A literature review of Cognitive Behavioural Therapy and
anxiety in Learning Disabilities- staff training
Sabiha Azmi- Lead Clinical Psychologist: BCHC NHS Trust
Ioanna Tsimopoulou- Mres Student- University of Birmingham
Gemma Unwin- Research Fellow- University of Birmingham
FLD Conference -27th March 2014. Llandudno- Wales
Introduction
People with LD suffer from mental health problems more often than the general population
and anxiety is between the most common disorders (Cooper et al., 2007; Reid et al. 2011;
Richards et al. 2001; Smiley 2005).
CBT is being used by therapists for its treatment, but there is little evidence on how effective
these interventions are (Willner 2005).
1. Examine the effectiveness of CBT interventions that are delivered by
therapists or staff for people with LD and anxiety.
Staff training is crucial, as it increases their ability to recognize mental health problems
that coexist with LD and improves their emotional intelligence (Costello et al.2007;
Quigley et al. 2001; Zijlmans et al. 2011).
2. Determine which are the most effective techniques of training staff that
works with people with LD and anxiety.
Methodology
We searched the following databases: Embase, MEDLINE and PsycINFO
Terms related to: LD, CBT, anxiety, staff and staff training.
Question 1
Population: Learning
disabilities, adults, anxiety
Intervention: CBT
Outcomes: effectiveness
Study: any study in English
from a peer-reviewed journal
Question 2
Population: care staff working
with people with LD
Intervention: training
Outcomes: most effective
methods/techniques of training
staff
Study: any study in English
from a peer-reviewed journal
Results
A. Effectiveness of CBT for adults with LD and anxiety
90 records identified through database searching.
76 records after duplicates removed.
76 titles and abstracts screened
61 records excluded
15 full texts assessed for eligibility
10 records excluded
5 studies included
Plus 2 more studies from crossreferencing
7 studies included
No staff-administered CBT intervention for anxiety.
The majority of the studies have important methodological limitations and flaws
• Small number of participants
• No control group
• Short-term or no follow-up assessment
• No masking process or fidelity assessment
Results
A1. LD and anxiety
-Douglass et al., 2007
-Lindsay, 1999
-Marwood & Hewitt, 2012
Quantitative
VS
CBT is not effective
More and of higher quality research is needed!
Qualitative
CBT is effective
Results
A2. LD and a mixed clinical picture with anxiety and depression or anger
-Ghafoori et al., 2010
-Hassiotis et al., 2013
-Pert et al., 2013
-Stenfert Kroese et al., 2013
Quantitative
VS
Mixed results
• The RCT shows no significant decrease in
anxiety
Qualitative
CBT seems to be effective
• service users
• staff
Generally, there is a difference between the quantitative
and the qualitative studies.
Results
B. Most effective methods of training staff that works with people with LD and anxiety
120 records identified through database searching.
87 records after duplicates removed.
87 titles and abstracts screened
74 records excluded
13 full texts assessed for eligibility
13 records excluded
0 studies included
A meta-analysis from van Oorsouw et al. (2009)
o 55 studies in a period of 20 years
Results
B1. Most effective methods of training staff that works with people with LD
Goals
More effective
Not intends to change clients’ skills or
behaviours.
Less effective
Intends to change clients’ skills or
behaviours.
Format
When training does not intents to
change clients’ skills or behaviours
When training intents to change clients’
skills or behaviours
In-service format
Combined in-service and job coaching
Techniques
In service format
Package of training techniques,
with
verbal feedback
Coaching-on-the-job format
Verbal feedback –corrective, neutral and praise
Avoid instructions
Conclusions and recommendations for future research
1. Not much persuading quantitative evidence for the effectiveness of CBT interventions in
reducing anxiety in people with LD.
RCTs
Sensitivity of the existing evaluation tools
2. No staff-administered CBT intervention for anxiety.
Development of CBT programmes delivered by staff
3. No study for effective techniques in training staff that works with people with LD and
anxiety
Identify the most effective methods and techniques
Training staff in CBT techniques
o Dodd et al. (2013)
o Brown & Marshall (2006)
Contact: Dr. Sabiha Azmi
Sabiha.Azmi@bhamcomm
unity.nhs.uk
Thank you!
References
Brown, M. and Marshall, K. (2006). Cognitive behaviour therapy and people with learning disabilities: implications for developing nursing practice.
Journal of Psychiatric and Mental Health Nursing, 13(2), 234–241.
Cooper , S.A., Smiley, E., Morrison, J., Williamson, A. & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: prevalence and
associated factors. The British Journal of Psychiatry, 190, 27–35.
Costello, H., Bouras, N. and Davis H. (2007). The Role of Training in Improving Community Care Staff Awareness of Mental Health Problems in
People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities, 20(3), 228–235.
Dodd, K., Austin, K., Baxter, L., Jennison, J. et al. (2013). Effectiveness of brief training in cognitive-behaviour therapy techniques for staff working
with people with intellectual disabilities. Advances in Mental Health and Intellectual Disabilities, 7(5), 300-311.
Douglass, S., Palmer, K., O’Connor, C. (2007). Experiences of running an anxiety management group for people with an intellectual disability using a
cognitive behavioural intervention. British Journal of Learning Disabilities, 35(4), 245–252.
Ghafoori, B., Ratanasiripong, P., Holladay, C. (2010). Cognitive Behavioral Group Therapy for Mood Management in Individuals With Intellectual
Disabilities: A Pilot Study. Journal of Mental Health Research in Intellectual Disabilities, 3(1), 1-15.
Hassiotis, Α., Serfaty, Μ., Azam, Κ., Strydom, Α., Blizard, R., Romeo, R., Martin, S. & King, M. (2013). Manualised Individual Cognitive Behavioural
Therapy for mood disorders in people with mild to moderate intellectual disability: A feasibility randomised controlled trial. Journal of Affective
Disorders, 151(1), 186–195.
Lindsay, W. (1999). Cognitive therapy. The psychologist, 12, 238- 241.
Marwood, H. and Hewitt, O. (2012). Evaluating an anxiety group for people with learning disabilities using a mixed methodology. British Journal of
Learning Disabilities, 41(2), 150–158.
Pert, C., Jahoda, A., Stenfert Kroese, B., Trower, P., Dagnan, D. & Selkirk, M. (2013). Cognitive behavioural therapy from the perspective of clients
with mild intellectual disabilities: a qualitative investigation of process issues. Journal of Intellectual Disability Research, 57(4), 359–369.
Quigley, A., Murray, G. C., McKenzie, K. and Elliot, G. (2001). Staff knowledge about symptoms of mental health problems in people with learning
disabilities. Journal of Learning Disabilities, 5(3), 235-244.
Reid, K.A., Smiley, E. & Cooper, S.A. (2011). Prevalence and associations of anxiety disorders in adults with intellectual disabilities. Journal of
Intellectual Disability Research, 55(2),
Richards, M., Maughan, B., Hardy, R., Hall, I., Strydom, A., Wadsworth, M. (2001).Long-term affective disorder in people with mild learning
disability. British Journal of Psychiatry, 179, 523–527.
Smiley, E. (2005). Epidemiology of mental health problems in adults with learning disability: an update. Advances in Psychiatric Treatment, 11, 214–222.
Stenfert Kroese, B., Jahoda, A., Pert, C., Trower, P., Dagnan, D. & Selkirk, M. (2013). Staff Expectations and Views of Cognitive Behaviour Therapy (CBT)
for Adults with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities.
van Oorsouw, W.M.W.J., Embregts, P.J.C.M., Bosman, A.M.T. and Jahoda, Α. (2009). Training staff serving clients with intellectual disabilities: A metaanalysis of aspects determining effectiveness. Research in Developmental Disabilities, 30(3), 503–511.
Willner, P. (2005). The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical overview. Journal of Intellectual
Disability Research, 49(1), 73-85.
Zijlmans, L. J. M., Embregts, P. J. C. M., Gerits, L., Bosman, A. M. T. & Derksen, J. J. L. (2011). Training emotional intelligence related to treatment skills
of staff working with clients with intellectual disabilities and challenging behaviour. Journal of Intellectual Disability Research, 55(2), 219–230.