Search results

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.

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).

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.

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.

This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD.

The findings indicate that a group intervention is both feasible for and acceptable to adults with ID.

To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID.

The purpose of this paper is to evaluate the prevalence of mental health disorder symptoms in a sample of prisoners in Trinidadian prisons who volunteered to attend anger management groups.

A survey was conducted using the 90-item Symptom Check-List revised (SCL-90-R) which was administered to prisoners in groups within the prison system. In total 132 prisoners (about 9 per cent of the prison population) completed the measure. The effect sizes of prisoners’ similarities to a psychiatric inpatient group and their differences from a non-patient group were used to identify symptoms most indicative of pathology in these prisoners.

The results on the SCL-90-R indicate that this group of prisoners (77.3 per cent male) had scores of psychiatric symptomatology that were much closer to a psychiatric inpatient population rather than to a general community population.

These results suggest there may be unmet psychiatric need among the population served by the prison services in Trinidad. It is not known how this sample differs from the general prison population. However, the unmet psychiatric need in this specific population suggests that a greater mental health focus in health services within prisons is to be considered to meet these needs.

These data suggest that there are significant mental health issues for some prisoners in Trinidad and possibly more generally in similar prison systems within the Caribbean and this may have significant implications for the treatment of prisoners and the delivery of mental health services in these prisons.

The terms capacity and competence are often used interchangeably, but are actually distinct. This aim of this paper is to clarify the application of these terms, and to illustrate some of the practical benefits of distinguishing them.

The concepts of capacity and competence are discussed in relation to restrictions that are placed on choice and action, respectively, when these qualities are judged to be absent. The paper explores the distinction between these two concepts in relation to their legal status, assessment, and scope.

Mental capacity refers to the ability to make decisions, while competence refers to the ability to perform the actions needed to put decisions into effect. Questions of capacity are governed by legislation (in the UK: the Mental Capacity Act (MCA); the Adults with Incapacity (Scotland) Act and the Sexual Offences Act); they apply only to people who can be demonstrated to have a “mental disorder”, and trigger best‐interests decision making and other legal provisions if capacity is assessed as absent. Questions of competence involve a range of formal and informal assessment procedures, and can apply to anyone; they arise where others possess legal powers to control a person's actions.

In addition to clarifying the conceptual confusion that exists in this area, the paper also considers some areas of practice where the MCA can be invoked to promote competence, in addition to capacity.

Cognitive behavioural therapy (CBT) is being used increasingly with people with learning disabilities. The evidence base to support these developments comes from uncontrolled trials of CBT in a variety of psychological disorders and eight to nine controlled trials of CBT for anger (plus a single controlled study in depression). This paper reviews the evidence for the effectiveness of group‐based anger management and the acquisition of anger coping skills, and the effectiveness of individual anger treatment, with some discussion of the status of CBT for other indications and the difficulties of conducting outcome research in this area.

An earlier study of health and social services professionals in community teams for people with intellectual disabilities (CTIDs) identified a number of significant gaps in their knowledge of mental capacity issues. The present study aims to ascertain the knowledge of staff working in residential services for people with intellectual disabilities.

Participants were staff working in three specialist residential settings catering to people with intellectual disabilities: qualified nurses working in the UK National Health Service (NHS) and in independent‐sector continuing health care settings; and senior staff in residential houses. They were administered the same structured interview as in the earlier study, which was constructed around three scenarios concerning a financial/legal issue, a health issue, and a relationships issue, as well as a set of ten “true/false” statements. Their performance was compared with that of two reference groups, the earlier CTID participants, and a group of staff working in generic (i.e. other than specialist intellectual disability) NHS services.

No differences in interview performance were found between the three groups of residential carers, who performed better than generic NHS staff but worse than CTID professionals. However, the three residential groups did differ in their self‐ratings of how well‐informed and confident they felt in relation to mental capacity issues.

The study shows that staff working in residential services for people with intellectual disabilities have only a limited understanding of mental capacity issues and their confidence in their own knowledge may not be a good guide to their ability to deal with such issues when they arise in practice.

The randomised control trial is regarded as the gold standard among the methods used in treatment outcome studies, whatever the treatment. This method imposes the highest level of control over other factors that may influence outcome so that the true effects of the treatment can be tested. In this paper the key features of an RCT are examined, along with potential challenges that emerge when applied to evaluations of psychotherapeutic interventions with people who have learning disabilities.

The purpose of this paper is to investigate how service managers perceive their service prior to, and following the delivery of a cognitive-behavioural therapy (CBT) anger management group for individuals with an intellectual disability.

Telephone interviews were conducted with seven service managers, before and after a CBT group intervention. The interviews were recorded, transcribed and analysed using thematic analysis to identify common and/or contrasting themes.

Before the intervention took place managers observed a lack of consistency in how their staff dealt with challenging incidents and the serious consequences these incidents had for service users as well as staff. They spoke about the importance of multi-disciplinary working and good quality staff selection, support and training. After the group intervention managers commented on a positive “spilling-out effect” whereby the whole organisation was influenced by the intervention, a greater willingness on the part of service users to talk about their problems, and an increased confidence in the staff members who had co-facilitated the group work.

The implications of the themes raised are discussed and recommendations for further research are suggested.

This research provides a unique contribution of managers’ views and insight into how hosting a CBT group intervention impacted on their wider services.

In the 1990s, scientists succeeded in demonstrating the highly positive effects of transformational and charismatic leadership on performance effectiveness, based on a large number of empirical findings. Bass (1985) predicted that this type of leadership would be related to “performance beyond expectations”. This has proved to be true to a very large extent. The so-called “new leadership approach “, however, has not yet succeeded in a close analysis of the interaction and influencing processes between charismatic leaders and their followers. This paper provides such an analysis. After pointing out the main problems with prior theoretical work, we offer an alternative model to help explain the emergence of charisma using social-cognitive and psycho-dynamic theories. Basically, we start from the premise that a focal person may be categorized as a charismatic leader on the basis of evaluative borderline attributes assigned to him or her, which are closely related to characteristics stigmatized by society. These attributes are exhibited consciously or unconsciously by the leader, either by means of social dramatization or by means of social reversion. We then propose a model of charismatic leadership relationships, which deal with both intra-personal and inter-personal feedback processes, based on recent theories of narcissistic behavior. Our overall intent is to help explain and clarify the processes between leadership behavior and the attribution of charisma.