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  • Andrew Jahoda
  • Biza Stenfert Kroese
  • Carol Pert
Chapter

Abstract

There is a high prevalence of mental health problems amongst adults with intellectual disability; yet access to mental health services, especially talking therapies, remains problematic for people with intellectual disabilities. Access is hampered by a lack of knowledge and confidence amongst generic therapists, and staff in learning disability services report that they lack training in mental health issues. Although the demand characteristics of CBT appear many and complex, we argue that a skilled therapist can adapt the methods and materials to make it accessible to people with intellectual disabilities. Learned helplessness, self-regulation and executive functioning are related and relevant concepts that must be considered in the context of the potential of CBT to have long-lasting benefits for our clients. Instead of a remediation approach to facilitating access to CBT, we consider a compensation approach. We argue that when adapting CBT practice for our clients, we must avoid ‘drifting’ into unfocused ways of working. Instead, we should aim for ‘metacompetent adherence’ to the CBT model.

References

  1. Alvarez, J. A., & Emory, E. (2006). Executive function and the frontal lobes: A meta-analytic review. Neuropsychology Review, 16(1), 17–42.CrossRefPubMedGoogle Scholar
  2. Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Clinical and Social Psychology, 4, 359–373.CrossRefGoogle Scholar
  3. Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50, 248–287.CrossRefGoogle Scholar
  4. Beck, A. T., Rush, A., Shaw, B., & Emery, G. (1979). Cognitive therapy for depression. New York: Wiley.Google Scholar
  5. Booth, T., & Booth, W. (1998). Growing up with parents who have learning difficulties. London: Routledge.Google Scholar
  6. Bordin, E. (1994). Theory and research on the therapeutic working alliance: New directions. In A. Horvath & L. Greenberg (Eds.), The working alliance: Theory, research and practice (pp. 13–37). New York: Wiley.Google Scholar
  7. Bruce, M., Collins, S., Langdon, P., Powlitch, S., & Reynolds, S. (2010). Does training improve understanding of core concepts in cognitive behaviour therapy by people with intellectual disabilities? A randomised experiment. British Journal of Clinical Psychology, 49, 1–13.CrossRefPubMedGoogle Scholar
  8. Buffin, J., Ahmed, N., & Singh, M. (2009). Using a community engagement approach to ensure equality of access, experience and outcome from the IAPT programme in the North West of England. Report UCLAN/NHS North West.Google Scholar
  9. Cain, N. N., Davidson, P. W., Dosen, A., et al. (2010). An international perspective of mental health services for people with intellectual disability. In N. Bouras & G. Holt (Eds.), Mental health services for adults with intellectual disability: Strategies and solutions. London: Psychology Press.Google Scholar
  10. Catani, C., & Sossalla, I. M. (2015). Child abuse predicts adult PTSD symptoms among individuals diagnosed with intellectual disabilities. Frontiers in Psychology, 6, 1600. Published online 2015 Oct 19 doi:  10.3389/fpsyg.2015.01600.
  11. Clements, J. (1997). Sustaining a cognitive psychology for people with learning disabilities. In B. Stenfert Kroese, D. Dagnan, & K. Loumidis (Eds.), Cognitive-behavioural therapy for people with learning disabilities (pp. 162–181). London: Routledge.Google Scholar
  12. Cooper, S. A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). An epidemiological investigation of affective disorders with a population-based cohort of 1023 adults with intellectual disabilities. Psychological Medicine, 37, 873–882.CrossRefPubMedGoogle Scholar
  13. Costello, H., Bouras, N., & Davies, H. (2007). The role of training in improving community care staff awareness of mental health problems in people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 20(3), 228–235.CrossRefGoogle Scholar
  14. Dagnan, D., & Chadwick, P. (1997). Cognitive-behaviour therapy for people with learning disabilities: Assessment and intervention. In B. Stenfert Kroese, D. Dagnan, & K. Loumidis (Eds.), Cognitive-behaviour therapy for people with learning disabilities (pp. 110–123). London: Routledge.Google Scholar
  15. Dagnan, D., Chadwick, P., & Proudlove, J. (2000). Toward an assessment of suitability of people with mental retardation for cognitive therapy. Cognitive Therapy and Research, 24, 627–636.CrossRefGoogle Scholar
  16. Dagnan, D., Mellor, K., & Jefferson, C. (2009). Assessment of cognitive therapy skills for people with intellectual disability. Advances in Mental Health and Learning Disabilities, 3, 25–30.CrossRefGoogle Scholar
  17. Department of Health. (2011). Talking therapies: A four year plan. www.iapt.nhs.uk
  18. Foundation for People with Learning Disabilities. (2014). Feeling down – Improving the mental health of people with learning disabilities. http://www.learningdisabilities.org.uk/content/assets/pdf/publications/feeling-down-report-2014.pdf
  19. Glenn, E., Bihm, E. M., & Lammers, W. J. (2003). Depression, anxiety and relevant cognitions in persons with mental retardation. Journal of Autism and Developmental Disorders, 33(1), 69–76.CrossRefPubMedGoogle Scholar
  20. Hatton, C. (2002). Psychosocial interventions for adults with intellectual disabilities and mental health problems: A review. Journal of Mental Health, 11(4), 357–374.CrossRefGoogle Scholar
  21. Hebblethwaite, A., Jahoda, A., & Dagnan, D. (2011). Talking about real-life events: An investigation into the ability of people with intellectual disabilities to make links between their beliefs and emotions within dialogue. Journal of Applied Research in Intellectual Disabilities, 24(6), 543–553.CrossRefGoogle Scholar
  22. Jahoda, A., Dagnan, D., Stenfert Kroese, B., Pert, C., & Trower, P. (2009). Cognitive behavioural therapy: From face to face interaction to a broader contextual understanding of change. Journal of Intellectual Disability Research, 53(9), 759–771.CrossRefPubMedGoogle Scholar
  23. Joint Commissioning Panel for Mental Health. (2013). Guidance for commissioning public mental health services. http://www.jcpmh.info/resource/guidance-for-commissioning-public-mental-health-services/
  24. Kendall, P. C. (1990). Challenges for cognitive strategy training: The case of mental retardation. American Journal on Mental Retardation, 94, 365–367.Google Scholar
  25. Lindsay, W. R., Steele, L., Smith, A. H., Quinn, K., & Allan, R. (2006). A community forensic intellectual disability service: Twelve year follow up of referrals, analysis of referral patterns and assessment of harm reduction. Legal and Criminological Psychology, 11(1), 113–130.CrossRefGoogle Scholar
  26. McGillivray, J., & Kershaw, M. (2015). Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability? Journal of Intellectual Disability Research, 59(2), 105–115.CrossRefPubMedGoogle Scholar
  27. MacMahon, P., Stenfert Kroese, B., Jahoda, A., Stimpson, A., Rose, N., Rose, J., Townson, J., Hood, K., & Willner, P. (2015). ‘It’s made all of us bond since that course…’ – A qualitative study of service users’ experiences of a CBT anger management group intervention. Journal of Intellectual Disability Research, 59(4), 342–352.Google Scholar
  28. Morgan, V. A., Leonard, H., Bourke, J., & Jablensky, A. (2008). Intellectual disability co-occurring with schizophrenia and other psychiatric illness: Population-based study. British Journal of Psychiatry, 193, 364–372.CrossRefPubMedGoogle Scholar
  29. Murphy, L., & Razza, N. (1998). Domestic violence against women with mental retardation. In A. Roberts (Ed.), Battered women and their families (pp. 271–290). New York: Springer.Google Scholar
  30. Pert, C., Jahoda, A., Stenfert Kroese, B., Trower, P., Dagnan, D., & Selkirk, M. (2013). Cognitive behavioural therapy from the perspective of clients with mild intellectual disabilities: A qualitative investigation of process issues. Journal of Intellectual Disability Research, 57(4), 359–369.CrossRefPubMedGoogle Scholar
  31. Rose, N., O’Brien, A., & Rose, J. (2007). Investigating staff knowledge and attitudes towards working with adults with learning disabilities and mental health difficulties. Advances in Mental Health and Learning Disabilities, 1(3), 52–59.CrossRefGoogle Scholar
  32. Rossiter, R., & Holmes, S. (2013). Access all areas: Creative adaptations for CBT with people with cognitive impairments – Illustrations and issues. The Cognitive Behaviour Therapist, 6(4). doi: 10.1017/S1754470X13000135.
  33. Roth, A. D., & Pilling, S. (2007). The competences required to deliver effective cognitive and behavioural therapy for people with depression and with anxiety disorders. London: Department of Health.Google Scholar
  34. Sams, K., Collins, S., & Reynolds, S. (2006). Cognitive therapy abilities in people with learning disabilities. Journal of Applied Research in Intellectual Disabilities, 19, 25–33.CrossRefGoogle Scholar
  35. Seligman, M. E. P. (1972). Learned helplessness. Annual Review of Medicine., 23(1), 407–412. doi: 10.1146/annurev.me.23.020172.002203.CrossRefPubMedGoogle Scholar
  36. Stenfert Kroese, B., Dewhurst, D., & Holmes, G. (2001). Diagnosis and drugs: Help or hindrance when people with learning disabilities have psychological problems? British Journal of Learning Disabilities, 29(1), 26–33.CrossRefGoogle Scholar
  37. Stenfert Kroese, B., Rose, J., Heer, K., & O’Brien, A. (2013). Mental health services for adults with intellectual disabilities – What do service users and staff think of them? Journal of Applied Research in Intellectual Disabilities, 26(1), 3–13.CrossRefGoogle Scholar
  38. Stenfert Kroese, B., Willott, S., Taylor, F., Smith, P., Graham, R., Rutter, T., Stott, A., & Willner, P. (2016). Trauma-focussed cognitive-behaviour therapy for people with mild intellectual disabilities: Outcomes of a pilot study. Advances in Mental Health and Intellectual Disabilities, 10(5), 299–310.CrossRefGoogle Scholar
  39. Tucker, B. M., & Johnson, O. (1989). Competence promoting vs. competence inhibiting social support for mentally retarded mothers. Human Organization, 48, 95–107.CrossRefGoogle Scholar
  40. Vereenooghe, L., & Langdon, P. E. (2013). Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis. Research in Developmental Disabilities, 34(11), 4085–4102.CrossRefPubMedGoogle Scholar
  41. Vereenooghe, L., Reynolds, S., Gega, L., & Langdon, P. E. (2015). Can a computerised training paradigm assist people with intellectual disabilities to learn cognitive mediation skills? A randomised experiment. Behaviour Research and Therapy, 71, 10–19.CrossRefPubMedGoogle Scholar
  42. Whitman, T. L. (1990). Self-regulation and mental retardation. American Journal on Mental Retardation, 94(4), 347–362.PubMedGoogle Scholar
  43. Whittington, A., & Grey, N. (2014). How to become a more effective CBT therapist -mastering metacompetence in clinical practice. Oxford: Wiley Blackwell.Google Scholar
  44. Willner, P., Rose, J., Jahoda, A., Stenfert Kroese, B., Felce, D., Cohen, D., MacMahon, P., Stimpson, A., Rose, N., Gillespie, D., Shead, J., Lammie, C., Woodgate, C., Townson, J., Nuttall, J., & Hood, K. (2013). Group-based cognitive-behavioural anger management for people with mild to moderate intellectual disabilities: Cluster randomised controlled trial. The British Journal of Psychiatry, 203(4), 288–296.CrossRefPubMedGoogle Scholar
  45. Zigler, E., & Hodapp, R. (1986). Understanding mental retardation. New York: Cambridge University Press.Google Scholar

Copyright information

© The Author(s) 2017

Authors and Affiliations

  • Andrew Jahoda
    • 1
  • Biza Stenfert Kroese
    • 2
  • Carol Pert
    • 3
  1. 1.Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
  2. 2.School of PsychologyUniversity of BirminghamBirminghamUK
  3. 3.Learning Disabilities ServiceNHS Greater Glasgow and ClydeGlasgowUK

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