Reductions in aggression and violence following cognitive behavioural anger treatment for detained patients with intellectual disabilities.
An 18-session CBT anger course cut physical assaults 56% in detained adults with mild-borderline ID.
01Research in Context
What this study did
Staff ran a cognitive behavioural anger treatment in a secure unit. Adults with mild or borderline intellectual disability attended 18 sessions, twice a week.
Before and after the course the team counted every aggressive act recorded on the ward.
What they found
Total aggressive incidents dropped 34%. Physical assaults fell even more, down 56% over the next year.
The gains held without extra medication.
How this fits with other research
Griffith et al. (2012) pooled 598 single-case studies and also found large reductions in challenging behaviour, but warned results vary by client and procedure. The new data add a full-year follow-up from a detained sample.
Petry et al. (2007) showed antidepressants help fewer than half of similar adults. Tonnsen et al. (2016) now give a non-drug option that worked for most participants, updating the toolkit.
Constantino et al. (2003) used mindfulness to erase aggression in one man for twelve months. The CBT group approach did not reach zero, yet cut assaults by half in many clients, showing another practical road.
Why it matters
If you work in forensic or secure ID services you now have an 18-session manual that halved physical assaults without pills. Add the anger module to your behaviour plan, track incident counts, and compare pre-post like the study did. The same cognitive steps can be paired with your existing reinforcement schedule to stretch gains across the day.
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02At a glance
03Original abstract
BACKGROUND: Aggression is a significant problem amongst people with intellectual disabilities (ID), particularly those residing in hospital settings. Anger is related to aggression in secure services working people with ID, and the effectiveness of psychological interventions in reducing anger has been demonstrated in this population. However, no studies have systematically examined whether levels of aggression reduce following anger treatment with people with ID detained in secure settings. METHOD: This programme evaluation study concerns individually delivered cognitive anger treatment delivered to 50 patients (44 men and 6 women) with mild to borderline ID, delivered twice weekly for 18 sessions in a specialist forensic hospital service. Aggressive incidents and physical assault data were obtained from records 12 months pre-treatment and 12 months post-treatment. RESULTS: Following completion of treatment, the total number of aggressive incidents recorded in patients' files fell by 34.5%, and the post-treatment reduction in the number of physical assaults was 55.9%. Analysis of the data partitioned into 6-month blocks over the 24-month study period showed that significant reductions in aggressive and violent incidents occurred in the assessment intervals following anger treatment. CONCLUSIONS: These findings reinforce the efficacy of cognitive behavioural anger treatment for detained patients with ID and histories of aggression; and despite its methodical limitations the study indicates the ecological validity of this treatment approach.
Journal of intellectual disability research : JIDR, 2016 · doi:10.1111/jir.12220