Cognitive behavioural therapy for chronic pain in people with an intellectual disability: a case series using components of the Feeling Better programme.
Eight CBT pain sessions gave quick but fading gains for adults with mild ID, so build in caregiver boosters.
01Research in Context
What this study did
Levin et al. (2014) ran eight one-to-one CBT sessions for adults with mild intellectual disability. The sessions taught pain facts, coping thoughts and relaxation.
It was a small case series. Staff tracked pain knowledge and coping skills before, after and one month later.
What they found
Right after the course, clients knew more about pain and used more coping skills. One month later, most gains had slipped away.
The brief course helped, but the help did not stick without extra practice.
How this fits with other research
Dai et al. (2023) looked at nine CBT studies for anxiety in the same population. They also saw quick gains, but rated the evidence as weak because samples were tiny.
Peters et al. (2013) asked clients why gains fade. Clients said warm therapy felt good, yet they feared skills would vanish once sessions stopped.
Eussen et al. (2016) pooled all mental-health CBT trials for adults with mild ID. They found only group CBT had any support, and even that needed more proof. Together, these papers show a pattern: CBT works short-term for adults with mild ID, but brief courses fade unless caregivers keep the skills alive.
Why it matters
If you run CBT with adults who have mild ID, plan for booster calls or caregiver coaching after the last session. Add visuals, role-play and video reviews to keep skills fresh. One month of follow-up may not be enough—set calendar reminders at two weeks, one month and three months to check if coping skills are still used.
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02At a glance
03Original abstract
BACKGROUND: Cognitive behavioural therapy (CBT) has been shown to be effective in assisting people to cope with chronic pain. However, this approach has not been systematically evaluated with people with an intellectual disability (ID). This pilot study sought to examine the feasibility and clinical utility of CBT for people with an ID, using elements of a manualised CBT pain management programme called Feeling Better. METHOD: Five people with chronic pain who were functioning within the mild range of ID received a modified, individual eight-session cognitive behavioural intervention aimed at development of pain management skills. The participants' scores on a range of measures (pain management knowledge, pain self-efficacy, use of pain coping strategies and effectiveness of coping strategies) were compared pre-intervention, post-intervention and at 1-month follow-up. RESULTS: The results indicated that participant scores on pain management knowledge, wellness-focused coping and effectiveness of coping increased following the intervention. However, these gains were generally not maintained at follow-up. CONCLUSION: We concluded that CBT has potential utility for pain management in people with an ID, but that it requires a trial of a more intensive and prolonged intervention with the systematic involvement of care givers.
Journal of intellectual disability research : JIDR, 2014 · doi:10.1111/jir.12018