Assessment of anger coping skills in individuals with intellectual disabilities

Abstract

Recent controlled studies have supported the effectiveness of anger management training for people with intellectual disabilities (IDs). This report describes an evaluation instrument designed to assess their usage of specific anger coping skills. The Profile of Anger Coping Skills (PACS) is designed for completion by a staff member or carer. Three situations are first elicited in which a client frequently displays anger. The respondent then rates each situation for the extent to which the client deploys each of eight behavioural and cognitive coping skills. In a preliminary reliability study, 20 users of a day service for people with IDs were rated independently by two staff members, with one of them completing the assessment on two separate occasions: the PACS showed good test-retest reliability and lower, but still acceptable, interrater reliability. The PACS was subsequently used, in a different day service, as part of the assessment pack administered before and after a 12-week anger management group, with a parallel assessment of an untreated control group. The treated group showed substantial decreases in measures of anger, which were maintained at 6-month follow-up. Increases in PACS-rated anger coping skills were also seen in all participants in the anger management group, but not in the control group. There were differences in the extent to which different coping skills were acquired by the treated group, and there were also individual differences in the profile of specific skills acquired. It is concluded that the PACS is a reliable instrument for assessing anger coping skills, particularly when used repeatedly with the same informant. It provides information that is useful for both individual care planning and the design of future anger management programmes.

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities

“…Table 2 shows the effect sizes obtained in these studies. All studies, bar two, reported large or very large effect sizes (mean d = 1.19); in the two studies in which only a medium-sized effect (< 0.8) was reported immediately post treatment, 11,42 the effect of the intervention subsequently increased at longer-term follow-up. Similar effect sizes were found for group (n = 10 studies; d = 1.15) and individual (n = 2 studies; d = 1.38) formats, and for self-ratings (n = 9 studies; d = 1.13) and carer ratings (n = 3 studies; d = 1.38).…”

“…It is only recently that CBT has been adapted for people with intellectual disabilities. There is a relatively large case study literature describing successful outcomes for CBT in a variety of mental disorders, [9][10][11][12] but the evidence from controlled trials is sparse. With the exception of two small controlled trials in depression, 13,14 anger is the only psychological presentation in which controlled trials have been used to evaluate CBT interventions for people with intellectual disabilities.…”

“…6. Several studies, including some of the largest, 43,44 did not include a long-term follow-up, and with few exceptions 11,16,42 studies that did include long-term follow-up followed up only the intervention group, not the control subjects. 35 using the following two sets of search terms: (1) (anger or aggression) and [(learning or intellectual) and (disability or disabilities)) or (mental retardation)] and (2) (anger or aggression) and cognitive and (behaviour or behaviour) and therapy.…”

“…50 In order to capitalise on the potential benefit of carer involvement, some studies have involved carers (day-service staff) to deliver an anger management intervention to people with intellectual disabilities, with positive outcomes. 11,48 A manualised group intervention delivered by day-service staff has also been reported to improve depression in people with intellectual disabilities. 14 There are potential advantages to this approach, because care staff who are recruited as 'lay therapists' become familiar with the anger coping techniques that participants learn and are, therefore, able to provide ongoing support outside the group sessions.…”

Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis

“…Additional eligibility criteria were applied to exclude studies if data were included in a later study (Rose, West, & Clifford, 2000;Taylor et al, 2002), or if insufficient data were reported to perform the meta-analysis (Matson, 1981;Willner et al, 2005). Finally, the study by Silvestri (1977) was excluded because twenty-three out of thirty items of its primary outcome however, that only half the number of trials delivering individual therapy were identified compared to those delivering group therapy.…”