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Background: Health professionals were trained to deliver adapted psychological interventions for depression to people with learning disabilities and depression alongside a supporter. Exploring the delivery of psychological interventions can help increase access to therapy. Method: Twenty-seven participants took part in six focus groups, and the data were subject to a Framework Analysis. Results: The structure and focus of the manualised therapies, and the use of specific techniques were perceived as key to service-user engagement. Supporters' involvement was valued by therapists if they had a good relationship and regular contact with the individual they supported. Regular clinical supervision was regarded as vital in understanding their role, assessing progress and delivering the interventions. Conclusions: The findings highlight that health professionals can embrace a focussed therapeutic role and increase access to psychological therapies for people with intellectual disabilities.

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]

Background: This article describes the development and use of the Formulation Understanding Measure to evaluate team formulation with staff supporting people with intellectual disabilities. Method: A quantitative design with an opportunistic sample was used to evaluate the psychometric properties of the Formulation Understanding Measure (FUM) including pre- and post-administration at case formulation workshops. The measure was developed based upon experience of delivering case formulation workshops and was administered alongside case formulation workshops with 347 staff team members. Results: The measure was found to have acceptable psychometric properties with good internal reliability, a single principal component, and associations with training and demographic factors. It was also sensitive to changes resulting from case formulation workshops with the measure showing that staff increased in their understanding of the person with intellectual disability following a formulation workshop. Conclusions: The FUM will enable routine evaluation of team formulations and further studies in the area.

Background: This study explored understandings that service-users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well-being. Methods: Eight participants (three female, five male) partook in individual semi-structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. Results: Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long-term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day-to-day life was perceived to reduce challenging behaviour in the long term. Conclusions: Implications for practice are discussed.

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.

Background: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. Method: Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. Results: Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. Conclusions: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.

Background: Current policy in the England suggests that people with intellectual disabilities should, where possible, access mainstream mental health services; this should include access to mainstream therapy services. It is likely that mainstream therapists will need training and support to work with people with intellectual disabilities. Method: Sixty-eight therapists working in an English Improving Access to Psychological Therapies (IAPT) service received one- or 2-day training on working with people with intellectual disabilities. Measures of confidence, general therapeutic self-efficacy and attitudes to people with intellectual disabilities' use of mainstream mental health services were completed pre-training, post-training and at 3-month follow-up; at which time, 12 participants were interviewed about the impact of the training on their practice. Results: There was a significant positive change in all measures immediately post-training which was maintained at 3-month follow-up. Conclusions: Training considerations for mainstream therapists who may work with people with intellectual disabilities are discussed.

Objectives: Developmental literature highlights peer relationships and parental overprotection as factors implicated in the development of social anxiety. These factors are highly prevalent in the lives of people with intellectual disabilities; however research has not examined whether these factors are associated with social anxiety for this population. Methods: Twenty-one individuals without intellectual disabilities and 21 individuals with intellectual disabilities (aged 16-24 years) completed the Social Anxiety Scale for Adolescents with follow-up questions, the Glasgow Anxiety Scale-Intellectual disabilities and the parental overprotection subscale of the Parental Bonding Instrument with follow-up questions. Results: Aspects of general and social anxiety were significantly greater in the intellectual disabilities group. There were no significant differences in parental overprotection between groups, however, qualitative analyses revealed differences in experiences of social anxiety and parental overprotection. Conclusions: Further research into factors associated with social anxiety in people with intellectual disabilities may inform adaptations to therapies and early intervention.

Objectives: There is a growing body of evidence revealing emotion regulation difficulties are a common factor in the development and maintenance of mental health problems in the general population, however relatively little is known of the emotion regulation strategies used by people with intellectual disabilities. Method: A qualitative approach was used to explore the emotion regulation strategies used by adults with a mild intellectual disability in interpersonal experiences. Semi-structured interviews were conducted with 11 participants with the transcripts analyzed using Thematic Analysis. Results: Three main-themes, each with two sub-themes were identified; regulatory talk (sub-themes of 'self-talk' and 'talking about emotions in beneficial'), avoidance (sub-themes of 'avoidance is bad' and 'avoidance can be good') and cognitive strategies (sub-themes of 'cognitive distraction' and 'cognitive reappraisal'). Conclusions: The main-themes and sub-themes suggest people with intellectual disabilities can use a range of strategies in different contexts. Research and clinical implications are discussed.

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. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop a self-report measure of paid caregivers' empathy towards people with intellectual disabilities. Materials and Methods: Following questionnaire development, 194 staff working in services for people with intellectual disabilities completed self-report questionnaires, including the new empathy measure. The measure's factor structure and psychometric properties were investigated. Results: A three factor solution suggested two key processes in empathizing: experiencing commonality between one's own and people with intellectual disabilities' psychological experiences and efforts to attune to their internal worlds. The final factor represented whether carers find it challenging to empathize. Correlations with beliefs about the self and others in caregiving relationships provided initial evidence of validity, although further investigation is needed. Conclusions: The most salient processes in empathizing with people with intellectual disabilities may be different from empathy in other contexts. Establishing determinants of carer empathy may facilitate the development of psychological interventions to promote and enhance this important quality.

Background: This study examines Weiner's recent cognitive emotional model which makes a distinction between judgements of control and responsibility and emphasizes the moderation of control by "mitigating" factors. Method: In response to four vignettes describing two conditions of control (high or low) and mitigating factors (present or absent), questionnaires rating judgements of responsibility and emotional responses (anger and sympathy) were completed by 52 care staff. Results: Analysis of the data for sympathy demonstrated that attributions of control were moderated by communication ability and that the effect of control upon sympathy was mediated by the judgement of responsibility. Conclusions: The data offer tentative support Weiner's account of the mitigation of control attributions in making responsibility judgements and their subsequent effects on emotional responses. Implications for research and clinical work are discussed.

Background: The aim of this paper was to evaluate the reliability and validity of the Equity Perception Scale -- Intellectual Disability Services (EPS-IDS), a detailed measure of staff equity perceptions in services for people with intellectual disability (ID). The EPS-IDS contains 3 relationship indices that assess staff relationships with their employing organisation, their co-workers, and service users. Method: Postal questionnaires were used to collect quantitative data from a purposive sample of ID service staff. Results: The EPS-IDS was found to have good internal consistency reliability. The overall test-retest reliability of the measure, however, was found to be less satisfactory. With the exception of the co-worker relationship index, the EPS-IDS indices were found to have promising validity. Conclusions: The findings from the study suggest that the EPS-IDS shows some promise as a measure of the equity perceptions of ID service staff. Further refinements to the relationship indices, however, may be required.

Aim: This paper reviews the evidence for changes in carers' attributions regarding the behaviour of people with intellectual disabilities as a consequence of carer training in challenging and complex behaviour. Method: Papers were included in the review if they reported outcomes for carer training on the behaviour of people with intellectual disabilities and used a measure of carer attribution of the behaviour of people with intellectual disabilities. The characteristics of the scales used and the content and length of training are considered as possible factors affecting changes in attribution. Results: Eleven papers were reviewed, most studies using behavioural curricula for their training, and none explicitly set out to change attributions. Eight of the 11 papers reviewed reported changes in attribution although core characteristics of training did not distinguish those papers that reported such changes and those that did not. Conclusions: Changes in beliefs and attributions occur even though these are not identified as a focus within the training provided. The present authors suggest that the formulation processes involved in behavioural training may play a key part in changing attributions as a consequence of this training. The present authors discuss the potential for more focussed intervention designed to change attributions and for better alignment of measures to specific attribution change expected as a result of specific training approaches.

Background: The evidence supporting the application of Weiner's motivational model of helping to the behaviour of carers' of people with intellectual disabilities and challenging behaviour is inconsistent. One suggested reason for this is that many studies use stimuli that might generate different responses from those to actual instances of behaviour of real people. Method: Sixty-two paid carers of people with intellectual disabilities reported attributions, emotions and intended behavioural responses to behaviour presented by an unnamed person and the same behaviour presented by a named and known person. They also completed a scale of behavioural knowledge. Results: Carers make more internal and global attributions and identify themselves as less optimistic in response to vignettes relating to named and known people than those relating to unnamed people. However, data from both unnamed and named vignettes are consistent in supporting Weiner's motivational model of helping in demonstrating a mediated model for controllability, anger and helping intention. Conclusions: Unnamed vignettes may underestimate the intensity of carers' responses to challenging behaviour; however, this study does not provide evidence that there are qualitative differences in the interrelationships between variables in data sets obtained from unnamed and named vignettes.

Background: This study compares how people with and without intellectual disabilities talk about events, beliefs and emotions in dialogues about real-life, emotive events and in a structured task assessing understanding of cognitive mediation. Materials and Methods: A cognitive-emotive interview was used to assist 19 adults with intellectual disabilities and 19 adults without disabilities in generating an account of an emotive, interpersonal event. Participants also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Results: Between-group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive-emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within-group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. Conclusions: Participants with intellectual disabilities had more difficulties than those without disabilities in talking about events, beliefs and emotions. Within a therapeutic context, they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors. Future therapeutic developments may benefit from placing greater emphasis on emotional understanding and the intuitive links that people make between events and emotions.

Background: This paper focuses on the transition to supported employment for people with intellectual disabilities paying particular attention to the impact of job breakdown on psychological well-being; an issue often omitted from studies. Materials and Methods: Forty-nine people with intellectual disabilities were interviewed within 3 months of entering supported employment and 9-12 months later. Data collection involved in-depth interviews with people with intellectual disabilities, their carers and employers and completion of a self-report measure of depression and anxiety (an adapted form of the Hospital Anxiety and Depression Scale), and a self-report measure of quality of life (the ComQol). Results: By time of the follow-up interviews, 13 of the 49 jobs had broken down. Analysis of scores measuring quality of life, anxiety and depression showed no effect for loss of employment. However, interviews with participants indicated that job loss had a considerable impact on those affected. Conclusions: There were a wide range of reasons for job breakdown, many of which were particular to the circumstances of people with intellectual disabilities. Although job breakdown does not have an impact of anxiety or depression many participants found job loss traumatic.

Background: Employment is viewed by policy makers as both a human right and as a means of changing the marginalized status of people with intellectual disabilities, with important social and emotional benefits. However, there has been little longitudinal research examining the experience of people with intellectual disabilities in the workplace. Methods: Thirty-five individuals with mild to borderline intellectual disabilities participated in this study. They were recruited from supported employment agencies in Scotland. A longitudinal approach was adopted, with the participants being interviewed around the time of starting their jobs, and again 9-12 months later. Results: The content analyses of the semi-structured interviews indicated that the participants perceived continuing benefits from entering mainstream employment, including more purposeful lives and increased social status. However, over the follow-up period the participants reported few social opportunities that extended beyond the workplace, and an anxiety about their competence to meet employers' demands remained a concern for some. Conclusions: The discussion addresses the importance of understanding work in relation to the participants' wider lives, along with the longer-term role for supported employment agencies to help people achieve their social and emotional goals in a vocational context.

Background: This study examines the relationship between the topography of challenging behaviour, subsequent attributions and emotional responses, with whether carers use physical intervention and their satisfaction with their intervention. Method: Thirty-seven carers described incidents where a person with an intellectual disability had exhibited verbal or physical aggression. The carer rated attributions of controllability, internality, globality and stability, global evaluations of the person's behaviour and of the persons themselves, emotions of anger and sympathy, and satisfaction with their intervention. The topography of the aggressive behaviour (verbal or physical) and the topography of the intervention (physical intervention or non-physical intervention) were coded from accounts of the incident given by carers in the interview. Results: Attributions of control and internality were significantly associated with less satisfaction with intervention. People who presented with physical aggression were evaluated more negatively. However, only the topography of the behaviour (whether the incident was verbal or physical aggression) was associated with the use of physical intervention. Conclusions: This study did not find a relationship between cognitive-emotional variables and the topography of intervention. However, relationships between cognitive variables and satisfaction with intervention were observed. Implications for research and clinical work are discussed.

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.

Background: It is striking that although cognitive behavioural therapy was developed to treat depression in the general population, there remains a paucity of research concerning its application to people with intellectual disabilities. Recent research points to the importance of understanding people's distress in the context of their particular life experience. Areas to be addressed: This paper examines how the life experience of people with intellectual disabilities may influence the nature of their self-perceptions and their vulnerability to depression. In addition to considering the impact of experience on the content of participants' self-perceptions, evidence concerning the mediating role played by cognitive factors in the genesis and maintenance of depression is also reviewed. Conclusions: These strands of research are discussed in the light of existing CBT models of depression, along with potential adaptations of interventions for people with intellectual disabilities.

A study examined the role of coping style attributions and emotions in response to challenging behavior in predicting helping behaviors of 33 support staff of people with mental retardation. Coping styles of practical problem solving and wishful thinking and attributions of controllability and internality were significant predictors of effort in helping. (Contains references.) (Author/CR)