Using Adapted Dialectical Behavioral Therapy to Treat Challenging Behaviors, Emotional Dysregulation, and Generalized Anxiety Disorder in an Individual With Mild Intellectual Disability

Abstract

Individuals with intellectual disability (ID) are at increased risk of presenting challenging behaviors and comorbid mental illness. Preliminary findings show decreased challenging behaviors and overall increased functioning in individuals with ID and mental health problems who receive adapted dialectical behavior therapy (DBT). However, more research and documentation on how to adapt DBT in this population is warranted given that DBT is a promising intervention in individuals with ID. This article presents the case of an individual with mild ID who received adapted DBT for the treatment of challenging behaviors, emotional dysregulation, and generalized anxiety disorder. Treatment lasted 1 year and was conducted in a residential facility for individuals with ID. Improvement of symptoms and decrease in frequency of challenging behaviors were observed throughout the case. This case study demonstrates the potential utility of adapted DBT for individuals with ID and underscores the importance of teaching skills to clients with ID to help them become agents of their own change.

Increasing Emotion regulation skills with dialectical behavior therapy skills training: A single-case study on an elementary school student with borderline intellectual functioning

“…This result supports the findings of a previous study about DBT effectivity among individuals with intellectual disability. Furthermore, the results supported the original hypothesis that DBT is not only effective for adolescents and adults (Brown et al, 2013;Charlton & Dykstra, 2011;Florez & Bethay, 2017) but also for school-aged children with intellectual disability. These outcomes can be achieved by adapting the module, as suggested by McNair et al (2016) that DBT skills training requires some basic modifications to meet the needs of a client with intellectual disability.…”

“…In vivo practice helps the client generalize the skills being taught (Florez & Bethay, 2017). One of the ways that can bring up an in vivo condition is by stimulating negative emotions through a chain behavior practice (Koerner, 2013).…”

“…Previous research demonstrated the effectivity of DBT skills training in adults and adolescents with intellectual disability (Brown et al, 2013;Charlton & Dykstra, 2011;Florez & Bethay, 2017), but DBT skills training has not yet been proven effective in school-age children. Given the importance of emotion regulation skills in children with BIF, DBT skills training in this population should be validated.…”

“…Rather than emphasizing cognitive changes, clients learn to regulate their emotion through mindfulness, or "the ability to consciously experience and observe one-self and surrounding events with curiosity and without judgement … to participate in the flow of the present moment effectively" (Linehan, 2015). Many studies have shown that dialectical behavior therapy (DBT), a mindfulness-based therapy, is effective to improve emotion regulation skills in adolescents and adults with intellectual disability (Brown, Brown, & Dibiaso, 2013;Charlton & Dykstra, 2011;Florez & Bethay, 2017;Lew, Matta, Tripp-Tebo, & Watts, 2006;McWilliams, 2014). By contrast, the effectivity of DBT has yet to be proven in school-aged children with intellectual disability.…”

Third‐wave therapies and adults with intellectual disabilities: A systematic review

“…Florez and Bethay () described the outcome of their DBT programme with an individual with an adult with a complex presentation (i.e., emotional dysregulation, generalized anxiety disorder and intermittent explosive disorder) who was exhibiting “challenging behaviour” (i.e., aggression and self‐harm) in the community. Results from their single‐case design study (ABAB) indicated that DBT eliminated their participant's challenging behaviour to zero, twice and within two months of implementation.…”