The effectiveness of cognitive behavioural therapy for individuals with an intellectual disability and anxiety: a systematic review.
CBT can reduce anxiety in clients with mild ID when you add visuals, modelling and run smaller groups—but evidence is still thin.
01Research in Context
What this study did
Dai et al. (2023) looked at every paper they could find on CBT for anxiety in people with intellectual disability. They kept only nine small studies. All used pictures, role-play, or small groups to make CBT easier to follow.
The team asked one question: does CBT lower anxiety for clients with mild ID? They rated the quality of each study and noted what helpers changed so clients could stay engaged.
What they found
CBT did cut anxiety, but the proof is thin. Every study had few people and weak designs. The best trials added visuals, modelling, and ran groups of three to five clients.
No study showed lasting change after sessions stopped. The authors say the idea is hopeful, but we need bigger, tighter trials before claiming it works.
How this fits with other research
Peters et al. (2013) talked to clients who had the same mild ID level. Clients liked warm therapists and short-term gains, yet they feared relapse once support ended. Dai et al. (2023) now shows that fear is real—no trial tracked long-term maintenance.
Johnson et al. (2009) argued CBT must fit real-life hardship, not just “fix thoughts.” The nine studies in Dai et al. (2023) followed that advice: they used real-life photos, social stories, and in-vivo practice. The new review turns the old idea into a list of concrete tweaks you can use Monday.
Taylor et al. (2017) found strong sleep gains with pure behavioural plans for adults with ID. Dai et al. (2023) finds weaker, shakier gains for CBT on anxiety. The gap warns us: behaviour alone can nail sleep, but anxiety needs added cognitive supports and far better data.
Why it matters
You can start using CBT for anxious clients with mild ID, but treat it like a pilot. Add visuals, keep groups tiny, and check progress weekly. Until larger trials arrive, pair CBT with booster sessions and track anxiety monthly to catch any slide-back early.
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02At a glance
03Original abstract
INTRODUCTION: Individuals with intellectual disability (ID) are at higher risk of experiencing difficulties with anxiety than the general population. However, there are major barriers for individuals to receive appropriate services. There is a growing understanding of the importance of developing appropriate psychological interventions for this group. The objective of the current review was to systematically evaluate the findings of studies investigating the effectiveness of cognitive behavioural therapy (CBT) for individuals with ID and anxiety. Another aim was to explore which adaptions to CBT and treatment components were currently being utilised within the field. METHOD: The electronic databases of CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection and Scopus were searched to identify relevant studies. The methodological quality of these studies was assessed using established quality assessment tools by the National Institutes of Health for pre and post studies and case series. RESULTS: Nine studies were included in this systematic review, all of which reported improvements in anxiety severity for some participants (25%-100%; N = 60) following CBT. Only three studies reported moderate effect sizes for CBT interventions on anxiety for individuals with ID. DISCUSSION AND CONCLUSIONS: There is emerging literature supporting the effectiveness of CBT for individuals with mild ID. Findings highlight that CBT for individuals with anxiety and mild ID, including cognitive components, may be feasible and tolerable. While the field is gradually receiving more attention, there are significant methodological flaws present, which limit the conclusions that can be drawn regarding the effectiveness of CBT for individuals with ID. However, there is emerging evidence for techniques such as cognitive restructuring and thought replacement and modifications such as visual aids, modelling and smaller groups based on this review. Future research is warranted to investigate whether individuals with more severe ID can benefit from CBT, as well as further exploring what are the necessary components and modifications.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.13046