Measures of readiness for cognitive behavioural therapy in people with intellectual disability: A systematic review.
Current CBT readiness tests for people with ID are too weak to decide who gets therapy, so teach readiness skills and start treatment instead of screening clients out.
01Research in Context
What this study did
Stott et al. (2017) hunted for every paper that tested CBT readiness tools in people with intellectual disability. They wanted to know if any screener could safely decide who is 'ready' for therapy.
They found only a handful of tools. None had solid proof they worked. Most were never checked for reliability or validity.
What they found
The review warns: do not use current readiness measures to gate-keep therapy. The tools are weak and may wrongly block clients who could benefit.
Short teaching sessions can boost readiness skills, but we need bigger studies before betting clinical decisions on them.
How this fits with other research
Kooijmans et al. (2024) shows a fix: simplify language and layout of self-report tools. When they did this, adults with mild ID understood questions better and their answers matched carer reports more closely. This extends Joshua’s call for better tools by giving a concrete way to build them.
Vassos et al. (2023) looked wider at mental-health measures for adults with ID. Only four of nine tools had both good reliability and any validity evidence. Together, the two reviews paint the same picture: most ID instruments are half-baked.
Porter et al. (2008) and Boudreau et al. (2015) prove staff can run group CBT that cuts depression scores. Joshua’s warning matters here: if we use shaky readiness screeners to exclude clients, we may lose people who could benefit from these proven programs.
Why it matters
Stop using readiness checklists as a wall. Instead, treat readiness as a teachable moment. Run a brief primer on feelings, thoughts, and session rules, then start therapy. Track progress weekly and adjust. This keeps the door open while we wait for better-validated tools.
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02At a glance
03Original abstract
BACKGROUND AND AIMS: Cognitive behavioural therapy (CBT) is a promising treatment for mental health problems in people with intellectual disabilities but some may not be suited or ready. This review critically evaluates the quality and utility of measures of CBT readiness in people with intellectual disabilities. METHODS AND PROCEDURES: Twelve studies of six measures based on three aspects of CBT readiness were identified through systematic review. OUTCOMES AND RESULTS: Across measures, measurement quality was largely poor or un-assessed. Only one study evaluated measurement change over the course of CBT. Not all participants with intellectual disabilities could 'pass' readiness measures and performance may be affected by levels of language and cognitive functioning. There was some evidence that CBT readiness is trainable with brief interventions. CONCLUSIONS AND IMPLICATIONS: Before using readiness measures in a clinical context, further work is needed to extend initial evidence on recognising cognitive mediation as a CBT readiness ability. Given the lack of consensus as to the definition of CBT readiness and the heterogeneity of CBT interventions, future research could also focus on developing readiness measures using a bottom up approach, developing measures within the context of CBT interventions themselves, before further refining and establishing their psychometric properties. WHAT THIS PAPER ADDS: This paper is the first to systematically review measures of skills thought necessary to be ready for cognitive behavioural therapy in intellectual disabilities. The findings suggest that while readiness skills may be trainable with brief interventions, the available measures of these skills have not been fully evaluated for quality. Levels of functioning on these measures have yet to be established relative to those without intellectual disabilities and critically, there is very little evidence as to whether these skills are important in cognitive behavioural therapy process and outcome. We suggest that future research could focus on those constructs where there is preliminary evidence for utility such as recognising cognitive mediation and also on developing the concept of readiness perhaps by developing measures within the context of specific CBT interventions. Until this is done, clinicians should exercise caution in using these measures to assess readiness for cognitive behavioural therapy in people with intellectual disabilities.
Research in developmental disabilities, 2017 · doi:10.1016/j.ridd.2016.11.003