with intellectual disability and/or autism, and examine the experiences of children and young people with intellectual disability and/or autism, their families and therapists, in receiving and delivering psychological treatment for depression. METHOD Databases were searched up to 30 April 2020 using pre-defined search terms and criteria. Articles were independently screened and assessed for risk of bias. Data were synthesised and reported in a narrative review format. RESULTS A total of 10 studies met the inclusion criteria. Four identified studies were clinical case reports and six were quasi-experimental or experimental studies. All studies were assessed as being of moderate or high risk of bias. Participants with intellectual disability were included in four studies. There was limited data on the experiences of young people, their families or therapists in receiving or delivering psychological treatment for depression. CONCLUSIONS Well-designed, randomised controlled trials are critical to develop an evidence base for psychological treatment for young people with intellectual disability and/or autism with depression. Future research should evaluate the treatment experiences of young people, their families and therapists.
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Affiliation(s)
- Lauren A Cameron
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Katelyn Phillips
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University; and Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, The University of New South Wales, Australia
| | - Glenn A Melvin
- School of Psychology, Deakin University, Australia; and Centre for Education, Appraisal and Research, University of Warwick, UK
| | - Richard P Hastings
- Centre for Education, Appraisal and Research, University of Warwick, UK; and Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Kylie M Gray
- Centre for Education, Appraisal and Research, University of Warwick, UK; and Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
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Knappe S. “Mutig werden kann ich lernen”: Kognitive Verhaltenstherapie bei ausgeprägter Angstsymptomatik, Entwicklungsstörung und Intelligenzminderung. VERHALTENSTHERAPIE 2021. [DOI: 10.1159/000516539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Die psychotherapeutische Behandlung von Kindern und Jugendlichen mit geistiger Behinderung unterliegt einer Vielzahl von Barrieren. <b><i>Fallbericht:</i></b> Der hier vorgestellte Behandlungsfall illustriert die erfolgreiche Anwendung kognitiver Verhaltenstherapie bei einem 10-jährigen Mädchen bei Entwicklungsstörung und Intelligenzminderung. Nach einer medizinisch notwendigen Untersuchung entstanden ausgeprägte Angstsymptome und Verhaltensprobleme. Infolge einer bekannten Epilepsie war der Einsatz expositionsbasierter Techniken fraglich. Die kognitive Verhaltenstherapie umfasste 64 Behandlungseinheiten. Das Vorgehen zur Selbstbeobachtung, Rationalvermittlung und Angstbewältigung war stark handlungsbezogen und wenig kognitiv orientiert und fand im häuslichen Setting mit Einbezug der Familienmitglieder statt. Nachfolgend wurden – auch aufgrund der zunehmenden Reifung des Kindes – kognitiv anspruchsvollere Techniken eingesetzt. Zur 38. Behandlungseinheit wurden zuvor angstbesetzte Situationen dem Entwicklungsstand angemessen und selbstständig bewältigt. Eine nachfolgende medizinische Untersuchung ähnlich der Auslösesituation wurde therapeutisch vorbereitet und sicher bewältigt. Zu Behandlungsende waren die Alltagskompetenzen maßgeblich erweitert. <b><i>Schlussfolgerungen:</i></b> Entgegen der Vorannahmen bedurfte es nur weniger Anpassungen an das Setting und die Behandlungstechniken im Vergleich zum Vorgehen bei ähnlicher Symptomatik ohne geistige Behinderung. Durch die psychotherapeutische Behandlung konnte kurz- und langfristig eine Manifestation (Eskalation) von weiterem Problemverhalten verhindert werden. Das Erkennen und die Auseinandersetzung mit dem “Anderssein” infolge der geistigen Behinderung und verfügbarer Alltagskompetenzen bergen Entwicklungsrisiken und -chancen, die durch eine psychotherapeutische Begleitung gut bewältigt werden können.
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IDTWO: A Protocol for a Randomised Controlled Trial of a Web-Based Mental Health Intervention for Australians with Intellectual Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052473. [PMID: 33802311 PMCID: PMC7967603 DOI: 10.3390/ijerph18052473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022]
Abstract
People with intellectual disability (ID) experience higher rates of mental illness and reduced access to appropriate care and treatment. Tailored electronic mental health (eMH) programs offer opportunities to address these disparities. The aim of this study is to examine whether a fully automated and self-guided eMH program tailored to the needs of people with ID can reduce symptoms of anxiety and depression and improve daily functioning in people with borderline-to-mild ID. Australians with borderline-to-mild ID, aged 16 years and older with mild-to-moderate depression and/or anxiety symptoms will be eligible to participate with the help of a nominated carer, if necessary. A randomised controlled trial with a sample size of 150 participants divided into treatment and waitlist control arms will be conducted. Participants randomised to the intervention group will have full access to the Healthy Mind program for eight weeks. The waitlist control group will gain full access to the program following the eight-week treatment period. Efficacy will be assessed on the Anxiety, Depression, and Mood Scale; Kessler-10; and the World Health Organisation Disability Assessment Schedule 2.0 across three time-points (baseline, eight weeks, and three months). We expect that people who use the intervention will report reduced depression and anxiety, relative to the control group. To our knowledge, this is the first study to examine the effectiveness of a fully automated eMH program for improving mental health in people with ID. We expect our study to render new knowledge on the delivery and effects of internet-based cognitive behaviour therapy (CBT) tools for people with ID.
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Schijven EP, Hulsmans DHG, VanDerNagel JEL, Lammers J, Otten R, Poelen EAP. The effectiveness of an indicated prevention programme for substance use in individuals with mild intellectual disabilities and borderline intellectual functioning: results of a quasi-experimental study. Addiction 2021; 116:373-381. [PMID: 32678489 PMCID: PMC7891383 DOI: 10.1111/add.15156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/20/2019] [Accepted: 06/05/2020] [Indexed: 01/30/2023]
Abstract
AIMS To assess the effectiveness of Take it personal!, a prevention programme for individuals with mild intellectual disabilities and borderline intellectual functioning (MID-BIF) and substance use (SU). The prevention programme aims to reduce SU (alcohol, cannabis and illicit drugs) among experimental to problematic substance users. DESIGN A quasi-experimental design with two arms and a 3-month follow-up. SETTING Adolescents were recruited from 14 treatment centres in the Netherlands specialized in offering intra- and extramural care for people with MID-BIF and behavioural problems. PARTICIPANTS Data were collected from 66 individuals with MID-BIF assigned either to the intervention condition (n = 34) or to the control condition (n = 32). INTERVENTIONS Take it personal! was designed to target four personality traits: sensation-seeking, impulsive behaviour, anxiety sensitivity and negative thinking. For each of these profiles, interventions were developed that were structurally the same but contained different personality-specific materials, games and exercises. The control group received care as usual. MEASUREMENTS Primary outcomes at 3-month follow-up were frequency of SU, severity of SU and binge drinking. RESULTS Results showed intervention effects for SU frequency (F(1, 50.43) = 9.27, P = 0.004) and binge drinking (F(1, 48.02) = 8.63, P = 0.005), but not for severity of SU (F(1, 42.09) = 2.20, P = 0.145). CONCLUSIONS A prevention programme to reduce substance use among experimental to problematic users with mild intellectual disabilities and borderline intellectual functioning helped participants to decrease substance use frequency and binge drinking.
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Affiliation(s)
- Esmée P. Schijven
- Research and DevelopmentPlurynNijmegenthe Netherlands,Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
| | - Daan H. G. Hulsmans
- Research and DevelopmentPlurynNijmegenthe Netherlands,Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
| | - Joanneke E. L. VanDerNagel
- TactusCentre for Addiction and Intellectual Disability (CAID)Deventerthe Netherlands,Radboud University, Nijmegen Institute for Scientist‐Practitioners in AddictionNijmegenthe Netherlands,AveleijnBornethe Netherlands,Faculty of Electrical Engineering, Mathematics, and Computer Science, Human Media InteractionUniversity of TwenteEnschedethe Netherlands
| | - Jeroen Lammers
- Trimbos InstituteNetherlands Institute of Mental Health and AddictionUtrechtthe Netherlands
| | - Roy Otten
- Research and DevelopmentPlurynNijmegenthe Netherlands,Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands,REACH Institute, Department of PsychologyArizona State UniversityTempeAZUSA
| | - Evelien A. P. Poelen
- Research and DevelopmentPlurynNijmegenthe Netherlands,Behavioural Science Institute, Radboud UniversityNijmegenthe Netherlands
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Blakeley-Smith A, Meyer AT, Boles RE, Reaven J. Group Cognitive Behavioural Treatment for Anxiety in Autistic Adolescents with Intellectual Disability: A Pilot and Feasibility Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:777-788. [PMID: 33410240 DOI: 10.1111/jar.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents with Autism Spectrum Disorder (ASD) and intellectual disability evidence significant anxiety. This study aimed to adapt a group cognitive behaviour therapies (CBT) programme designed for youth with ASD and anxiety to meet the cognitive, communication, and behavioural needs of adolescents with intellectual disability, and assess initial feasibility and efficacy of the intervention. METHODS Structural, content and procedural adaptations were made to a 14-week family-focused CBT intervention. Twenty-three adolescents with ASD, intellectual disability and anxiety were included. Treatment acceptability along with adolescent anxiety symptoms was assessed via parent report measures. RESULTS Of the 23 participants, 19 completed treatment and attended 94% of sessions. Parent acceptability was high. Significant reductions were noted on anxiety symptoms post-intervention. CONCLUSIONS Results indicate that the CBT group was feasible and acceptable. Preliminary outcomes suggest that adolescent anxiety improved, although replication with a larger sample and comparison to a control group is needed.
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Affiliation(s)
- Audrey Blakeley-Smith
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison T Meyer
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard E Boles
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Mulhall P, Taggart L, McAloon T, Coates V. Challenges to conducting randomised controlled trials with adults with intellectual disabilities: Experiences of international experts. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:891-904. [PMID: 33277777 DOI: 10.1111/jar.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Globally, conducting randomised controlled trials can be a complex endeavour. The complexity increases when including participants with cognitive or intellectual disabilities. A fuller understanding of the barriers and challenges that can be expected in such trials may help researchers to make their trials more inclusive for people with disabilities. METHOD Semi-structured interviews were conducted with twelve international trial experts. RESULTS Eight themes emerged relating to challenges linked to: 1) participant co-morbidities, 2) participant ability levels, 3) ethics and consent, 4) the RCT methodology, 5) gatekeeping, 6) staff turnover, 7) lack of technical understanding and 8) attitudes and perceptions. CONCLUSION Conducting trials with cognitively disabled participants can pose unique challenges although many can be overcome with 'reasonable adjustments'. Challenges that are harder to overcome are attitudes and perceptions that people (professional staff, funding bodies, carers or fellow researchers) hold towards the utility of conducting trials with cognitively disabled populations.
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Affiliation(s)
- Peter Mulhall
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Laurence Taggart
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Toni McAloon
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Vivien Coates
- School of Nursing, Ulster University, Newtownabbey, Northern Ireland
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Syed AA, Neelofur S, Moran A, O'Reilly G. Investigating the potential clinical utility of therapeutic techniques based on eidetic imagery as adapted by the Eidetic Model of Growth (EMG) for people with intellectual disability (ID). Heliyon 2020; 6:e05115. [PMID: 33033764 PMCID: PMC7533367 DOI: 10.1016/j.heliyon.2020.e05115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 11/03/2022] Open
Abstract
Eidetic model of growth (EMG) is a form of psychotherapy developed for people with intellectual disabilities (ID). EMG is based on the theoretical tenets of eidetic psychotherapy of Akhter Ahsen, which uses eidetic imagery as its major therapeutic tool. The literature review did not find any empirical study on eidetic imagery-based psychotherapy for people with ID except reviews and case histories. This study investigates the clinical utility of therapeutic techniques based on eidetic imagery as developed by Ahsen and Syed. In this study thirty participants with mild and moderate ID were recruited. Participants were recruited from the services for people with ID. These services were contacted to recruit participants who had experiential (i.e., abuse, trauma etc.), emotional (i.e., bereavement, attachment problems), psychiatric (i.e., anxiety, depression) and behavioural (i.e., anger, aggression) problems and to seek consent from the potential participants. The Anxiety Depression and Mood Scale (ADAMS) was administered to the participants before the therapy started, after every 5th session and once the therapy was terminated. The statistical analysis of the pre-therapy and post-therapy scores of participants on the ADAMS was carried out to measure the therapeutic outcome. Paired-sample t-test revealed a significant difference between the pre-therapy and post-therapy scores of participants on ADAMS, with a large effect size (d = 1.54). The result indicates existence of eidetic imagery in people with ID and its promising therapeutic utility.
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Byrne G, O'Mahony T. Acceptance and commitment therapy (ACT) for adults with intellectual disabilities and/or autism spectrum conditions (ASC): A systematic review". JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Schijven EP, VanDerNagel JEL, Otten R, Lammers J, Poelen EAP. Take it personal! Development and modelling study of an indicated prevention programme for substance use in adolescents and young adults with mild intellectual disabilities and borderline intellectual functioning. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:307-315. [PMID: 32990417 PMCID: PMC7820965 DOI: 10.1111/jar.12808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
Background This paper describes the theory and development of Take it personal! an indicated prevention programme aimed at reducing substance use in individuals with mild intellectual disabilities and borderline intellectual functioning. Method The process of the development of Take it personal! followed the steps of the Intervention Mapping protocol. Take it personal! is based on the theory that personality traits are an important construct to understand substance use (14–30 years old). A small modelling study was conducted with six adolescents to examine the feasibility, user‐friendliness and potential effectiveness of the intervention. Results The results showed that the intervention has good feasibility and user‐friendliness. Post‐intervention evaluation of frequency, binge drinking and problematic use indicated that use was lower than at pre‐intervention. Conclusions Take it Personal! can be a promising preventive intervention designed to reduce substance use in individuals in this target group. A larger scale study is needed to draw further conclusions.
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Affiliation(s)
- Esmée P Schijven
- Research and Development, Pluryn, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Joanneke E L VanDerNagel
- Centre for Addiction and Intellectual Disability (CAID), Tactus, Deventer, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University Nijmegen, Nijmegen, The Netherlands.,Aveleijn, Borne, The Netherlands.,Human Media Interaction, Faculty of Electrical Engineering, Mathematics, & Computer Science, University of Twente, Enschede, The Netherlands
| | - Roy Otten
- Research and Development, Pluryn, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,REACH Institute, Arizona State University, Tempe, AZ, USA
| | - Jeroen Lammers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Evelien A P Poelen
- Research and Development, Pluryn, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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Kim J, Kim H, Park S, Yoo J, Gelegjamts D. Mediating effects of family functioning on the relationship between care burden and family quality of life of caregivers of children with intellectual disabilities in Mongolia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:507-515. [PMID: 32954571 PMCID: PMC7891464 DOI: 10.1111/jar.12814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
Background Intellectual disabilities are characterized by constant and complex needs for care that place a heavy burden on the families of affected individuals and affect their overall quality of life. We evaluated the mediating effects of family functioning on the relationship between care burden and the family quality of life of caregivers of children with intellectual disabilities in Mongolia. Methods Data were collected from a sample of 150 caregivers of children with intellectual disabilities from October 2017 to November 2017. Multiple linear regression analyses were performed to examine the mediating effects of family functioning. Results Family functioning had a partial mediating effect (β = .702, p < .001) on the relationship between care burden and family quality of life. Conclusion Family functioning should be considered when developing a social support intervention to improve family quality of life among caregivers of children with intellectual disabilities.
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Affiliation(s)
- Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - Hyunlye Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - Seojin Park
- Department of Nursing, Donggang University, Gwangju, South Korea
| | - Jaeyong Yoo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - Delgersuren Gelegjamts
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea.,Department of Nursing, College of Medicine, Mongolian National University, Ulaanbaatar, Mongolia
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Graser J, Menge E, Lyons N, Willutzki U, Michalak J. Verhaltenstherapie bei Erwachsenen mit intellektueller Beeinträchtigung: Eine systematische Review. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000508955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Menschen mit intellektueller Beeinträchtigung (IB) sind häufig von psychischen Störungen betroffen. Gleichzeitig ist die psychotherapeutische Versorgung in diesem Bereich bisher unzureichend, und die Evidenz bezüglich der Wirksamkeit verhaltenstherapeutischer Interventionen bei Erwachsenen mit IB ist unklar. <b><i>Ziele:</i></b> Eine systematische Literaturrecherche in den Datenbanken PubMed, PsycINFO und Google Scholar wurde durchgeführt, um die aktuelle Studienlage zu verhaltenstherapeutischen Interventionen bei Menschen mit IB zu evaluieren. Ausgewählt wurden Studien zu verhaltenstherapeutischen Verfahren bei psychischen Störungen und Problemverhalten im Erwachsenenalter. <b><i>Ergebnisse:</i></b> Zweiunddreißig Studien entsprachen den Einschlusskriterien; es wurden sowohl einzeltherapeutische als auch gruppentherapeutische Interventionen eingeschlossen. Für Menschen mit leichter IB (IQ 50–69) und teilweise auch bei mittlerer IB (IQ 35–49) konnten in einigen Studien Hinweise auf effektive und gut umsetzbare Verfahren gefunden werden. Deutliche positive Effekte aus verschiedenen Studien zeigten sich bei depressiven Symptomen und bei aggressivem Verhalten sowohl im ambulanten wie auch im forensischen Setting. Für Angstsymptome und bei Raucherentwöhnung liegen ebenfalls positive Befunde vor. Bei psychotischen Störungen und bei pathologischem Horten muss die Wirksamkeit von verhaltenstherapeutischen Interventionen noch als unklar eingeschätzt werden. <b><i>Schlussfolgerungen:</i></b> Es bedarf weiterer Forschung (insbesondere randomisierter kontrollierter Studien mit aktiven Kontrollbedingungen), in der differenzierter überprüft wird, welche Aspekte der Therapien/welche Settingbedingungen die Effektivität bei den verschiedenen Graden der IB beeinflussen.
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Kim YS, Moon JH, Hong BK, Ho SH. Effect of a Multicomponent Intervention Program on Community-Dwelling People With Intellectual Disabilities. Ann Rehabil Med 2020; 44:327-337. [PMID: 32721986 PMCID: PMC7463116 DOI: 10.5535/arm.19124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/03/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the effectiveness of a novel and complex intervention in community-dwelling people with intellectual disabilities. Methods Forty-three participants completed the experiment. The subjects were randomly assigned the experimental (n=33) or control (n=10) groups. The multicomponent intervention program comprised exercise and nutrition management and behavior modification. The intervention was performed for 60 minutes once weekly for 10 weeks. The assessment included anthropometric data, body composition and blood pressure analysis, and blood tests. In addition, pulmonary function, physical function, and health-related quality of life were measured before and after the intervention. Results No adverse events occurred during the intervention. After the intervention, the experimental group showed a significantly higher increase in high-density lipoprotein cholesterol level than did the control group (effect size=0.152, p=0.019). Conclusion This innovative intervention was effective in improving cardiovascular health. Even greater effects could be achieved through improvements in implementation strategies to increase compliance.
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Affiliation(s)
- Ye-Soon Kim
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Jong-Hoon Moon
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Bo Kyoon Hong
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Korea
| | - Seung Hee Ho
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
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Hamers PCM, Festen DAM, Bindels PJE, Hermans H. The effect of bright light therapy on depressive symptoms in adults with intellectual disabilities: Results of a multicentre randomized controlled trial. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1428-1439. [PMID: 32583931 PMCID: PMC7687277 DOI: 10.1111/jar.12770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/09/2020] [Accepted: 05/22/2020] [Indexed: 01/01/2023]
Abstract
Background Although a large number of adults with intellectual disabilities have depressive symptoms, non‐pharmacological treatments are scarce. The present authors investigated whether bright light therapy (BLT) is effective in decreasing depressive symptoms compared to care as usual. Methods This multicentre randomized controlled trial consisted of three study groups (10,000 lux BLT, dim light BLT and a no‐BLT group). Participants received BLT for 30 min in the morning (14 consecutive days), additional to their regular care. Primary outcome was as follows: depressive symptoms measured with the ADAMS Depressive Mood subscale 1 week after the end of BLT (same time period in the no‐BLT group). Results Forty‐one participants were included in our trial. In both BLT groups, a significant decrease in depressive symptoms was seen. No significant differences were found between 10,000 lux BLT and no‐BLT (p = .199) and no significant differences between dim light BLT and no‐BLT (p = .451). A minimum amount of side effects and no adverse events were reported. Conclusions In both BLT interventions, a decrease in depressive symptoms was seen. With 10,000 lux BLT, depressive symptoms decreased even below the clinical cut‐off point, which makes BLT a promising intervention for clinical practice.
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Affiliation(s)
- Pauline C M Hamers
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Amarant, Healthcare Organization for People with Intellectual disabilities, Tilburg, The Netherlands
| | - Dederieke A M Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Ipse de Bruggen, Healthcare Organization for People with Intellectual Disabilities, Zoetermeer, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heidi Hermans
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Amarant, Healthcare Organization for People with Intellectual disabilities, Tilburg, The Netherlands
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43
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Challenges in pain assessment and management among individuals with intellectual and developmental disabilities. Pain Rep 2020; 5:e821. [PMID: 32656458 PMCID: PMC7302581 DOI: 10.1097/pr9.0000000000000822] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Pain is common for individuals with intellectual and developmental disabilities, and we need to accelerate the use of evidence-based approaches to assess and manage pain. Introduction: Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. Objectives: This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. Methods: This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. Results: The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. Conclusion: Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
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Evans L, Randle-Phillips C. People with intellectual disabilities' experiences of psychological therapy: A systematic review and meta-ethnography. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:233-252. [PMID: 30003831 DOI: 10.1177/1744629518784359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The effectiveness of a range of psychological models adapted for use with people with intellectual disabilities has been well documented. A number of studies have used qualitative methods to examine people with intellectual disabilities' experiences of these adapted interventions. Such research is important for identifying service users' views on the helpful and challenging aspects of psychological interventions to ensure that they meet the needs of people with intellectual disabilities. To consolidate this research, a systematic review using a meta-ethnographic approach was undertaken. A systematic search identified 16 relevant studies. These studies were reviewed, critically appraised and key themes were extracted. Five key concepts were identified: adapting to therapy, the therapeutic environment, group dynamics, the therapeutic relationship and the impact of therapy on life. The need for further consideration of power differentials within the therapeutic relationship and further adaptations to ensure accessibility of therapy for people with intellectual disabilities is discussed.
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Ho LYW, Chin KCW, Fung CYY, Lai CKY. Validation of the Chinese Non-pharmacological Therapy Experience Scale in persons with intellectual disability. Nurs Open 2020; 7:390-397. [PMID: 31871724 PMCID: PMC6917964 DOI: 10.1002/nop2.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/25/2019] [Indexed: 11/08/2022] Open
Abstract
Aim To validate the 4- and 7-point Chinese Non-pharmacological Therapy Experience Scales and test the psychometric properties of the scales on persons with intellectual disability. Design A validation study. Methods Sixty-seven persons with intellectual disability were recruited from six hostels or centres for persons with intellectual disability in Hong Kong. A total of 1,163 and 1,161 observations were collected by the trained observers with the 4-point and 7-point scales, respectively. The floor and ceiling effects, inter-rater reliability, internal consistency, responsiveness of both scales and the scale equivalence were examined. Results The Cronbach's α of the 4- and 7-point scales was .762 and .797, respectively. The correlation between the two scales was 0.906. The inter-rater reliability of the 4- and 7-point scales was 0.774 and 0.835, respectively. Neither scale had the floor or ceiling effects. The effect size of the 7-point scale was consistently higher than that of the 4-point scale.
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Affiliation(s)
- Lily Yuen Wah Ho
- School of NursingThe Hong Kong Polytechnic UniversityKowloonHong Kong
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Hronis A, Roberts R, Roberts L, Kneebone I. Potential for children with intellectual disability to engage in cognitive behaviour therapy: the parent perspective. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:62-67. [PMID: 31659831 DOI: 10.1111/jir.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/18/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study aimed to obtain the opinions of parents and carers of children with intellectual disability (ID) as to whether cognitive behaviour therapy (CBT) could be useful for their children. METHODS A mixed qualitative and quantitative method was employed. Twenty-one carers of children aged 10 to 17 having borderline to moderate intellectual functioning responded to an online questionnaire. Participants were provided with information about CBT and asked to respond to open-ended questions. Quantitative data pertained to questions about their child's ability to identify and describe thoughts, feelings and behaviours. Thematic analysis of responses was conducted using an inductive method of identifying themes from the qualitative data collected. RESULTS Five themes emerged from the qualitative analysis: Emotional Attunement (i.e. parent's understanding and recognition of their child's emotions), Role of the Therapist (i.e. ways therapists could facilitate the intervention), Role of the Parent (i.e. ways parents could engage in the therapy process), Anticipated Obstacles (i.e. what may get in the way of the therapy) and Suggested Adaptations for Therapy (i.e. how CBT can be adapted to suit the needs of children with ID). Seventy-six per cent agreed that their child would be able to engage in CBT with assistance. CONCLUSIONS The majority of parents believed that CBT is an intervention that children with ID could engage in, provided the therapy is adapted, and the therapist accommodates their needs.
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Affiliation(s)
- A Hronis
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - R Roberts
- The University of Adelaide, Adelaide, Australia
| | - L Roberts
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - I Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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O'Malley G, Irwin L, Guerin S. Supporting People with Intellectual Disability Who Have Experienced Abuse: Clinical Psychologists' Perspectives. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2019. [DOI: 10.1111/jppi.12323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Grace O'Malley
- UCD School of PsychologyUniversity College Dublin Dublin Ireland
- Department of PsychologyBrandenburg Medical School Theodor Fontane Neuruppin Germany
| | - Lynn Irwin
- UCD School of PsychologyUniversity College Dublin Dublin Ireland
| | - Suzanne Guerin
- UCD School of PsychologyUniversity College Dublin Dublin Ireland
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Non-Behavioral and Non-Medical Psychosocial Interventions in Individuals with Intellectual Disabilities. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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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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Vereenooghe L, Westermann K. Co-development of an interactive digital intervention to promote the well-being of people with intellectual disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 65:128-134. [PMID: 34141333 PMCID: PMC8115515 DOI: 10.1080/20473869.2019.1599606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 06/12/2023]
Abstract
Digital technologies have great potential in offering interventions for people with intellectual disabilities. In this study, we aimed to co-develop a digital psycho-educational intervention, using a positive resource-oriented approach, to improve the mental well-being of people with intellectual disabilities. Using a two-phase design process, we first used a theory-guided approach to develop the content. Next, iterative consultations with an advisory group of people with and without intellectual disabilities were conducted to proceed with the digital design of the intervention. Feedback from the advisory group addressed issues regarding the intervention's accessibility, interactivity, design and content. Changes were either implemented during the meetings or presented at consecutive meetings until the design and content were deemed satisfactory by the advisory group. This approach demonstrates that people with intellectual disabilities can be included in the development of a novel digital intervention. A future intervention study should determine the practicality and acceptability of this co-developed intervention in routine practice.
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Affiliation(s)
- Leen Vereenooghe
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Kristian Westermann
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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