Depression and anxiety are well-defined psychological conditions, however, the symptoms may be different for everyone. It doesn’t matter your age, gender, socioeconomic status, cultural background, or intellectual capacity, we may all experience depression and anxiety at some stage throughout our lives. Whether it be the loss of a job, a loved one, sickness and ill health the emotions which this brings about can become very difficult to process, understand, and respond to.
Different biological, psychological, and social situations often contribute to someone developing both depression and anxiety. When working with people with an intellectual disability, it is important to be mindful that they may experience greater difficulty expressing complex emotions like depression, anxiety, and also anger.
In these situations, the emotional experience of a person with an intellectual disability can often be best understood through observation of both behaviours and mood. Sudden changes in behaviour, or the inability to engage in activities which were previously enjoyed, are important signs of changes to one’s emotional health and mental state that may need to be closely monitored.
Similar to depression, anxiety can be defined by low mood, irritability, fatigue, aggressive or avoidant behaviour, and being easily upset. The signs and symptoms may present differently so it is important to be aware and sensitive to more subtle changes in behaviour.
Cognitive Behavioural Therapy Treatment in People with Intellectual Disabilities
Cognitive Behavioural Therapy (CBT) is a collaborative approach to therapy whereby the client and therapist work to identify thought, behaviour and mood links. Behavioural strategies are taught and practiced within session for the client to then use in everyday life and stressful situations. For therapy to be most effective the therapist may need to adjust their communication and delivery of the traditional CBT model. When the necessary modifications in therapeutic approach and communication style, CBT has been found to be an effective intervention for people with an intellectual disability whom are experiencing depression and anxiety particularly when the therapeutic relationship when characterised by warmth, empathy and personal validation.
Communicating in the Therapeutic Setting
One important consideration when working with people with an intellectual disability is the complex nature of their communication needs. Clients may have a reduced vocabulary, experience difficulty forming sentences, have reduced understanding of concepts, and may require greater processing time. To further complicate therapy, the cognitive ability will vary greatly from person-to-person.
A therapist trained in working with people with an intellectual disability, will have the appropriate skill set to utilise CBT in a way that is effective in achieving emotional and behavioural change for a client. It is also important to consider the characteristics of a therapist that your loved one or client will connect with.
Therapeutic Characteristics and Approach
Regardless of the level of disability or the amount of technical modification required to engage in therapy, the therapist should keep the following interpersonal skills in mind.
Warmth – convey warmth through encouragement and offering positive reinforcement where appropriate; coupled with an empathetic, informal and friendly style.
Genuineness – Honesty without being overly harsh or judgemental. It is very important when working with this population group that directness isn’t misinterpreted as criticism or hostility. This is made more difficult as people with depression are more likely to focus on negative.
Rapport Building & Therapeutic Alliance – Developed rapport building to ensure the client feels secure and begins to trust their therapist. This is one of the most important first steps to ensure the benefits of therapy.
Accurate therapy – As the therapist develops an understanding of how to the client sees and feels about themselves, they will begin to be able to understand how the client feels, processes and responds to events. This is essential to developing rapport and engaging effectively in therapy.
If you know of someone with an intellectual disability who is showing signs that they may be experiencing emotional or psychological difficulties, then they may benefit from working with a therapist experienced with clients with an intellectual disability.
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McGillivray, J., McCabe, M., & Kershaw, M. (2008) Depression in people with intellectual disability: An evaluation of a staff-administered treatment program. Research in Developmental Disabilities, 29, 524-536.
Pert, C., Jahoda, A., Stenfert Kroese, B., Trower, P., Dagnan, D., & Selkirk, M. (2013). Cognitive behavioural therapy from the perspective of clients with mild intellectual disabilities: A qualitative investigation of process issues: What clients with intellectual disabilities say about CBT. Journal of Intellectual Disability Research, 57(4), 359-369. doi:10.1111/j.1365-2788.2012.01546.x