Using repertory grid techniques to measure change following dialectical behaviour therapy with adults with learning disabilities: two case studies

Abstract

Accessible summary• Dialectical behaviour therapy (DBT) can be adapted for individuals with learning disabilities. DBT aims to teach people how to control their feelings, communicate with other people, manage distress and be more self-aware.• This article presents the case studies of two adults with learning disabilities who completed DBT and shows how their opinions of themselves and others changed.• The results discussed include overall change in construing, changes in self-esteem and changes in dilemmas they had about themselves before DBT. AbstractBackground: Government strategy indicates that individuals with learning disabilities should have access to adapted psychological therapies. Dialectical behaviour therapy (DBT) is recommended for the treatment of borderline personality disorder (BPD); however, there is little published research regarding whether it can be appropriately adapted for adults with learning disabilities. The research available primarily focuses on measures of behavioural and psychiatric change, with little emphasis on the psychological changes that occur. Materials and Methods: Two case studies are presented that using repertory grid technique, based on personal construct psychology (PCP). Both individuals completed repertory grids prior to, and following, adapted DBT for adults with learning disabilities within a specialist community psychology service in the United Kingdom.Results: The case studies show some of the psychological changes that have occurred within adults with learning disabilities who received adapted DBT within a community psychology service. Changes included altered self-esteem and dilemmas individuals have about themselves. Conclusion:The contrasting case studies demonstrate the complexity and idiosyncrasy of the experiences of individuals with learning disabilities who receive DBT,The Official Journal of the British Institute of Learning Disabilities and discuss how this information can be integrated into clinical practice.

Outcomes and experiences of an adapted Dialectic Behaviour Therapy skills training group for people with intellectual disabilities

“…Sakdalan et al (2010) Both Brown et al (2013) and Lew et al (2006) incorporated specific training for support staff as part of the intervention, although additional information about the nature of this training, and the possible impact this may have had on outcomes was not included. McNair et al (2016a) found significant changes in self-esteem and resolution in personal dilemmas and a reduction in self-reported self-harm for their two participants. The variability of the interventions included in these papers appears idiosyncratic and most studies did not provide a specific rationale for inclusion or exclusion of the different components of DBT.…”

“…McNair et al. () found significant changes in self‐esteem and resolution in personal dilemmas and a reduction in self‐reported self‐harm for their two participants. The variability of the interventions included in these papers appears idiosyncratic and most studies did not provide a specific rationale for inclusion or exclusion of the different components of DBT.…”

“…() used a range of outcome measures which were completed by staff but also collected feedback directly from group members of the group, who indicated that it had been a positive experience for them. McNair, Woodrow, and Hare () used a repertory grid technique prior to, and following, adapted DBT to measure change in two case studies in a specialist community psychology service in the UK. Repertory grid technique presents a person‐centred perspective of change; however, using additional standardised measures of outcome would have improved the design of this study.…”

“…() and McNair et al. () both report on an intervention that comprised a combination of group skills and individual therapy, Brown et al. () used an adapted skills training called skills system [SS], a manual for emotion regulation skills which uses modified versions of the DBT skills modules for people with intellectual disabilities.…”

Adapting dialectical behaviour therapy in forensic learning disability services: A grounded theory informed study of “what works”

“…Early case studies utilizing DBT techniques with PWID and BPD (Esbensen & Benson, ; Mavromatis, ; Wilson, ) reported marked improvements in aggressive and self‐injurious behaviours; however, conclusions on the effectiveness of DBT as a standalone intervention were precluded. More recently a pre–post case series delivering fully adapted DBT programmes reported significant reductions in aggression, risk‐taking and/or self‐harm (Brown, Brown, & Dibiasio, ; Charlton & Dykstra, ; Lew, Matta, Tripp‐Tebo, & Watts, ; McNair, Woodrow, & Hare, ) and the prevention of community placement breakdown (Baillie & Slater, ). An unpublished study of adapted DBT by McNair () found significant reductions in levels of depression, anxiety and anger, and significantly improved mindfulness skills, yet participants’ anxiety remained within the clinical range.…”