Cognitive behavioural therapy (CBT) is used in mainstream services and the evidence for its effectiveness is growing.
For people with learning disabilities, there is a growing evidence base for in relation to psychological interventions more generally, although much of the much of the research on CBT has come from forensic secure units.
CBT Randomised controlled trials
There are two RCTs looking at the use of CBT in anger management, one which randomised 19 detained men with learning disabilities to either a specially modified cognitive–behavioural anger treatment or a routine care waiting-list control which showed some self reported benefits from the therapy. (Taylor et al) and the second randomised fourteen people referred for anger management to a CBT treatment group and a waiting-list control group and found improvement in both self- and carer-ratings, relative to their pre-treatment scores, and to the control group post-treatment. (Wilner et al) These are both very small trials and there are some issues regarding the self reporting outcome measures, but the results are encouraging none the less.
Clearly, as CBT relies significantly on the use of language, there needs to be some significant adaptation around working with people who may have lingual communication difficulties and one of the key development issues has been the need for a standardised approach to this issue.
New CBT Manual Published
Now as the result of a two and half year research project, a team of researchers, led by Angela Hassiotis a clinical academic in the psychiatry of learning disabilities at University College London has published a series of documents that represent a ‘manualised’ cognitive behavioural therapy (CBT) treatment that can be used by trained CBT therapists to treat common mental disorders (depression and/or anxiety) in people with mild learning disabilities.
The documents are all available to download. The CBT manual provides an introduction to the use of CBT in people with learning disabilities and has a specific chapter on communication in the therapeutic setting which as well as setting out the process and content for sessions, also deals with problems that might arise in the therapy and what to do about them. There are chapters on specific cognitive techniques and specific behavioural techniques.
As well as the manual for the therapist, there is a carer’s guide which is designed for carers and/or support workers. This is to provide guidance for those who are in the role of supporting the person who is receiving the therapy and vcovers such thinfs as how the person might benefit from CBT and the role of the carers as a ‘CBT helper’, which might include taking people to sessions, or reminding them about their attendance, reminding people about homework tasks, or indeed helping them to do them.
There are also printable information, resource and work sheets.
A Manual of Cognitive Behaviour therapy for People with Learning Disabilities an Common Mental Disorders, (therapists version), Hassiotis A, Serfaty M, Azam K, Martin S, Strydom A, King M [abstract]
Taylor, J. L., Novaco, R. W., Gillmer, B. and Thorne, I. (2002), Cognitive–Behavioural Treatment of Anger Intensity among Offenders with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities, 15: 151–165 [abstract]
Willner, P., Jones, J., Tams, R. and Green, G. (2002), A Randomized Controlled Trial of the Efficacy of a Cognitive-Behavioural Anger Management Group for Clients with Learning Disabilities. Journal of Applied Research in Intellectual Disabilities, 15: 224–235 [abstract]