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Many studies have shown that CBT can be an extremely effective therapy for people suffering from problems with their mood, however little research has been done to find out whether this type of treatment could be effective for someone with mild learning disabilities. Studies have shown that people with mild learning disabilities have the skills needed to take part in CBT. The aim of this study is to test the effectiveness of CBT in treating those with mild learning disabilities that are experiencing problems with their mood. Who can participate? Adults with mild learning disabilities who are also experiencing mental health problems that affect their mood such as depression or anxiety.
What does the study involve? Participants are randomly allocated to one of two groups. Participants in the first group receive weekly one-to-one sessions of CBT for up to 16 weeks. These participants also continue to receive the usual service that they receive from the intellectual disability service, involving care management and emotional and social support.
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Participants in the second group continue to receive the usual service from the intellectual disability service, but do not receive any additional support throughout the 16 weeks of the study. At the start of the study and then again after 4 and 6 months, participants in both groups complete a number of questionnaires in order to find out whether the treatment has made any changes to their mood, quality of life or thinking ability cognitive aspects.
What are the possible benefits and risks of participating? Not provided at time of registration Where is the study run from? March to August Who is funding the study? Dr Angela Hassiotis a. Cognitive behaviour therapy CBT for anxiety and depression in adults with mild intellectual disabilities ID : a randomised controlled trial. Not available in web format, please use the contact details below to request a patient information sheet. CBT plus treatment as usual: Participants will receive up to 16 one-to-one manualised cognitive behavioural therapy treatment sessions over a period of 16 weeks 4 months in addition to the usual service they receive from the intellectual disability service.
Some RRs were more challenging to code than others, e. It was decided by the researchers to code these RRs according to the overall meaning. These procedures were done to increase the credibility of the results.
Can CBT work for people with learning disabilities? | LDT
Repetition of the research cycle means that the raw data was revisited to check and re-check earlier assumptions and inferences made. Two methods of Triangulation were used: 1. Qualitative research is vulnerable to researcher bias.
Some of the RRs were difficult to categorise, particularly the roles that were abstract or had many parts to them. In these cases they were coded by meaning for the first researcher. The first researcher was independent of the therapy. This was an advantage in the sense that she could be more objective about the data, but a disadvantage with regards to having a true understanding of the nature of each RR.
The second researcher also coded the RRs. She was involved in the therapy of all the participants, either as a therapist or as a supervisor and therefore understood the implicit meanings of all the RRs. Overall, the sixteen participants identified eightythree RRs, twenty of which were ideal RRs. There was an average of 5. Whilst analysing the data, differences between community and forensic participants were noted.
Figure 1 shows how the RRs were distributed between forensic and community participants.
It can be seen from the graph that three of the most commonly identified RRs are found fairly evenly in both the community and forensic population. The graph shows that there were some RRs that were identified mainly in the community population. The aim of this study was to identify common RRs for people with learning disabilities.click here
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Four common RRs for people with learning disabilities were identified:. Further investigation is needed to determine whether these RRs are common enough to be included as a generalisation. This reflects their response to being abandoned. Blanking off is a coping mechanism employed to protect the self from the experience of being abandoned, rather than being overwhelmed.
The ideal RRs reflect a fantasy or idealised projection of a relationship. One example of this would be the experience of a disability as a trauma, particularly if it causes a disruption to attachment see p4 and 5. Because of their limited language skills, therapy is for many people with learning disabilities the first time that they have been helped to express their thoughts about sexual feelings and discuss memories of traumatic sexual events. Attachment issues for people with learning disabilities have been discussed by a number of people see Linington, These two RRs may be addressing similar issues from different perspectives.
Reyes-Simpson discusses the challenging nature of therapy for both the therapist and client with learning disabilities. It is important that the therapist does not reinforce any of the RRs in therapy, although the identification of them can be a useful therapeutic tool. It is important to address these issues in supervision. People with learning disabilities seem to have fewer RRs than people without learning disabilities. This may be influenced by dependence on other people and services, and may reflect not having a strong sense of self. Also, fewer roles are identified or can be worked on throughout the duration of therapy.
A formal comparison of the numbers of RRs between people with and without learning disabilities could prove this. This may differ from working with other client groups. The sample size of this research was small, partly due to the qualitative nature of the investigation and partly to using criterion sampling. Criterion sampling may have led to sample bias for two reasons:. The size was sufficient for a small pilot investigation, but a larger and more diverse sample would increase the external validity and generalisability.
Research into the RRs of people with learning disabilities who are not referred to psychological services would give a more general idea of common RRs in this client group. Hollins and Sinason suggest that increased emotional disturbance is a function of learning disability. It would therefore be interesting to see which RRs are related specifically to having a learning disability, as opposed to mental health problems.
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This could be done by comparing RRs of people with learning disabilities with the RRs of their non learning disabled peers —highlighting which RRs were specifically due to having a learning disability. This study addressed the research aim by identifying common Reciprocal Roles for people with learning disabilities. Although not generalisable to all people with learning disabilities in psychological services, by increasing the research knowledge base, these results are useful for CAT therapists working with people with learning disabilities.
This research formally endorses the common RRs initially suggested by Ryle It may also be useful for other clinicians considering the use of CAT or any other psychotherapy with people with learning disabilities. Awareness of these findings should help therapists avoid colluding with unhelpful RRs. Further research has been suggested to find out more about RRs with people with learning disabilities. Clinicians must take care not to assume RRs, to listen to the client, and to use their words. Ainsworth, M; Eichberg, C. Attachment Across the Life Cycle.
Bates, R. Psychotherapy and Mental Handicap London, Sage. Bender, M. Clinical Psychology Forum Bowlby, J. The Making and Breaking of Affectional Bonds. Coolican, H. Research Methods and Statistics in Psychology. Cohen, S. Journal of the American Psychoanalytical Association Crowley, V. Chichester: Wiley. Decker, R.
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Effective Psychotherapy. New York, Hemisphere Publications. Hollins, S; Sinason, V. British Journal of Psychiatry Krippendorf, K. Content Analysis: An Introduction to its Methodology. Beverly Hills, CA, Sage. Linington, M. British Journal of Psychotherapy 18 3 : Lovett, H. Cognitive Counselling and Persons with Special Needs. New York, Praeger. Miles, M; Huberman, A. Qualitative data analysis.
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Nezu, C; Nezu, A. Journal of Consulting and Clinical Psychology 62 1: Reyes-Simpson, E. When there is too much to take in: Some factors that restrict the capacity to think. In Simpson, D; Miller, L.
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Unexpected gains: Psychotherapy with people with learning disabilities. Karnac Books, London, p Ryle, A. Chichester, Wiley. Sigman, M. Individual and group psychotherapy with mentally retarded adolescents. In Sigman, M. Sinason, V. Free Association Books, London. Stokes, J; Sinason, V. Secondary Mental Handicap as a defence. Psychotherapy and Mental Handicap. Sage Publications, London. Szivos, S. E; Griffiths, E. Group processes involved in coming to terms with a mentally retarded identity.