Can a computerised training paradigm assist people with intellectual disabilities to learn cognitive mediation skills? A randomised experiment

Abstract

Aims:The aim was to examine whether specific skills required for cognitive behavioural therapy (CBT) could be taught using a computerised training paradigm with people who have intellectual disabilities (IDs). Training aimed to improve: a) ability to link pairs of situations and mediating beliefs to emotions, and b) ability to link pairs of situations and emotions to mediating beliefs.Method: Using a single-blind mixed experimental design, sixty-five participants with IDs were randomised to receive either computerised training or an attention-control condition.Cognitive mediation skills were assessed before and after training. Results:Participants who received training were significantly better at selecting appropriate emotions within situation-beliefs pairs, controlling for baseline scores and IQ. Despite significant improvements in the ability of those who received training to correctly select intermediating beliefs for situation-feelings pairings, no between-group differences were observed at post-test. Conclusions:The findings indicated that computerised training led to a significant improvement in some aspects of cognitive mediation for people with IDs, but whether this has a positive effect upon outcome from therapy is yet to be established. Prevalence rates of mental health problems among people with intellectual disabilities (IDs) vary widely depending on the diagnostic criteria and assessments used, with recent estimates suggesting that between thirteen and forty percent of people with IDs are affected (Cooper, Smiley, Morrison, Williamson, & Allan, 2007;Deb, Thomas, & Bright, 2001;Emerson & Hatton, 2007). The high prevalence rates, when compared to the general population, can be partly explained by the genetic vulnerability of people with IDs, and disadvantageous life events such as stigmatisation and isolation (Clarke, 2003;Cooper et al., 2007;Emerson & Hatton, 2007;Hulbert-Williams & Hastings, 2008;Reiss & Benson, 1984).Even though people with IDs have an elevated risk of developing mental health problems, the evidence regarding the efficacy of psychological therapies for this population has only been emerging slowly. A recent meta-analysis concluded that cognitive behavioural therapy was at least moderately effective for the treatment of anger regulation problems and depression (Vereenooghe and Langdon, 2013), and previous reviews have also supported the potential benefits of cognitive-behavioural therapy (CBT) for anger management (Hamelin, Travis and Sturmey, 2013;Nicoll, Beail and Saxon, 2013). However, there is insufficient evidence to conclude that psychological treatments for mental health problems amongst people with IDs are empirically validated (Vereenooghe & Langdon, 2013). One of the reasons for this is that people with IDs are thought to have difficulty grasping some of the concepts presented within CBT (Biza Stenfert-Kroese, Dagnan, & Loumidis, 1997), and while suitability criteria for CBT have been described in terms of the potential to form a therapeutic alliance, motivation ...

Using computers to teach people with intellectual disabilities to perform some of the tasks used within cognitive behavioural therapy: A randomised experiment

“…The findings of both Bruce et al (2010) and Vereenooghe et al (2015) are encouraging and potentially offer a new approach to prepare people with IDs prior to accessing CBT, in addition to adaptations to the content and delivery of CBT itself (Whitehouse, Tudway, Look, & Stenfert-Kroese, 2006). Building on this, the current study developed and evaluated a computerised training programme to help people with IDs learn some of the component skills of CBT: i.e.…”

“…Most of the above studies reported a significant correlation between cognitive mediation ability and level of verbal comprehension, but it is important to bear in mind that participants with limited verbal skills were excluded from these studies. More recently, Vereenooghe, Reynolds, Gega, and Langdon (2015) did not employ exclusion criteria based on verbal skills, but reported substantially higher pass-rates on these tasks using an adapted and computerised version of the tasks.…”

“…Within the first study (Bruce, Collins, Langdon, Powlitch, & Reynolds, 2010), using an experimental methodology comparing a training programme to a relaxation condition, participants' ability to link thoughts to feelings significantly improved, but training had no significant effect on ability to discriminate between behaviours, thoughts and feelings. In another experimental study, Vereenooghe et al (2015) used a computerised training programme which was based on the Reed and Clements COMPUTERISED TRAINING IN CBT COMPONENT SKILLS 8 (1989) assessment, which led to improvements in ability to identify appropriate emotional consequences in a cognitive mediation task of the type 'AB, choose C'. However, when compared to an attention-control condition, no training effect was found for the ability to identify appropriate mediating beliefs for a cognitive mediation task of the type 'AC, choose B'.…”

“…The response options and pictures were introduced prior to the assessment as follows: (a) Dagnan et al (2000), which have been adapted for computerised delivery in a previous study by Vereenooghe et al (2015), we used two assessment tasks to evaluate cognitive mediation skills: the 'AB, choose C' task assessed the ability to recognise emotions as consequences of thoughts, and the 'AC, choose B' task assessed the ability to recognise thoughts as mediators of emotions.…”

Intellectual disability and computers in therapy: Views of service users and clinical psychologists

“…Brief computerised training programmes may improve the ability of people with mild to moderate ID to gain some of the basic skills to engage in cognitive behaviour therapy (CBT; Vereenooghe, Gega, Reynolds, & Langdon, 2016;Vereenooghe, Reynolds, Gega, & Langdon, 2015). This is important because CBT has the potential to reduce anger problems and depression in people with ID (Vereenooghe & Langdon, 2013) but its underlying theoretical rationale is difficult to grasp (Dagnan, Mellor, & Jefferson, 2009;Joyce, Globe, & Moody, 2006;Oathamshaw & Haddock, 2006;Reed & Clements, 1989).…”