Generalization of Anger‐Coping Skills from Day‐Service to Residential Settings

Abstract

Objective To evaluate the extent to which anger management training provided within a learning disabilities day service generalizes to residential settings. Method Eleven day-service users participated in one of two anger management groups. Treatment was delivered by day-service staff and an assistant psychologist, using a standard cognitive-behavioural therapy (CBT) package shown to be effective in earlier studies. Evaluation was by the Provocation Index and the Profile of Anger-Coping Skills, which measure, respectively, the potential to react in an angry manner, and the utilization of eight different anger-coping skills. Results Participants showed a decrease in anger and an increase in anger-coping skills, which was maintained at 6-month follow-up. Similar changes were reported by day-service key-workers and by residential carers (and by the participants themselves). At the level of the group, key-workers and home carers did not differ significantly, at any time, in their ratings of anger, aggregate coping skills or individual coping skills. Within each setting, profiles of coping skills differed between individuals but were relatively stable across the 6-month follow-up period. However, there was no significant correlation between the profiles of coping skills reported for individual service users in the two settings.Conclusions The results confirm that group-based CBT is an effective treatment for people with learning disabilities and anger management problems. Therapeutic gains are maintained for at least 6 months and generalize across settings. Different anger-coping skills may be used by different people, or by the same person in different environments. A Manual for the group is available on request.

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities

“…Provocation Index scores were similar to those observed in earlier studies on a comparable population, 11,48 with service users rating themselves higher than they were rated by their key workers or home carers [F(2,487) = 38.05; p < 0.001]. Key worker and home carer PACS scores were also similar to those reported previously.…”

“…50 In order to capitalise on the potential benefit of carer involvement, some studies have involved carers (day-service staff) to deliver an anger management intervention to people with intellectual disabilities, with positive outcomes. 11,48 A manualised group intervention delivered by day-service staff has also been reported to improve depression in people with intellectual disabilities. 14 There are potential advantages to this approach, because care staff who are recruited as 'lay therapists' become familiar with the anger coping techniques that participants learn and are, therefore, able to provide ongoing support outside the group sessions.…”

“…Participants in services randomised to the intervention group of the trial received a manualised CBT intervention, 48 consisting of 12 weekly psychoeducational group sessions supplemented by 'homework'. The intervention was delivered by day service staff acting as 'lay therapists', under the supervision of one of three clinical psychologists, each of whom was herself supervised by a consultant psychologist.…”

“…The PACS 11,48 was completed by both service user and key worker to assess the development of alternative, more functional coping skills. The PACS first identifies three situations that reliably trigger anger in the individual service user, then asks for ratings of the usage of each of eight coping skills in each of those three situations.…”

Social Skills Group for Adults Living with Intellectual Disabilities

“…Thanks to this work, the patients reduced their anxiety (expressed, by example, by hypervigilance or nervousness) and behavioral problems (asking the same question over and over, for example, becoming aggressive, insulting or even leaving work after an altercation). Secondly, it confirms that personnel can offer CBT interventions that are effective and adapted to this population provided that they are trained [32][33][34][35][36][37][38].…”