Psychotherapeutic interventions in learning disability: focus on cognitive behavioural therapy and mental health

Abstract

Cognitive behavioural therapy (CBT) assumes that psychological disorders are characterized by distorted or dysfunctional thinking, and can be treated by working with the patient to modify thinking in the direction of more realistic or adaptive evaluations of events. CBT has been evaluated extensively and is now the first-line treatment of choice for many psychological disorders. It is increasingly being used with people with learning disabilities, although the evidence base with this population is relatively weak, consisting largely of case studies and case series. There are also controlled trials in anger and depression, for which all published studies report significant clinical improvements that are well maintained over 3–6-month follow-up periods. There are many barriers to engagement with CBT for people with learning disabilities, which reflect limitations of ability and motivation. The limitations of ability reflect the fact that people with learning disabilities have to cope with cognitive deficits in addition to the cognitive distortions that are the target of CBT interventions. If barriers to treatment are recognized, significant steps can be taken to increase accessibility by adapting the therapy. Adaptations include involving carers, simplifications of the delivery of therapy (e.g. by using simple language and a slower pace), and simplifications of the model (e.g. by the therapist adopting a more directive, less collaborative, approach). If the current policy of increasing access to psychological therapies is extended to people with learning disabilities, it is likely that evidence will also accrue to support the use of other psychotherapeutic approaches.