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Abstract Psychosocial treatments like psychotherapy and group therapy are common for the treatment of depression in the general population. Depression in people with intellectual disability presents challenges, because people with intellectual disability often cannot consent to various treatments, clinicians and family members must be involved and use their best judgment. A selected review was conducted to highlight the progress in psychosocial treatment of depression within the last four decades. The main search terms were intellectual disability (ID), depression, and treatment. Nine articles were chosen; and included cognitive behaviour therapy (CBT), computer-assisted CBT, mindfulness-based cognitive therapy (MBCT), exercise therapy, behaviour activation, self-help intervention, dialectal behaviour therapy (DBT), and psychodynamic/psychoanalytical therapy. There were no articles on mental health nursing. Adaptions included smaller groups (in group intervention), visual material, simplifying of concepts, longer duration/more sessions, more practical help, more repetitions when learning new skills, more guiding, professional caregiver/family involvement, and individual support within group interventions. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions We report the effect of quality of therapy delivery on outcomes in a randomized, controlled trial of behavioural activation (BA) and guided self‐help (GSH) for depression in adults with intellectual disabilities.A study specific measure of quality was used in a linear mixed effect model to determine the effects therapy and therapy quality on therapy outcome.There was a significant interaction between quality and treatment type, with lower quality therapy associated with better outcome for GSH but poorer outcome for BA, with little difference in outcomes at higher levels of therapy quality.Factors suggesting high quality in individualized BA may indicate problematic engagement for GSH. More research into processes in therapy for people with intellectual disabilities is required. [ABSTRACT FROM AUTHOR]

As the life expectancy of individuals with intellectual disabilities (ID) continues to increase, there is an increased risk of developing dementia. While psychosocial interventions are gaining prominence, evidence is limited for people with both dementia and ID. This review discusses the effectiveness of direct psychosocial interventions and adaptations to facilitate delivery within this population. The review followed the PRISMA guidelines. Five electronic databases, grey literature, and reference lists of included articles were searched for relevant studies. 10 eligible studies were appraised and analysed by narrative synthesis. Ten distinct interventions were identified and categorised based on their purpose and delivery. All interventions were beneficial in improving a range of outcomes, though some studies were of low quality and most had small samples. Common adaptations included simplification of tasks and material, higher staff-to-client ratio, and alternative communication methods. There is emerging evidence for several psychosocial interventions for people with ID and dementia, though further research is required on effectiveness and generalisability. The adaptations discussed may guide implementation into routine care and contribute to current policies and guidelines on improving ID and dementia care. [ABSTRACT FROM AUTHOR]

Purpose: Intellectual disability is one of the neurodevelopmental disorders. Studies indicated that depression and anxiety are the most prevalent emotional problems among the people with intellectual disability. The aim of this study was to investigate the utility of behavioral activation therapy in addressing emotional problems of two depressed students with borderline intellectual disability. Method: This study is a single‐subject design with multiple baseline and one month follow‐up. Two students with borderline intelligence underwent behavioral activation therapy for 12 sessions. Beck Depression Inventory‐Second Edition, Beck Anxiety Inventory, Oxford Happiness Inventory and Rosenberg Self‐Esteem Scale were used. Data were analyzed using visual inspection of graphed data, changes in trends, improvement percentage and effect size. Findings: The findings of this study support the utility of behavioral activation therapy in addressing the emotional problems of two depressed students with borderline intellectual disability. Conclusion: Behavioral activation therapy has had favorable outcomes in reducing depression and anxiety in depressed students with borderline intellectual disabilities. [ABSTRACT FROM AUTHOR]

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This review paper reflects on the existing literature on cognitive behaviour therapy for adults, adolescents and children with intellectual disabilities. People with intellectual disabilities have high rates of comorbid mental health disorders, but low rates of accessing treatments with limited treatment options available to them. Historically, they have been excluded from cognitive-based therapies such as cognitive behaviour therapy. However, recent research has shown that people with mild to moderate intellectual disabilities do have the capacity to engage in cognitive-based interventions. The review highlights the progress that has been made in the field of adapting CBT for people with intellectual disabilities, as well as the current gaps in the literature and suggestions for future research. [ABSTRACT FROM AUTHOR]

• Tested the effectiveness of Take it Personal!+ in individuals with MID-BIF. • A multiple baseline single-case experimental design using a diary method. • Daily substance use decreased in 8 of 10 participants. • Substance use severity decreased in 8 of 12 participants. Individuals with mild intellectual disabilities or borderline intellectual functioning are at increased risk to develop a substance use disorder—however, effective treatment programs adapted to this target group are scarce. This study evaluated the effectiveness of Take it Personal!+ in individuals with mild intellectual disabilities or borderline intellectual functioning and substance use disorder. Take it Personal!+ is a personalized treatment based on motivational interviewing and cognitive-behavioral therapy supported by an mHealth application. Data were collected in a nonconcurrent multiple baseline single-case experimental design across individuals with four phases (i.e., baseline, treatment, posttreatment, and follow-up). Twelve participants were randomly allocated to baseline lengths varying between 7 and 11 days. Substance use quantity was assessed during baseline, treatment, and posttreatment with a daily survey using a mobile application. Visual analysis was supported with statistical analysis of the daily surveys by calculating three effect size measures in 10 participants (two participants were excluded from this analysis due to a compliance rate below 50%). Secondary, substance use severity was assessed with standardized questionnaires at baseline, posttreatment, and follow-up and analyzed by calculating the Reliable Change Index. Based on visual analysis of the daily surveys, 10 out of 12 participants showed a decrease in mean substance use quantity from baseline to treatment and, if posttreatment data were available, to posttreatment. Statistical analysis showed an effect of Take it Personal!+ in terms of a decrease in daily substance use in 8 of 10 participants from baseline to treatment and if posttreatment data were available, also to posttreatment. In addition, data of the standardized questionnaires showed a decrease in substance use severity in 8 of 12 participants. These results support the effectiveness of Take it Personal!+ in decreasing substance use in individuals with mild intellectual disabilities or borderline intellectual functioning. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities (ID) should be able to access the Improving Access to Psychological Therapies ( IAPT) programme, currently a main provider of mainstream mental health services in England. IAPT offer cognitive behavioural therapy ( CBT) to individuals experiencing mental health problems, although its effectiveness for people with ID, when delivered within IAPT, is unclear. Method Ten high-intensity therapists took part in semi-structured interviews, analysed using thematic analysis, regarding their experiences of delivering CBT to people with ID in IAPT. Results The rigidity of the IAPT model appears to offer a poor fit with the needs of people with ID. Therapists appeared uncertain about how to modify CBT and highlighted training and service development needs. Conclusions Findings suggest barriers to accessing IAPT largely remain unaddressed where people with ID are concerned. Services may need to reconsider what constitutes appropriate reasonable adjustments to ensure equitable access. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

People with learning disabilities (LDs) sometimes struggle with mental health concerns, which can make it difficult for them to live happy lives. The purpose of this study is to investigate the various therapies and reasonable adaptations that can be done to assist people with learning disabilities and mental health issues. Individuals with learning disabilities and mental health issues frequently encounter considerable barriers to adequate care and assistance owing to a variety of physical, cognitive, and emotional impairments. The study opens by underlining the prevalence of learning disabilities and mental health disorders in the population, as well as the difficulties that people with these conditions confront. It then looks at the many interventions and reasonable adaptations that can be done in various settings, such as healthcare, education, and employment, to help individuals with learning disabilities and mental health issues. Environmental modifications, such as creating sensoryfriendly environments, communication adjustments, such as utilizing plain language and visual aids, and psychological interventions, such as cognitive-behavioral therapy and social skills training, are among the interventions available. The study also emphasizes the significance of including people with learning disabilities and mental health issues in decision-making and planning, as well as the need for a person-centered approach to care. This study intends to contribute to the development of more effective and inclusive ways to care and support for this group by analyzing the many interventions and reasonable changes that can be made to support people with learning disabilities and mental health concerns. [ABSTRACT FROM AUTHOR]

The editorial discusses the importance of innovative trauma treatment methods in modern psychotherapy, focusing on Eye Movement Desensitization and Reprocessing (EMDR) and the Adaptive Information Processing (AIP) model. The Research Topic review features 16 articles exploring various psychotherapeutic methods, including EMDR, AIP, and other innovative approaches. Studies highlighted the effectiveness of EMDR in treating conditions such as fibromyalgia, PTSD, obsessive-compulsive symptoms, and prolonged grief, showcasing its potential in improving mental health outcomes. The research emphasizes the versatility and efficacy of EMDR therapy in addressing a wide range of trauma-related disorders and symptoms, offering new insights into trauma therapy and mental health treatment. [Extracted from the article]

This systemic review investigates the current evidence for the effectiveness of anger and/or aggression interventions for people with intellectual disabilities (ID) in receipt of forensic mental health services. Due to the prevalence within this population of difficulties with anger and aggression, and the associated substantial individual and societal consequences, the provision of psychological interventions has become increasingly common. However, no critical synthesis of the empirical evidence relating to their effectiveness has previously been conducted. Sixteen peer-reviewed controlled trials or case series designs published between 2001 and 2016 met the inclusion criteria. The results highlight an emerging evidence base for the use of CBT in improving anger regulation, and for a range of psychological therapies in reducing aggressive behaviour. However, consistent methodological shortcomings limit the generalisability of findings and currently preclude firm conclusions on effectiveness. Recommendations are made for future research to address these shortcomings, including clearly-defined adaptations, adequately powered sample sizes, carefully designed baselines and follow-up periods. Despite the current status of evidence, the review provides an accessible and objective foundation to inform decision-making by service commissioners and clinicians providing anger and aggression interventions to people with ID. [ABSTRACT FROM AUTHOR]

Young people with intellectual disabilities are at greater risk of developing mental health issues. However, their mental health needs are often not recognised and therefore remain untreated. This article discusses a case study concerning a young man with a mild intellectual disability and co-existing obsessive-compulsive disorder, which was first identified in adolescence. It describes his experience of accessing appropriate services and interventions, and details the care and support that he received from community-based services, which enabled him to continue living with his family. The case study reveals various issues that are relevant to other young people in similar situations, as well as for service providers and professionals, including intellectual disability nurses. [ABSTRACT FROM AUTHOR]

Highlights: [•] We describe a fidelity-monitoring instrument, the MAnualized Group Intervention Check (MAGIC). [•] The MAGIC is designed to monitor manualized group-based CBT for people with IDs. [•] The MAGIC is easy to use and evidence is presented for its reliability and validity. [•] It is designed for completion by direct observation, so does not require sessions to be recorded. [•] The MAGIC may also be usable for other client groups with cognitive limitations. [Copyright &y& Elsevier]

Cognitive behavioural therapy (CBT) has become established as a method for treating psychological disorders experienced by the general population, with considerable evidence available to support its efficacy. However, little research has been conducted into its effectiveness in treating psychological disorders experienced by people with intellectual disabilities. This article explores the various factors involved in the use of CBT for people with intellectual disabilities and how healthcare professionals and the multidisciplinary team have an important role in the CBT process. The input of learning disability nurses is also explored, particularly their vital role in supporting CBT and providing information that is concurrent with an individual's level of understanding. Challenges in the provision of CBT for this population are also examined, for example the prevalence of diagnostic overshadowing, which can make it difficult to distinguish between cognitive impairment and mental health issues in people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose – Whilst there is a growing evidence base for the use of cognitive behavioural therapies (CBT) for people with intellectual disabilities, there may be challenges to using an approach that locates problems within people rather than as being generated and maintained through social relations and social discourses. The purpose of this paper is to present a cautionary case that demonstrates some of the potential dilemmas and challenges that can be experienced in therapy when applying this way of working to a client with intellectual disabilities. Design/methodology/approach – The authors present a case example of work with Mark, a young man with intellectual disabilities who accessed services for support with his low mood and outline the challenges faced when using CBT in understanding his presenting problem. Findings – There is evidence from the case example that there is the potential for therapeutic techniques used in CBT to promote questions that invite, generate and reinforce feelings of incompetence and inability in people with intellectual disabilities. Originality/value – The use of narrative techniques is discussed as a means of avoiding locating the problem as being within clients with intellectual disabilities; the implications that this has for the use of CBT with this client group are considered. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: In recent years, third‐wave therapies have risen to prominence. Research into adapting and evaluating third‐wave therapies for adults with intellectual disabilities has identified that third‐wave therapies are accessible, acceptable, and effective (improving a range of symptoms and skills). Method: This meta‐ethnography followed Noblit and Hare's approach to synthesising findings from qualitative studies to examine how adults with intellectual disabilities experience third‐wave therapy groups. A systematic review of three databases identified 13 studies that met our inclusion criteria. Results: We identified that third‐wave therapy groups can be a 'Transformational' process for adults with intellectual disabilities that involves three stages: 'Concealment', 'Opening up' and 'Flourishing'. Conclusion: Findings highlight the importance of therapeutic processes; especially, working with defences, and developing and maintaining safety/trust. Recommendations include the development of an objective measure of group safety/trust. [ABSTRACT FROM AUTHOR]

Aims Cognitive therapies are increasingly being offered by clinical psychologists to people with intellectual disabilities. This paper reviews some of the factors that influence people's readiness to engage in cognitive therapy. Literature review Limited verbal ability, psychological-mindedness (particularly in relation to the understanding of emotions and the mediating role of cognitions), and self-efficacy, are all likely to present significant barriers. There may also be motivational barriers to treatment, including the functionality of some psychological presentations, maladaptive beliefs promoting resistance to change, the intellectually challenging nature of cognitive therapy, and external factors such as inappropriate settings. Engagement with therapy can be promoted by involving carers to support the therapy, but carers may themselves display a range of limitations of ability and motivation similar to those displayed by clients, which need to be recognized, and where possible addressed, in order for their involvement to be effective. Recommendations If barriers to treatment are recognized, significant steps can be taken to increase accessibility. In addition to simplifying the delivery of therapy, there is also scope to simplify the model; this point is illustrated by case examples, and some principles for formalizing modifications to standard procedures are suggested. As barriers to treatment can often be surmounted, a decision whether or not to offer cognitive therapy should be derived from a comprehensive formulation, and should never be based solely on a client's performance on tests of cognitive ability. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in the provision of cognitive behaviour therapy (CBT) to people with intellectual disabilities. A small number of studies have begun to address therapy process issues. Aims: The aim of this paper is to contribute to process research through the development of a taxonomy of question types for use in analysing therapy interactions in CBT for people with intellectual disabilities. Method: A taxonomy of CBT question types was adapted and applied to the transcriptions of session 4 and 9 of 15 CBT therapy dyads. Results: The taxonomy was reliably applied to the data. Therapists used significantly more questions in session 4 than in session 9, therapists used fewer questions in the final quarter of all sessions, and therapists used more questions with people with higher IQ scores in session 4 but not in session 9. Conclusions: The taxonomy of questions is reliable and may be used in future studies of CBT therapy process with people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

The article discusses the 50th anniversary of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and its journal, Behavioural and Cognitive Psychotherapy (BCP). The BABCP was founded 50 years ago as a special interest group and has since become the leading UK organization for cognitive and behavioural psychotherapies. The BCP journal has evolved over the years and now exists as a hybrid online and print publication. The article highlights the diverse range of contributions to the field of cognitive behavioural therapy (CBT) and discusses various topics covered in the journal, including improving access to CBT for children, anger management for adults with intellectual disabilities, and the application of theory to specific disorders. The article also mentions the BABCP's commitment to addressing complex and neglected areas, such as motivational interviewing, psychosis, and prolonged grief. The tCBT journal, a complementary publication, has also focused on under-examined areas and published papers on equity in CBT, cultural adaptation of CBT, and assessing CBT competence. The article concludes by acknowledging the future challenges of CBT and the BABCP's commitment to improving treatment for all groups. [Extracted from the article]

Background: There is increasing evidence that cognitive behavioural therapy (CBT) can be effective for people with intellectual disabilities. The aim of this review was to report the nature and frequency of adaptations reported in studies of CBT for people with intellectual disabilities. Method: This review updated and extended a previous review by (Whitehouse et al. 2006, J Appl Res Intellect Disabil, 19, 55), which used a framework of adaptations developed by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). Adaptations included simplification, language, activities, developmental level, use of directive style, flexible methods, involve caregivers, transference/countertransference and disability/rehabilitation approaches. A search identified peer‐reviewed papers that reported individual CBT informed psychological interventions for people with an Intellectual Disability. Results: The search identified 23 studies which met the inclusion criteria for review. Studies reported the majority of the categories of adaptation described by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). Conclusions: The results suggest that the framework of adaptations needs further development to increase sensitivity in identifying and categorizing adaptations of CBT. Increased, systematic reporting of adaptations to studies of CBT with people with intellectual disabilities is recommended. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on an inpatient cognitive behavioural sex offender treatment group programme developed and provided to people with intellectual disabilities detained in medium and low security hospital settings. The programme was delivered five times between 2012 and 2020. This paper describes the integration of the programme within a wider treatment pathway model and provides analysis of outcome data. Design/methodology/approach: The programme was evaluated over five group programmes using self-report psychometric measures related to treatment targets in the reduction of sexual offending risk, including cognitive distortions, sexual attitudes and knowledge and locus of control; recidivism data spanning up to 7 years post discharge is also provided. The treatment pathway and a description of the programme are provided. Findings: The results of this paper showed improvements in sexual knowledge, cognitive distortions and locus of control, however not to a statistically significant degree. No recidivism was observed in the follow-up period. Originality/value: This paper adds to the evidence base of interventions focused on cognitive behavioural approaches to the treatment and risk reduction of sexual offending in men with intellectual disabilities and adds to the debate regarding the effectiveness of such programmes with offenders with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to underline the importance of using a collaborative approach when designing and adapting a post diagnostic psychosocial intervention of cognitive stimulation therapy (CST) for people with intellectual disability and dementia. Design/methodology/approach: As part of a service improvement, a manual of CST was adapted, for delivery in clinical practice. A qualitative co-production method allowed participants with a lived experience to provide regular feedback relating to the development of the adapted CST manual and intervention programme. This feedback was used to make continual development changes to the CST manual. Findings: The study demonstrated co-production with those who provide care is valuable in adapting psychosocial therapies for people with an intellectual disability and dementia. Additional findings identified the need for carer education in ageing, dementia care and the physical health needs for older people with intellectual disability. Originality/value: To the best of the authors' knowledge, this is the first study that has used a co-production approach with families and carers in adapting a group therapy programme for people with an intellectual disability. This paper underlines the need for post diagnostic clinical interventions for people with dementia and those who provide care. [ABSTRACT FROM AUTHOR]

Background: Sexual offending has been attributed to empathy deficits, implicating interventions targeting empathy as a potential mechanism for reducing sexually harmful behaviour. However, there is less known about how appropriate and effective interventions are for individuals with intellectual disabilities. This review aims to provide a comprehensive synthesis of research findings in this area. Method: Four databases were searched, yielding 13 studies meeting the inclusion criteria which were appraised using the CCAT. Results: CBT group treatments adapted from mainstream treatment programmes for people with intellectual disabilities were widely used, demonstrating improvements in empathy and reductions in sexually abusive behaviour overall. Conclusions: Studies are limited by sample sizes, lack of control groups and inconsistent definitions of intellectual disabilities and sexually abusive behaviour. Future research should include evaluation of models other than CBT, further assessment of empathy‐specific interventions and understanding of the mechanism underpinning empathy change. [ABSTRACT FROM AUTHOR]

Background: Interventions for anger represent the largest body of research on the adaptation of cognitive behavioural therapy (CBT) for people with intellectual disabilities. The extent to which the effectiveness of these interventions reflects the behavioural or cognitive components of CBT is uncertain. This arises in part because there are few measures of angerrelated cognitions. Method: The Profile of Anger-related Cognitions (PAC) is built around interpersonal scenarios that the participant identifies as personally anger-provoking, and was designed as an extension of the Profile of Anger Coping Skills (PACS). A conversational presentational style is used to approach ratings of anger experienced in those situations and of four relevant cognitive dimensions: attribution of hostile intent, unfairness, victimhood, and helplessness. The PAC, and other measures, including the PACS, was administered to (i) people with ID identified as having problems with anger control (n = 12) and (ii) university students (n = 23); its psychometric properties were investigated and content analyses were conducted of participants' verbal responses. In a third study, clinicians (n = 6) were surveyed for their impression of using the PAC in the assessment of clients referred for help with anger problems. Results: The PAC had good consistency and test-retest reliability, and the total score on the four cognitive dimensions correlated significantly with anger ratings but not with impersonal measures of anger disposition. The predominant cognitions reported were perceptions of unfairness and helplessness. People with ID and university students were in most respects very similar in both the psychometric analyses and the content analyses of their verbal responses. The PAC had high acceptability both to people with ID and to clinicians. Conclusions: The PAC may be a useful instrument for both clinical and research purposes. Personal relevance and the conversational mode of administration are particular strengths. [ABSTRACT FROM AUTHOR]

Innovative technological solutions are increasingly being introduced into psychotherapy. Understanding service user perspectives is a key aspect in adapting this technology to treatment. This study investigated service users' personal experience of the utility, challenges, and rewards of using an mHealth solution in cognitive behavioral therapy for psychosis (CBTp). People participating in an early intervention program for psychosis (n = 16) utilized the mHealth solution for up to 6 months. Semi-structured qualitative interviews were conducted to capture participant experiences, and quantitative data were collected on psychopathology, usage, and quality of the solution. The solution was widely accepted and utilized in treatment. Four dominant themes were constructed from the interviews: (a) Accessibility and supporting recall, (b) Promotion of dialogue with the therapist, (c) Encouraging reflection, and (d) Factors that affected engagement with the solution. The mHealth solution was perceived as facilitating psychotherapeutic processes and supported underlying CBTp treatment principles. [ABSTRACT FROM AUTHOR]

Background Cognitive skills thought to be necessary to undertake cognitive–behavioural therapy (CBT) include the ability to recognize emotions, link events and emotions, and recognize cognitive mediation. These skills have been assessed in people with intellectual disabilities, but not in those who also have psychosis. Materials and methods Tasks assessing receptive language ability and cognitive skills including the ability to differentiate between behaviours, thoughts and feelings were administered to 50 participants who had intellectual disabilities and psychosis. Results The majority of participants were able to link events and emotions and differentiate behaviours and feelings. Participants found any task involving cognitions significantly more difficult. Performance on recognizing emotions, linking events and emotions and on some of the cognitive mediation and differentiation tasks was associated with receptive language ability. Conclusions People with intellectual disabilities and psychosis have some of the skills thought to be required to undertake cognitive behaviour therapy. Recognizing cognitions and cognitive mediation is particularly challenging. The differentiation task introduced in this study may usefully supplement existing assessments. [ABSTRACT FROM AUTHOR]

Aims Training has been shown to improve the ability of people with intellectual disabilities (IDs) to perform some cognitive behavioural therapy (CBT) tasks. This study used a computerised training paradigm with the aim of improving the ability of people with IDs to: a) discriminate between behaviours, thoughts and feelings, and b) link situations, thoughts and feelings. Methods Fifty-five people with mild-to-moderate IDs were randomly assigned to a training or attention-control condition in a single-blind mixed experimental design. Computerised tasks assessed the participants’ skills in: (a) discriminating between behaviours, thoughts and feelings (separately and pooled together), and (b) cognitive mediation by selecting appropriate emotions as consequences to given thoughts, and appropriate thoughts as mediators of given emotions. Results Training significantly improved ability to discriminate between behaviours, thoughts and feelings pooled together, compared to the attention-control condition, even when controlling for baseline scores and IQ. Large within-group improvements in the ability to identify behaviours and feelings were observed for the training condition, but not the attention-control group. There were no significant between-group differences in ability to identify thoughts, or on cognitive mediation skills. Conclusions A single session of computerised training can improve the ability of people with IDs to understand and practise CBT tasks relating to behaviours and feelings. There is potential for computerised training to be used as a “primer” for CBT with people with IDs to improve engagement and outcomes, but further development on a specific computerised cognitive mediation task is needed. [ABSTRACT FROM AUTHOR]

Background: Despite strong evidence for cognitive behaviour therapy (CBT) in treating mental health, its use, thus far, has been limited for people with intellectual disabilities. This study describes a CBT‐based guided self‐help (CBT‐GSH) manual for individuals with intellectual disability, and focus groups explore the views of clinicians, therapists, support staff and managers. Material and methods: Using a qualitative methodology, an expert team adapted the manual. Focus groups provided feedback, followed by thematic content analysis for modifications. Results: Participants supported using the manual, with varying views about the delivery. Quality of relationships and competence of the administrator determined the best person to deliver the treatment. Heterogeneity in the intellectual disability population was a challenge to delivering manual‐based interventions. Participants made suggestions about language and organization. Conclusions: Amendments were made to the manual in line with expert feedback. An evaluation is warranted to test for feasibility, delivery, acceptability and efficacy. [ABSTRACT FROM AUTHOR]

Purpose – There is little research addressing the delivery of training for health professionals who are interested in using cognitive-behaviour therapy (CBT) techniques as an adjunct to their current role. This paper describes the establishment and evaluation of a CBT training course to develop CBT skills in staff working with people with intellectual disabilities in Trust healthcare settings. The course would enable staff to learn how they could incorporate these skills into their daily practice to help them understand and work more effectively with people with intellectual disabilities. Design/methodology/approach – A CBT training course was designed to teach staff the use of a number of basic and specific CBT techniques and principles that staff could use within their current roles. Specific issues in relation to people with intellectual disabilities were included, e.g. understanding cognitive deficits as well as cognitive distortions. The course ran for six sessions on a fortnightly basis, followed by a two-month follow-up session. Participants completed a pre- and post-assessment questionnaire and kept a reflective diary. Findings – The training clearly focused on teaching skills that were feasible for staff to use in their own work settings. The evaluations, especially from the reflective diaries and the post-course questionnaires clearly demonstrated that this aim was achieved. Originality/value – This was a pilot study as there has been no previously published evidence of using this approach within intellectual disabilities services. A further training course has been planned to continue evaluating the effectiveness of this approach. [ABSTRACT FROM AUTHOR]

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

Purpose: This paper aims to assess the quality of systematic reviews on the effectiveness of psychological therapy for adults with intellectual disabilities (ID) and mental health difficulties. Design/methodology/approach: Four electronic databases were used: Cochrane, PsycINFO, PubMed and Scopus. Studies were included if they were a systematic review focused primarily on psychological therapy for adults with ID and mental health difficulties. Systematic reviews focused on anger were also considered for inclusion. These reviews were rated for quality on the Amstar-2, a quality rating tool designed to evaluate systematic reviews. Findings: Twelve relevant systematic reviews were identified, which included seven reviews focused primarily on cognitive behavioural therapy, two on psychodynamic therapy and three on third-wave therapies. The AMSTAR-2 indicated that all 12 reviews were of "critically low" quality. Thus, there are significant problems with the evidence base. Originality/value: To the best of the authors' knowledge, this is the first systematic review of systematic reviews of the effectiveness of psychological therapies for people who have ID. It provides an overview of the quality of the evidence base into one place. [ABSTRACT FROM AUTHOR]

Aims The aim was to examine whether specific skills required for cognitive behavioural therapy (CBT) could be taught using a computerised training paradigm with people who have intellectual disabilities (IDs). Training aimed to improve: a) ability to link pairs of situations and mediating beliefs to emotions, and b) ability to link pairs of situations and emotions to mediating beliefs. Method Using a single-blind mixed experimental design, sixty-five participants with IDs were randomised to receive either computerised training or an attention-control condition. Cognitive mediation skills were assessed before and after training. Results Participants who received training were significantly better at selecting appropriate emotions within situation–beliefs pairs, controlling for baseline scores and IQ. Despite significant improvements in the ability of those who received training to correctly select intermediating beliefs for situation-feelings pairings, no between-group differences were observed at post-test. Conclusions The findings indicated that computerised training led to a significant improvement in some aspects of cognitive mediation for people with IDs, but whether this has a positive effect upon outcome from therapy is yet to be established. [ABSTRACT FROM AUTHOR]

Background. People with intellectual disabilities (ID) experience similar or even higher rates of mental health problems than the general population and there is a need to develop appropriate treatments. Cognitive behaviour therapy (CBT) is effective for a wide range of disorders in the general population. However, there is some evidence that people with ID may lack the cognitive skills needed to take part in CBT. Aims. To test if people with ID can learn skills required for CBT, specifically the ability to distinguish between thoughts, feelings, and behaviours and to link thoughts and feelings (cognitive mediation). Method. A randomized independent groups design was used to examine the effect of training in CBT on two tasks measuring CBT skills. Thirty-four adults with ID were randomly allocated to the experimental condition (N = 18) or to the control condition (N = 16). CBT skills were assessed blind at baseline and after the intervention. Results. The training led to significant improvements in participants' ability to link thoughts and feelings, and this skill was generalized to new material. There was no effect of training on participants' ability to distinguish amongst thoughts, feelings, and behaviours. People with ID can, therefore, learn some skills required for CBT. This implies that preparatory training for CBT might be useful for people with ID. The results might be applicable to other groups who find aspects of CBT difficult. [ABSTRACT FROM AUTHOR]

Background Distinct cognitive models and treatments have been developed for people without intellectual disability with a wide range of anxiety disorders. However, these have not been reported as applied to people with intellectual disabilities. In fact, much of the cognitive therapy literature for people with intellectual disabilities does not distinguish between different presentations of anxiety. Methods We take the particular example of social phobia and describe the specific cognitive model and associated intervention developed for people without intellectual disabilities. We then consider research on the social context of people with intellectual disability and research on developmental factors predictive of anxiety and make suggestions for adaptation of treatment approaches. Conclusion We suggest that such an approach would be useful to apply to other anxiety presentations and to identify areas for further clinical and research development. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To examine the feasibility, acceptability and fidelity of individual Cognitive Stimulation Therapy (iCST) in people with intellectual disability (ID) and dementia. We aimed to recruit forty dyads (carer and individual with dementia and ID) who were randomised to iCST or a waiting list control group. Both groups received treatment as usual. Family and paid carers delivered the manualised intervention (40 sessions over 20 weeks). Recruitment and retention of participants, intervention adherence, fidelity and acceptability were assessed. Outcome measures of cognition, adaptive functioning, quality of life (QoL) and carer outcomes were collected at baseline, midpoint (11 weeks) and at 21 weeks. Qualitative interviews were conducted with six carers about their experience of iCST. Forty dyads were recruited over 10 months from 12 National Health Service trusts. One dyad dropped out and 87.5% and 97.5% completed the midpoint and end-point assessments respectively. Assessment of fidelity indicated that the correct session structure was not followed; 70% completed at least 20 sessions and there was a high level of satisfaction with iCST. QoL was significantly higher in the iCST arm at 21 weeks (adjusted mean difference: 3.11; 95% CI: 0.64 to 5.58). There were no differences in the other outcome measures. The intervention was feasible and acceptable. A full-scale trial is warranted but some modifications are needed, including improved training and supervision for carers to improve fidelity. [ABSTRACT FROM AUTHOR]

Anger and associated aggressive behaviour are significant clinical issues for many people with intellectual disabilities (IDs) that can lead to serious constraints to their liberty, which, in turn, adversely affects their quality of life. There is some evidence to support cognitive–behavioural anger treatment in this client group; however, anger assessment protocols for people with IDs should be diversified. In this regard, a method for anger assessment using imaginal provocation scenes was extended for use with this client population and the context in which treatment takes place. Two studies of the Imaginal Provocation Test (IPT) were conducted: the first with 48 patients examined its internal reliability and concurrent validity with anger psychometric scales; the second investigated whether it was sensitive to change associated with anger treatment in a small outcome study involving men with IDs and histories of offending. The IPT was found to successfully induce anger, be internally reliable, have strong concurrent validity and detect statistically significant changes in anger following anger treatment (N = 9), compared with a routine care waiting-list control group (N = 8). The IPT also had value in highlighting clinical improvements for anger treatment condition participants compared with the control group. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore how care staff working with people with learning disabilities experienced psychologist-facilitated team formulation sessions in a cognitive analytic style (contextual reformulation). Design/methodology/approach: Eleven participants attended at least one contextual reformulation session regarding a client their team referred because of challenging behaviour. Post-intervention semi-structured interviews were analysed using qualitative inductive thematic analysis. Findings: Five themes were developed: multiple roles and functions of sessions and clinicians; challenging behaviour in relationship; making links – understanding can be enlightening, containing and practical; the process of developing a shared understanding and approach; and caught between two perspectives. Findings suggested contextual reformulation helped staff see challenging behaviour as relational, provided them with the space to reflect on their emotions and relate compassionately to themselves and others, and ultimately helped them to focus their interventions on understanding and relationally managing rather than acting to reduce behaviour. Research limitations/implications: Qualitative methodology allows no causal inferences to be made. Ten of 11 participants were female. Originality/value: This qualitative study adds to the limited research base on team formulation in learning disabilities settings and specifically that using a cognitive analytic approach. [ABSTRACT FROM AUTHOR]

Background: The prevalence of anxiety disorders is high in 22q11.2 deletion syndrome (22q11.2DS), an under-recognized multisystem condition. Prominent features include an array of somatic, cognitive, and neuropsychiatric disorders. This case study reports for the first time on the application of individual cognitive behavioral therapy in 22q11.2DS.Method: Two young adults with 22q11.2DS and an anxiety disorder received cognitive behavioral therapy based on standard protocols. Feasibility and efficacy were assessed through clinical interviews, clinical observations by the therapist, and questionnaires.Results: Both participants were engaged in the therapy and showed understanding of basic cognitive behavioral therapy principles. However, they did not show a clear clinical improvement. Adjustments to the protocol were required, including increased flexibility and a proactive approach by the therapist, additional time per session, written information, and significant involvement of the family and multidisciplinary team.Conclusions: Our findings may help identify required adaptations to cognitive behavioral therapy protocols for this and similar genetic conditions. [ABSTRACT FROM AUTHOR]