Visual Cognitive Behavioural Intervention: An Adaptation of Cognitive Behavioural Therapy for People with Intellectual Disability and Mental Health Difficulties

Author: Michelle Carney

Carney, Michelle, 2018 Visual Cognitive Behavioural Intervention: An Adaptation of Cognitive Behavioural Therapy for People with Intellectual Disability and Mental Health Difficulties, Flinders University, School of Education

Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact with the details.


Evidence indicates that people with intellectual disability (ID) are at greater risk of developing mental health difficulties (MHD) than the general population (Bennett, Pridding & Lawrence, 2004; Tonge, Einfeld & Mohr, 2010). The impact of MHD has significant costs for individuals, their families and the community. Currently, pharmacological treatment is the primary intervention used for adults with the dual disability (DD) of ID and MHD. To date, there has been limited research on the use of Cognitive Behaviour Therapy (CBT) for people with DD. Researchers have suggested adapted versions of CBT combining visual material with cognitive behavioural treatment may be an appropriate approach (Taylor, Lindsay & Willner, 2008). This study utilised a multiple baseline, single-case experimental design to investigate whether five adults with ID could (a) increase their self-management to (b) decrease their mental health difficulties using a visual CBI system. Social validation interviews considered the impact of the intervention in everyday life. Results demonstrated that visually adapted cognitive behavioural intervention (CBI) can be effective for some persons with DD. Randomisation tests indicated the overall result for participants was not statistically significant for reduction of mental health difficulty (p=0.76 providing a rank of 544 out of 720) or for self-management (p=0.45 providing a rank of 327 out of 720). However, clinical significance of the overall intervention was determined by calculation of a medium effect size of d-0.72 for reduction of mental health difficulty and an overall medium NAP effect size of 0.34 for self-management. Several factors impacted these findings, including frequency of use, functional level of disability, capacity and readiness, and commitment to the intervention. Implications for policy, practice and further research are also considered. This study highlighted the need for people with DD to be better represented in policy provision, so that resources can be directed towards their needs. At a practice level, it demonstrated the need for mental health training to be delivered to staff and parents and/or carers. There is also a need for further research to be conducted with persons with DD, including investigating suitable interventions for management of MHD. Without attention to these issues people with DD will continue to experience significant barriers to receiving appropriate and timely treatment for their MHD, which directly impacts on their day-to-day living and quality of life.

Keywords: Intellectual disability, mental health difficulties, dual disability, mental illness, cognitive behavioural intervention, cognitive behavioural therapy

Subject: Disability Studies thesis, Education thesis

Thesis type: Professional Doctorate
Completed: 2018
School: School of Education
Supervisor: Dr Julie McMillan