Treatment Approach and Sequence Effects in Cognitive Behavioral Therapy Targeting Emotion Regulation Among Adolescents with Externalizing Problems and Intellectual Disabilities

Abstract

Background Over the past years, it has become clear that adapted cognitive behavior therapy can be effective for adolescents with externalizing problems and mild intellectual disabilities or borderline intellectual functioning (MID–BIF). Most adapted treatment protocols consist, however, of a combined cognitive and behavioral approach, even though it is actually unclear which approach is most suitable for these adolescents. This experimental study aimed to examine which treatment approach (cognitive versus behavioral) and which treatment sequence (cognitive–behavioral versus behavioral–cognitive) is most effective. Methods Participating adolescents (N = 42, 50% boys, Mage = 15.52, SD = 1.43) consecutively received a cognitive and behavioral emotion regulation training module, but were randomly assigned to a different module sequence condition. Emotion regulation and externalizing problems were measured before and after the modules, and with continuing weekly assessments. Results Results indicated that the cognitive module, by itself, was more effective than the behavioral module. In addition, the results indicated that it is most effective to include behavioral exercises after (rather than before) cognitive training. Conclusions These findings highlight the importance of cognitive treatment approaches for adolescents with MID–BIF, and show that treatment approaches may have different effects, depending on the order in which they are presented.

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

“…Research suggests that CBT is an effective treatment for a number of psychiatric problems in adults with MID-BIF (e.g., Byrne, 2020; Dagnan et al, 2018; Koslowski et al, 2016). Although recent studies suggest that outcomes of treatments containing CBT elements for MID-BIF youth may be similar to the promising outcomes of CBT for MID-BIF adults (Klein et al, 2018; Laborde et al, 2017; Schuiringa et al, 2017; Te Brinke et al, 2022), there is a dearth of theoretically informed and evidence-based interventions suitable for use with this population (Hronis, 2021; Siegel et al, 2020). Several factors may explain this.…”

“…A recent study which explored the effectiveness of a CBT for adolescents with MID-BIF and externalizing problems found that a cognitive therapy module was more effective than a behavioral therapy module. In addition, the timing of the presentation of the treatment modules influenced their effectiveness: results indicated that it was most effective to include the behavioral therapy module after (rather than before) the cognitive therapy module (Te Brinke et al, 2022). This study illustrates that CBT can be applied to MID-BIF youth if it is creatively delivered and tailored to take into account the cognitive strengths and weaknesses of the young person.…”

Trauma‐Informed Care for Justice‐Involved Youth: A narrative review and synthesis

“…This approach may help children weigh the positive and negative consequences of their behavior and is often a successful approach to changing their behavior, thoughts, and feelings. Phase 1 of TF‐CBT is of particular interest for several reasons: (1) previous empirical evidence has noted the importance of parent involvement in treatment (Feinfield & Baker, 2004; Ormhaug & Jensen, 2018), parenting (Miner & Clarke‐Stewart, 2008), and emotion regulation in treatment of youth with externalizing behavior problems (Te Brinke et al, 2022); (2) the majority of components that have been investigated as mechanisms of change are housed in Phase 1; and (3) Phase 1 is posited to be the active phase of TF‐CBT, especially for youth with externalizing behaviors.…”