Can a mindfulness-informed intervention reduce aggressive behaviour in people with intellectual disabilities? Protocol for a feasibility study

Abstract

BackgroundApproximately 10–20 % of adults with intellectual disabilities engage in challenging behaviours such as aggression, destructiveness, and self-injury, which are often accompanied by feelings of anger. The inability to manage anger can reduce quality of life. For example, aggression is a strong predictor of out-of-area placements and is a risk variable for abuse. Recent research suggests that mindfulness-based therapies (specifically, Singh’s Soles of the Feet meditation) can help people with intellectual disabilities manage angry emotions, with resultant reductions in challenging behaviour. However, previous research has been single-case design studies, and no group studies have been published with people with intellectual disabilities and aggressive behaviour.Methods/designFor this feasibility study, a UK protocol will be developed for use by health professionals within National Health Service (NHS) Intellectual Disability (ID) teams, based upon Singh’s Soles of the Feet manual. Twenty adults with intellectual disabilities and identified problems with anger control will be recruited and six sessions will be delivered by a trained ID clinician. The study will monitor participant’s aggressive behaviour, health-related quality of life, anxiety, depression, and use of support services (medication, hospital appointments etc.). These will be measured at three time points: (1) Baseline (within 2 weeks prior to the first session of the intervention), (2) 2 months post-baseline, and (3) 6 months post-baseline. Qualitative interviews will be conducted with participants, their carers, and the therapists who delivered the intervention. In order to help design an economic evaluation alongside a future full trial, we will cost the intervention and test the acceptability and validity of health economics measures to record resource use and health-related quality of life outcomes.DiscussionThe data from this study will inform the feasibility of the project protocol and intervention, which will help develop future research and to determine whether a larger, randomised controlled trial with concurrent economic evaluation is feasible.Trial registrationUKCERN: 16743.

Mixed Experiences of a Mindfulness-Informed Intervention: Voices from People with Intellectual Disabilities, Their Supporters, and Therapists

“…This qualitative study was part of a larger feasibility study which recruited 19 people with ID who engaged with UMAA-LD SoF and retained 14 participants at the 6-month follow up. The protocol of the feasibility study is detailed in Griffith et al (2016). Broadly, recruitment was via clinician referral in NHS ID services in Wales, and UMAA-LD SoF was delivered within NHS services.…”

“…MBPs have the practice of mindfulness as a central methodology, whereas mindfulnessinformed interventions draw upon the practice and philosophy of mindfulness, but also integrate other methodologies into the program. The intervention was delivered over six sessions, with sessions approximately 1 week apart, and is further described in Griffith et al (2016). In brief, core SoF meditations by Singh et al (2008) were used as a basis, during which participants were taught to recall situations that made them angry, then guided through the steps of the SoF meditation.…”

The Experiences of People with an Intellectual Disability of a Mindfulness-Based Program

“…More recently, Griffith et al (2016) suggested that interventions integrating mindfulness may be useful for people with ID, as unlike multicomponent procedures, the core of mindfulness is centred on one aspect: the ability to shift the focus of one's attention, allowing an individual time to calm themselves and choose how to react to a triggering thought or event (Adkins et al 2010). There are many definitions of mindfulness; however, it is generally understood as intentionally focusing one's attention on the present moment experience, in a non-judgemental and accepting way (Kabat-Zinn 1990).…”

Soles of the Feet Meditation Intervention for People with Intellectual Disability and Problems with Anger and Aggression—a Feasibility Study

“…A number of small-scale studies have demonstrated the success of SoF with people with ID who have aggressive behavior with reductions or elimination of aggressive behaviors at long-term follow-up (Adkins et al 2010;Singh et al 2007;Singh et al 2008a;Singh et al 2011b). Singh's SoF intervention (Singh et al 2003) has primarily been researched in the USA, involves extensive training, and includes little in terms of a taught psychoeducational component regarding emotional problems or about mindfulness (Griffith et al 2016). Additionally, SoF delivery in the USA demonstrated significant cost savings as a result of a reduction in staff absenteeism (Singh et al 2008a).…”

“…The study also aimed to develop and carry out a preliminary test of the acceptability and accessibility of the Mindful Awareness for Adults with an Intellectual Disability Scale (MAIDS) with further analysis of reliability and validity if positively indicated. We also calculated the costs of the UK SoF intervention and evaluated the acceptability and validity of the health economic outcomes (Griffith et al 2016).…”