Cognitive Behaviour Therapy (CBT)
Manualised Cognitive Behaviour Therapy (CBT)
for anxiety and depression in adults with mild intellectual disabilities (ID)
This is a two and half year research project that focuses on developing a manualised cognitive behavioural therapy (CBT) treatment that can be used by trained CBT therapists to treat common mental disorders (depression and/or anxiety) in people with mild intellectual disabilities.
Cognitive behavioural treatment (CBT) is now recognised by the NHS as the best treatment for depression and anxiety. CBT helps people learn to think about their problems in a different way and how to cope better. In the UK, current policy states that people with intellectual disabilities should have the same access to healthcare as the general population. People with mild intellectual disabilities are often more likely to experience depression and/or anxiety compared to the general population however; CBT is not readily available to people with intellectual disabilities. This is mainly because it needs to be modified appropriately to cater for the cognitive problems and complex communication needs.
There is now growing evidence of CBT being used in clinical practice for a range of mental health problems in people with intellectual disabilities. These include treatment of psychosis, obsessive-compulsive disorder, anxiety, depression and anger. However most CBT interventions have focused on the behavioural rather than cognitive aspects of the intervention with observable behaviour rather than psychological change being the most frequently used outcome measure.
The broad outcome of the study will be to produce clear guidelines for therapists to apply an established intervention and identify how and whether it works with people with intellectual disabilities. We will also use the information from this study to prepare for a larger trial that will tell us more about the benefits of CBT in this population.
- Develop a Cognitive behavioural Therapy (CBT) manual for treatment of common mental disorders in people mild to moderate learning disabilities.
- Use a small randomised controlled trial to find out if CBT is suitable for people with mild learning disabilities and see how the manual works it practice.
- Use a randomised controlled trial to find out if the CBT manual can improve mental health (depression and/or anxiety) in people with mild to moderate learning disabilities.
Duration of study: March 2009 - August 2011
Develop the CBT manual
(March 2009 – March 2010)
The CBT manual will be developed by the research team that consists of specialists in the field of intellectual disabilities, cognitive behavioural therapy and health interventions. The content of the manual will be informed by various books and journals where CBT treatments have been described for either people with intellectual disabilities or child/adolescents.
The manual will provide detailed information and a step by step approach to trained CBT therapists on how to conduct CBT in people with intellectual disabilities suffering from common mental disorders. For example, outlining changes in cognitive and/or behavioural techniques, how materials and techniques can be modified, session duration and length of the treatment, etc.
Randomised controlled trial
(March 2010 – August 2011)
We will then carry out a pilot clinical trial to evaluate the CBT manual. We will recruit participants from the local intellectual disabilities services in the London boroughs of Camden and Islington.
Participants: A total of 30 participants will be randomly allocated to either receive either:
1) Manualised CBT (n=15): The participant will
received up to 20 hourly one-to-one manualised CBT sessions over a period of 4
2) Treatment as usual (n=15): The participant will keep receiving the standard treatment which is available to any adult with an intellectual disability who is referred to the service. This includes care management, medical, nursing or social support.
Assessments: We will interview participants at the beginning (baseline), end of treatment (4 months) and at 6 months follow-up to find out how they feel and any changes they have experienced. There will also be an open question about their experience and process of therapy to both service users and their carers.
Dr. Angela Hassiotis is a clinical academic in the psychiatry of learning disabilities. She is employed by University College London and works clinically in the Camden Learning Disabilities Service and with Camden & Islington NHS Foundation Trust. She has carried out epidemiological and applied research studies on older people and adolescents with learning disabilities, interventions for challenging behaviour, mental health services and stigma. She is treasurer of the Royal College of Psychiatry Faculty of the Psychiatry of Learning Disabilities.
Dr Marc Serfaty, Senior Lecturer, Mental Health Sciences, University College Medical School, Hampstead Campus. Dr Serfaty is a consultant CBT psychotherapist and is chief investigator in CBT trials in older people and adults with terminal cancer.
Professor Michael King is a clinical academic psychiatrist with extensive experience in national and international epidemiological and intervention studies in primary and secondary mental health care
Miss Sue Martin, Speech & Language Therapist, Islington Learning Disabilities Partnership, Islington Social Services. Miss Martin is providing assistance with the development of accessible materials and has supervised the communication methods of the CBT manual.
Dr Andre Strydom is a clinical academic who works with Islington Learning Disabilities Partnership. He has expertise in epidemiological studies and research design.
Dr Charles Parkes, Clinical Psychologist, Camden Learning Disabilities Service, Camden & Islington FT. Dr Parkes has supervised psychological and cognitive measurements of the trial and contributed to the manual.
Mr Robert Blizard, Statistician, University College Medical School. Mr Blizard is an experienced statistician with several years experience of multicentre and complex trials.
Miss Kiran Azam, Research Assisstant, Camden Learning Disaiblities Service, Camden & Islington FT. BSc in Human Psychology and MSc in Psychoanalytic Developmental Psychology.
Lorna Vincent, CBT Therapist, she specialises in working with anxiety disorders for both adults and young people and has a private practice in North London. She is currently working as a Consultant Cognitive Behaviour Therapist for the NHS.
Matt Broadway-Horner, CBT therapist, Clinical Director of CBT in the City Clinics and is one of the Consultant Cognitive Behaviour Therapist working in the centre for Anxiety Disorders, Depression and Trauma. He is a lecturer at Hertfordshire University and he is involved with the NHS IAPT programme. He and his team work in Public, Private and Corporate sectors offering solutions to Wellness
Sonia Arteaga Poveda, Support Worker, recruited part time for 18 months to assist with homework tasks and facilitate appointments for participants recruited to the trial.
Mr Spencer Smith, Professional Writer, who is revising the manual. He has worked with many authors in the fields of psychology and health whose professional academic work he has translated into a program that any lay reader can enjoy, understand, and most importantly utilize effectively.
RB is a client with mild intellectual disabilities who was referred for
CBT for depression and anxiety.
In this clip RB talks about this experience and provides feedback following
the end of this manualised cognitive behavioural therapy (CBT) intervention.
1. Azam K,Serfaty M,King M,Martin S,Strydom
A,Parkes C,Hassiotis A (2012) The development of manualised cognitive
behaviour treatment for adults with mild intellectual disability and common
mental disorders. Psychiatrike, 23(2), 109 - 116.
2. Hassiotis A,Serfaty M,Azam K,Strydom A,Martin S,Parkes C,Blizard R,King M (2011) Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial. Trials, 12(1), 95. 10.1186/1745-6215-12-95.
3. Angela Hassiotis, Marc Serfaty, Kiran Azam, Andre Strydom, Robert Blizard, Renee Romeo, Sue Martin, Michael King. "Manualised Individual Cognitive Behavioural Therapy for mood disorders in people with mild to moderate intellectual disability: A feasibility randomised controlled trial. Journal of Affective Disorders ( 2013).
For further information on the CBT for intellectual disabilities study, please contact the research team:
Dr Angela Hassiotis
Reader in the Psychiatry of Learning Disabilities
Department of Mental Health Sciences
Charles Bell House
67-73 Riding House Street
London W1W 7EJ
Tel: 020 7974 3737/ 88
Fax: 020 7974 3759/ 020 7679 9426
Miss Kiran Azam
Research Assistant Mental Health Camden Learning Disabilities Service 4th Floor. Bedford House
125 Camden High Street
London NW1 7JR
Tel: 020 7974 3737
The treatment manual and associated resources are available to download free of charge and are intended for the use of Therapists and Carers.
Page last modified on 15 feb 11 14:36