Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature.
CBT is doable for adults with mild ID and may slightly cut depression, but the evidence base is tiny and exercise shows bigger gains.
01Research in Context
What this study did
Unwin et al. (2016) hunted for every paper that tested CBT for anxiety or depression in adults with intellectual disability.
They found only 11 small studies. Most used simple CBT workbooks or group lessons.
All studies together had fewer than 200 adults, almost all with mild ID.
What they found
CBT sessions were easy to run and no one dropped out because the lessons were too hard.
Depression scores went down a little, but only a handful of people were tracked after therapy ended.
For anxiety, the evidence was even thinner—too few studies to trust the result.
How this fits with other research
Cox et al. (2015) ran one of the very trials Gemma counted. Their trans-diagnostic CBT manual produced large symptom drops that lasted 3–6 months. This single strong result lifts the “weakly positive” label Gemma gave the whole set.
Delgado-Lobete et al. (2020) looked at exercise instead of CBT. Their meta-analysis of 18 trials found very large reductions in anxiety and depression for adults with ID. Exercise looks more powerful than CBT right now, but the two treatments have never been tested head-to-head.
Dewsbury (2003) warned that depression in ID is hard to measure. Gemma’s review still relied on those same shaky tools, so small score changes might reflect measurement noise rather than true mood gains.
Why it matters
If you serve adults with mild ID and mood problems, CBT is worth trying, but keep expectations modest. Use short concrete worksheets and picture-based feeling cards. Track progress with the Glasgow Depression Scale or simple daily mood ratings. Until bigger trials appear, combine CBT with movement breaks or walking groups to tap the stronger exercise evidence.
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02At a glance
03Original abstract
Relatively little is known about the application of cognitive behavioural therapy (CBT) to people with intellectual disabilities (ID). This review sought to synthesise available evidence on the effectiveness of CBT for anxiety or depression to assess the current level of evidence and make recommendations for future research. A comprehensive systematic literature search was conducted to identify qualitative and quantitative studies. Robust criteria were applied to select papers that were relevant to the review. Included papers were subject to quality appraisal. Eleven out of the 223 studies considered met our inclusion criteria and were included in the review in which CBT was used with participants with ID and anxiety (n=3), depression (n=4) or a mixed clinical presentation (n=4). There remains a paucity of evidence of effectiveness, however, the studies indicate that CBT is feasible and well-tolerated and may be effective in reducing symptoms of depression among adults with mild ID. Qualitative data reflect a positive perception of CBT amongst clients and carers. Further research is required to investigate the components of CBT, suitability for CBT, and requisite skills for CBT, which uses valid, sensitive and more holistic outcome measures.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2015.12.010