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From a medical perspective, hearing voices is perceived as a symptom of mental illness and their content as largely irrelevant. The effectiveness of antipsychotic medication has made it central to the treatment of psychosis. However pharmacological treatment alone is rarely sufficient for this disabling condition. This review examined the feasibility of formulating an understanding of the meaning of voices in psychosis to inform intervention. Examination of the literature demonstrated the need for a paradigm shift to a recovery model, drawing on biopsychosocial factors in formulating an understanding of the meaning of voices in the context of a person’s life. Providing the opportunity to talk about their experiences may aid the development of an interpersonally coherent narrative representing opportunities for psychological growth. Findings have implications for treatment planning and assessment of outcome. Collaborative formulation regarding the subjective meaning of voices may aid in understanding their development and maintenance and guide intervention. Hearing voices with reduced negative effects on wellbeing and functioning may reduce distress and improve quality of life even in the presence of voices. CFT, CBT, Relating Therapy and Open Dialogue may be effective in applying these principles. Findings are limited by the lack of controlled studies. Further controlled studies and qualitative explorations of individual experiences are recommended.

CBT may be effective in reducing child reported pain symptomology. Future studies using a larger sample and examining the differential impact of varied control conditions are needed.

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Accessible summary People with an intellectual disability may have feelings that are hard to manage when a loved one dies. People with an intellectual disability may not receive access to enough support to help them understand and manage difficult feelings when someone dies. Cognitive behavioural therapy is a therapy that can be adapted and may be useful to support people with intellectual disability when someone they love has died. AbstractBackgroundAs the life expectancy of adults with intellectual disability has increased, experience of familial bereavement is becoming more frequent. However, this group may not receive adequate information and support to enable them to understand and cope with the experience of loss.MethodThis narrative review examined the impact of bereavement, the ability to engage in cognitive behavioural therapy (CBT) and learn skills to understand and cope with bereavement, in an intellectual disability context.ResultsFindings indicated that the loss of someone close can render adults with intellectual disability at increased risk for additional mental health difficulties. Among variables associated with better death comprehension are higher levels of cognitive ability, adaptive behaviour skills and receptive language ability. However, research indicates that understanding the concept of death is not a requirement for experiencing the emotions associated with grieving. Findings indicated that the successful use of CBT for bereavement in people with intellectual disability requires adaptation, such as the use of visuals and preparatory training in relation to the CBT model.ConclusionsWith adaptation, CBT may be beneficial in supporting adults with intellectual disability to understand and cope with bereavement. The lack of controlled studies available for review exploring the impact of CBT on bereavement and the lack of standardised measures available in a population intellectual disability limit this review's findings. Controlled studies examining the effectiveness of adapted CBT for bereavement in a population with intellectual disability are recommended.