A review of the frequency and nature of adaptations to cognitive behavioural therapy for adults with Intellectual Disabilities

Abstract

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.

Adapting the protocol for narrative exposure therapy for adults with mild intellectual disabilities

“…The adaptations made to therapy for people with ID in the studies reviewed were consistent with most of the categories of adaptation identified in previous research Whitehouse, Tudway, Look, & Kroese, 2006). None of the adaptations in the studies reviewed appeared to fall in the categories of 'transference/countertransference' or 'disability/rehabilitation approaches', which was also reported by Surley and Dagnan (2019) in their review of adaptations of CBT for people with ID. However, they reported that the use of 'directive methods' was one of the most frequently reported interventions, in contrast to the current review where this was not apparent in any study.…”

“…With this factor seemingly playing such a fundamental part in the emotional difficulties of people with ID, it raises the question of whether the reporting of research accurately captures this aspect in descriptions of interventions, rather than this issue not being prevalent in documented therapy. The quality of reporting of adaptations in studies of psychological interventions with people with ID has been highlighted consistently as a significant issue Surley & Dagnan, 2019;.…”

“…These will be elaborated and referred to in the results section. In a recent review of adaptations to CBT for people with ID (Surley & Dagnan, 2019), the most frequently reported adaptations, using the above categories, were the use of activities to facilitate learning and the use of directive methods, including the structuring of sessions. However, these are arguably central components of CBT for the general population regardless of intellectual ability.…”

A Plea for Diversity in Eating Disorders Research

“…Thus, it may be necessary to adjust treatment approaches toward anticipating differences in literacy and other education-related aspects of the patients and provide patients from less privileged backgrounds with additional access options to disorder-specific treatments. Although these implications are not entirely different from those proposed for adjusting psychotherapy for patients with intellectual disabilities (89) or for an aging patient population (90, 91) -which is another challenge ED research might soon face -the effort of their implementation will likely outweigh the social and economic costs of additional social disparities in ED treatment.…”

Effects of Cognitive Behavioral Therapy on Pain and Sleep in Adults with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

“…Strong evidence has shown that cognitive behavioral therapy (CBT) is beneficial for the nonbrain-injured population that has cognitive impairments, such as those with anxiety, depression, or intellectual disabilities [ 12 , 13 ], or for the population with acquired brain injuries, such as those who experienced cerebral vascular accident, anoxia, and neurosurgery [ 14 ]. The mechanisms underpinning these improvements appear to be that CBT helps TBI patients understand how to identify and change disturbing thought patterns that have a negative influence on behavior and emotions through a psychotherapeutic approach [ 15 , 16 ].…”