Cognitive–Behavioural Treatment of Anger Intensity among Offenders with Intellectual Disabilities

Abstract

Background Aggressive behaviour has been identified as a significant problem amongst people with intellectual disabilities living in institutional settings. Anger is a key activator of aggressive behaviour, as well as being an important element of clinical distress related to adverse life experiences. There is some evidence for the value of cognitive-behavioural treatments for anger problems with people having intellectual disabilities. No controlled studies of anger treatment involving intellectually disabled offenders living in secure settings have been conducted to date. A pilot study of an elaborated anger treatment protocol for this client population was undertaken, comparing the specialised anger treatment with routine care. Methods Detained men with intellectual disabilities and histories of offending were allocated to specially modified cognitive-behavioural anger treatment (n ¼ 9) or to routine care waiting-list control (n ¼ 10) conditions. Eighteen sessions of individual treatment were delivered over a period of 12 weeks. Treatment outcome was evaluated by participants' self-report of anger intensity to an inventory of provocations and by staff-ratings of the anger attributes of participants' ward behaviour. Results Participants' reported anger intensity was significantly lower following the anger treatment, compared to the routine care wait-list condition. There were largely no treatment condition effects in staff-rated anger. Limited evidence for the effectiveness of anger treatment was provided by the staff ratings of participant behaviour post-treatment. Conclusions Detained offenders with intellectual disabilities can benefit from intensive individual cognitive-behavioural anger treatment. Further research is required to examine the mechanisms for change and their sustainability.

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

“…169 However, there was no significant effect on challenging behaviour in the only previous controlled trials of anger interventions where this was evaluated. 16,46 To the best of our knowledge, this is the first controlled study to report improved selfmanagement of aggressive challenging behaviour by people with intellectual disabilities.…”

“…The participants in these studies included people with mild intellectual disabilities as well as some more intellectually able people whose FSIQ was in the 'borderline' range. 16,46,47 In reviewing these studies, a number of methodological issues are apparent:…”

Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities: a randomised controlled trial (NACHBID)

“…67 There is considerable interest in the use of different drug treatments, such as topiramate, 68 and also in psychological treatments in challenging behaviour, with some indications that anger management and cognitive behavioural approaches are effective, [69][70][71][72] and developments in these management strategies are likely to be accelerated as a result of our findings.…”

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.…”