Two cases of Acceptance and Commitment Therapy leading to rapid psychological improvement in people with intellectual disabilities
| Date | 24 October 2019 |
| Pages | 257-267 |
| Published date | 24 October 2019 |
| DOI | https://doi.org/10.1108/AMHID-04-2019-0012 |
| Author | Mark A. Oliver,Matthew Selman,Samuel Brice,Rebecca Alegbo |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Two cases of Acceptance and
Commitment Therapy leading to rapid
psychological improvement in people
with intellectual disabilities
Mark A. Oliver, Matthew Selman, Samuel Brice and Rebecca Alegbo
Abstract
Purpose –The purpose of this paper is to show that Acceptance and Commitment Therapy (ACT) may have
utility with this client group in routine clinical practice.
Design/methodology/approach –This uncontrolled double case study describes the targeting of ACT
processes with people referred to a mental health service for people with intellectual disabilities because of
distressing intrusive thoughts. It includes qualitative data to illustrate the opinions of the participants eight
weeks after the end of therapy.
Findings –Both clients described rapid relief from distress, with some additional untargeted benefits
emerging too. The participants provided follow-up qualitative data in which they described how the therapy
had helped them as well as areas where it had not.
Research limitations/implications –This paper presents uncontrolled case studies selected from routine
clinical practice. They were selected due to their similarity of outcome and will not represent the experience of
every client treated this way.
Practical implications –The practical implications are that a therapy often considered to rely on the use of
metaphors and the manipulation of complex metacognitions may be useful for people with more limited
verbal and cognitive ability if the therapy is adapted to meet their level of ability.
Originality/value –There has been very little published on using ACT with an intellectual disabilities
population. This paper has originality value in that it illustrates the applicationof the approach in routine clinical
practice. Additionally, the qualitative follow-up allows the participants’voices to be heard about their
experience of this approach.
Keywords Anxiety, Mindfulness, ACT, Acceptance and Commitment Therapy, Defusion,
Relational frame theory
Paper type Case study
People with ID experience psychological distress at least as much as the typically developing
population (Buckles et al., 2013). A recent review document prepared for the British
Psychological Society (Beail, 2016) identified that while evidence is beginning to be gathered for
a number of therapeutic orientations, the literature is not as yet clear which approach is best
suited to which presentations in this population. The review notes that evidence continues to
come predominantly from routine clinical practice and that clinicians in the field should be
“aspirational and seek opportunities to expand our research efforts”(p. 206) and that innovations
and adaptations should be evaluated as they are applied. One such innovation for this client
group would be the application of Acceptance and Commitment Therapy (ACT).
ACT (Hayes, Pistorello and Levin, 2012; Hayes, Strosahl and Wilson, 2012) is a “third wave”
behavioural therapy (Hayes, 2004) that has attracted a growing number of studies over recent
years (Hooper and Larsson, 2015). ACT is an explicitly behavioural psychotherapy, drawing
upon operant principles of verbal language acquisition and rule governance for theoretical
support, principally relational frame theory (RFT) (Hayes et al., 2001). The ability to relationally
Received 16 April 2019
Revised 4 August 2019
Accepted 31 August 2019
There was no external funding
involved in this paper.
Mark A. Oliver is based at
Northumberland Community
Learning Disability Service
(Psychological Services),
Northumberland Tyne and
Wear NHS Foundation Trust,
Newcastle upon Tyne, UK.
Matthew Selman is based at
Northumberland Tyne and
Wear NHS Foundation Trust,
Newcastle upon Tyne, UK and
Children and Young People’s
Services, Tees Esk and Wear
Valleys NHS Foundation Trust,
Durham, UK.
Samuel Brice is based at
Northumberland Community
Learning Disability Service
(Psychological Services),
Northumberland Tyne and
Wear NHS Foundation Trust,
Newcastle upon Tyne, UK and
Institute of Neuroscience,
Newcastle University,
Newcastle Upon Tyne, UK.
Rebecca Alegbo is based at
Northumberland Tyne and
Wear NHS Foundation Trust,
Newcastle upon Tyne, UK and
Norfolk and Suffolk NHS
Foundation Trust,
Norwich, UK.
DOI 10.1108/AMHID-04-2019-0012 VOL. 13 NO. 6 2019, pp.257-267, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE257
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