Trauma-focussed cognitive-behaviour therapy for people with mild intellectual disabilities: outcomes of a pilot study

Abstract

Purpose Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD are among the most complex and challenging patients seen by intellectual disability psychology and psychiatry services. The purpose of this paper is to study TF-CBT intervention for people with intellectual disabilities and complex PTSD. Design/methodology/approach Three groups of adults with intellectual disabilities (ID) presenting with complex PTSD (n=3, n=5 and n=4) were treated using a 12-week manualised intervention adapted from a procedure routinely used in adult mental health services. Participants completed the Impact of Event Scale as adapted for people with intellectual disabilities (IES-ID) before and after the intervention, and interviews conducted to ascertain their experiences of the group were analysed using interpretative phenomenological analysis (IPA). Findings The ten participants who completed the intervention showed a 27 per cent decrease in median Impact of Event Scale Intellectual Disabilities scores, equivalent to a medium effect size (d=0.50). Five themes were identified from the interviews: being listened to; it is nice to know you are not the only one; being in a group can be stressful; the importance of feeling safe; achieving and maintaining change. Participants also provided constructive feedback to promote improvements to the manual. Research limitations/implications A feasibility study followed by methodologically robust clinical trials is now needed to establish the effectiveness of the intervention and its utility in clinical practice. Practical implications This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD. Social implications The findings indicate that a group intervention is both feasible for and acceptable to adults with ID. Originality/value To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID.

Is it possible to use interpretative phenomenological analysis in research with people who have intellectual disabilities?

“…Four of the papers investigated the experiences of parents with intellectual disabilities (Baum & Burns, ; Gould & Dodd, ; Shewan et al, ; Wilson et al, ). Seven of the studies explored the experience of receiving psychological therapy (Anslow, ; Lewis et al, ; MacDonald et al, ; MacMahon et al, ; Merriman & Beail, ; Roscoe et al, ; Stenfert Kroese et al, ). Three studies looked at the experiences of people with intellectual disabilities as inpatients in hospital (Brown & Beail, ; Clarkson et al, ; Cookson & Dickson, ).…”

“…A stronger indicator is time taken to step aside from the main narrative and explore cases where a single participant might strongly exemplify—or contradict—a thematic point. Some of the better papers also provided evidence of triangulation, audit and credibility checks (e.g., Stenfert Kroese et al, ).…”

“…The remaining six papers were rated as “good” (Clarkson, Murphy, Coldwell, & Dawson, ; Cookson & Dickson, ; Dinwoodie, Greenhill, & Cookson, ; Roscoe, Petalas, Hastings, & Thomas, ; Rose et al, ; Stenfert Kroese et al, ). These papers met the majority of quality criteria but there were some exceptions, which included specifying the level of intellectual disability of the participants, and a lack of homogeneity in some samples.…”

The clinical approach used in supporting individuals with intellectual disability who have been sexually abused

“…Despite the clear need for evidence regarding how to support this population, intervention‐based studies—particularly after the event, and examining abuse of a sexual nature—are lacking (Jones et al, ). Cognitive behavioural therapy (including trauma‐focused variations, i.e., TF‐CBT; see Stenfert Kroese et al, ), eye movement desensitisation and reprocessing (EMDR), exposure therapy and psychodynamic therapy are routinely used in the general population (Jonas et al, ; Schaffner Wilen, ). Indeed, a series of case studies have indicated the effectiveness and acceptability of EMDR in intellectual disability populations (Jowett et al, ).…”

“…A pilot study by Stenfert Kroese et al () showed that PTSD in the context of intellectual disability is responsive to TF‐CBT, and further, that participants found the intervention to be acceptable. Only a handful of qualitative studies have reported on responsive interventions where people presented with a clinical need regarding a history of SA specifically (Monahan & Lurie, ; Peckham, Howlett, & Corbett, ; Stenfert Kroese & Thomas, ).…”