DBT and intellectual disabilities: the relationship between treatment fidelity and therapeutic adaptation
| Published date | 09 March 2020 |
| DOI | https://doi.org/10.1108/AMHID-10-2019-0031 |
| Pages | 61-67 |
| Date | 09 March 2020 |
| Author | Christopher Patterson,Jonathan Williams,Robert S.P. Jones |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
DBT and intellectual disabilities:
the relationship between treatment
fidelity and therapeutic adaptation
Christopher Patterson, Jonathan Williams and Robert S.P. Jones
Abstract
Purpose –There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with
adults with intellectualdisabilities (IDs). To draw upon the evidence-basefrom mainstream approaches,
adapted interventionsmust remain true to their theoretical foundations andretain key components. The
purpose of this paperwas to establish the extent to which DBT has been adapted for adultswith ID, and
whetherexisting adapted protocols can still be consideredDBT.
Design/methodology/approach –The theoretical underpinnings and key components of DBT were
identified.Six DBT studies were critiqued according to these criteria.
Findings –In terms of content, only one intervention comprised all necessary elements. All of the
remaininginterventions included a skills group;two included individual therapyand another two included
group consultation. None of the remaininginterventions provided 24-h telephone support. Furthermore,
none of the studiesexplicitly described using dialecticalstrategies.
Originality/value –To the best of the authors’ knowledge,this is the first paper to critically examine the
evidence-basefor the use of DBT in ID, particularly itsfidelity.
Keywords Psychotherapy, Fidelity, Intellectual disabilities, Systematic review,
Dialectical behaviour therapy, Third-wave therapies, Mindfulness,Acceptance
Paper type Literature review
Research evidence shows that psychological therapies can be used to alleviate mental
health problems in the non-intellectual disability population. Such evidence has been
reviewed and consolidated to provide clinicians with guidance on how to treat a range of
mental health problems (e.g. National Institute for Health and Care Excellence). It is now
widely established that people with intellectual disabilities (IDs) have access to the same
psychological therapies as people without IDs (Department of Health, 2001). Previously,
it was argued that people with ID have neither the cognitive nor language abilities
necessary to access, engage with and benefit from psychological therapies (Sturmey,
2004). However, recent evidence has emerged indicating that, when adapted (Taylor
et al., 2013), psychological therapies (e.g. cognitive behaviour therapy [CBT]) can
produce positive outcomes for people with mild intellectual disabilities (Vereenooghe
and Langdon, 2013). Recommended adaptations include:
䊏simplifying language;
䊏making abstract concepts more concrete; and
䊏focusing more on behavioural, rather than cognitive, interventions (Patterson et al.,
2019;Taylor et al., 2013).
Chris Patterson and
Jonathan Williams are both
based at Betsi Cadwaladr
University Health Board,
Bangor, UK. Chris works in
Older Person’s Psychology.
Jonathan works in Child
and Adolescent Mental
Health Service. Robert S.P.
Jones is based at North
Wales Clinical Psychology
Programme, School of
Psychology, Bangor
University, Gwynedd, UK.
Received 31 October 2019
Revised 12 January 2020
Accepted 31 January 2020
DOI 10.1108/AMHID-10-2019-0031 VOL. 14 NO. 3 2020, pp. 61-67, ©Emerald Publishing Limited, ISSN 2044-1282 jADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES jPAGE 61
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