Cognitive Therapy Abilities in People with Learning Disabilities

Background There is a need to develop and adapt therapies for use with people with learning disabilities who have mental health problems. Aims To examine the performance of people with learning disabilities on two cognitive therapy tasks (emotion recognition and discrimination among thoughts, feelings and behaviours). We hypothesized that cognitive therapy task performance would be significantly correlated with IQ and receptive vocabulary, and that providing a visual cue would improve performance. Method Fifty‐nine people with learning disabilities were assessed on the Wechsler Abbreviated Scale of Intelligence (WASI), the British Picture Vocabulary Scale‐II (BPVS‐II), a test of emotion recognition and a task requiring participants to discriminate among thoughts, feelings and behaviours. In the discrimination task, participants were randomly assigned to a visual cue condition or a no‐cue condition. Results There was considerable variability in performance. Emotion recognition was significantly associated with receptive vocabulary, and discriminating among thoughts, feelings and behaviours was significantly associated with vocabulary and IQ. There was no effect of the cue on the discrimination task. Conclusion People with learning disabilities with higher IQs and good receptive vocabulary were more likely to be able to identify different emotions and to discriminate among thoughts, feelings and behaviours. This implies that they may more easily understand the cognitive model. Structured ways of simplifying the concepts used in cognitive therapy and methods of socialization and education in the cognitive model are required to aid participation of people with learning disabilities.     

Exit examination for sexual offenders

Sexual offender treatment has a large educational, as well as therapeutic, component. An exit examination was devised to measure retention of knowledge gained by the offender during the course of a community-based treatment program. The exit examination, which signifies transition from a 3 hr-per-week 2-year therapy program to a once-per-month follow-up program, was structured to sample the domain of the offender's new learning. The sample was culled from elements of six major topic categories—relationships, judgment, understanding of feelings, identification of appropriate and inappropriate control techniques, recognition of damage done by victimizing behaviors, and recognition of patterns of deviance—in order to provide the therapist with an understanding of how much information was supplied to and retained by the offender. In addition, two other topic categories—thinking errors and tactics to avoid change—were addressed in their entirety in the examination because of their importance in providing an external view of the offender's recognition and recall of his ways of thinking that contributed to his deviance.     

Are inappropriate or dysfunctional feelings in rational-emotive therapy qualitative or quantitative?

A reply is made to Cramer and Fong's (1991) findings that inappropriate or dysfunctional feelings, as hypothesized in rational—emotive theory, are quantitatively rather than qualitatively different from appropriate or functional feelings.     

Future-Event Schemas: Automaticity and Rumination in Major Depression

We examined the proposition that individuals with major depression make predictions about future events relatively automatically and pessimistically, reflecting use of a future-event schema, while they also ruminate about the future. Depressed participants and nondepressed controls indicated whether or not various positive and negative future events would happen to them or to an average other—either under a concurrent attentional load or no such load—while their response latencies were assessed. As hypothesized, depressives showed relatively greater automaticity in their predictions than did nondepressives, and a lack of optimism as well. More specifically, depressives showed a smaller increase in response latency due to the introduction of the attentional load than did nondepressives, suggesting relatively greater processing efficiency, and they also predicted reliably fewer positive events. Indeed, depressives also reported ruminating more about the future based on a recent distressing life event. Overall, the results extend research on future-event schemas and automaticity (Andersen, Spielman, & Bargh, 1992) from moderate to major depression and establish a link with future-event rumination.     

Depression,Social Context and Cognitive Behavioural Therapy for People who have Intellectual Disabilities

Background It is striking that although cognitive behavioural therapy was developed to treat depression in the general population, there remains a paucity of research concerning its application to people with intellectual disabilities. Recent research points to the importance of understanding people's distress in the context of their particular life experience. Areas to be addressed This paper examines how the life experience of people with intellectual disabilities may influence the nature of their self‐perceptions and their vulnerability to depression. In addition to considering the impact of experience on the content of participants’ self‐perceptions, evidence concerning the mediating role played by cognitive factors in the genesis and maintenance of depression is also reviewed. Conclusions These strands of research are discussed in the light of existing CBT models of depression, along with potential adaptations of interventions for people with intellectual disabilities.     

Dysphoric deficits in interpersonal standards,self-efficacy,and social comparison

This study examined the role of personal standards, self-efficacy expectations, and social comparison in depression. Nondepressed and dysphoric subjects estimated their own interpersonal standards and efficacy, as well as the standards and efficacy of their peers. Contrary to common theory, dysphoric subjects set lower —not higher — goals than did nondepressed subjects. As expected, nondepressed subjects made more favorable social comparisons than did dysphoric subjects. Nondepressed subjects made more positive judgments for themselves than for their peers, whereas dysphoric subjects made similar judgments for self and other. Results are discussed in terms of their implications for the role of goals and social comparison processes in depression. In particular, it is suggested that, in response to a gap between standards and performance expectations, one might raise expectations, lower standards, or maintain both standards and expectations. The latter two are likely to be associated with depression. Not only are evaluations made in absolute terms, but they are also made by social comparison, especially when evaluation concerns one's goals. This study suggests that dysphoric people no longer judge that they are superior to their peers, which might hinder them in mobilizing their efforts. The authors are grateful to Al Bandura, Nancy Cantor, Philip Kendall, and two anonymous reviewers for their helpful comments on prior drafts of this paper. Research for this paper was funded, in part, by a National Science Foundation Fellowship to the first author.     

Cognitive Therapy for Bipolar Illness—A Pilot Study of Relapse Prevention

Twenty-five (25) bipolar patients taking mood stabilizers and yet still relapsing were recruited into a randomized controlled pilot cognitive therapy study. All subjects were taking mood stabilizers on recruitment. The control group had treatment as usual—that is, the usual outpatients and multidisciplinary team input. The therapy group received between 12 and 20 sessions of cognitive therapy adapted for bipolar illness in addition to treatment as usual. Therapy consisted of a relapse prevention approach and lasted 6 months. Independent assessments showed that the therapy group had significantly fewer bipolar episodes, higher social functioning, and better coping strategies for bipolar prodromes. Furthermore, there was evidence of less fluctuation in symptoms of mania and depression, less hopelessness, and better medication compliance from subjects' monthly self reports. There was no evidence that improvement in the therapy group was due to more medication being prescribed. In fact, there were significantly less neuroleptics being prescribed in the therapy group for the 6 months after therapy. A further study with a larger sample size and longer follow-up period is warranted.     

Regional gray matter variation in male-to-female transsexualism

Gender identity—one's sense of being a man or a woman—is a fundamental perception experienced by all individuals that extends beyond biological sex. Yet, what contributes to our sense of gender remains uncertain. Since individuals who identify as transsexual report strong feelings of being the opposite sex and a belief that their sexual characteristics do not reflect their true gender, they constitute an invaluable model to understand the biological underpinnings of gender identity. We analyzed MRI data of 24 male-to-female (MTF) transsexuals not yet treated with cross-sex hormones in order to determine whether gray matter volumes in MTF transsexuals more closely resemble people who share their biological sex (30 control men), or people who share their gender identity (30 control women). Results revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women. However, MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity.     

Experimental and Psychotherapeutic Demand Characteristics and the Cognitive Therapy Rationale: An Analogue Study

In cognitive therapy (CT) for depression, the treatment rationale is presented in lay terms as an ABC sequence such that A represents a recent event, B represents automatic thoughts about the event, and C represents the resulting affective response. The role of demand characteristics in rationales such as this has been extensively explored in research on systematic desensitization but little has been done with regards to CT. This study investigated the influence of the CT rationale and an alternative rationale on participants' self-reported thoughts and feelings in response to images. While the CT rationale assumes that cognition precedes and causes affect, the alternative rationale flipped the terms of ABC into an ACB theory in which affect is assumed to precede and cause cognition. We found that both rationales influenced reporting: Those who received the ABC rationale reported that more automatic thoughts were evoked first, while those who received the ACB rationale reported that more automatic feelings were evoked first. The rationales also were more influential on high arousal images and less influential for participants with previous therapy experience. Results are discussed in terms of experimental demand characteristics (conscious compliance) and psychotherapeutic demand characteristics (nonconscious changes in clinically relevant behavior) and implications for therapy.     

Sexuality and aged women in nursing homes

Despite all evidence that sexuality in all its forms is essential to health and identity, society continues to make the aged sexually invisible; some aged people continue to suffer guilt for having sexual feelings or acting sexually, and many aged people internalize the misconception that they are asexual. Aged women, in the main, have had their sexuality defined as being dependent on males and youthful beauty. Pfeiffer, cited in Reinzo,¹¹ points out that as we age “sexual needs may not only be continuing but actually heightened due to losses in other areas of life.” Elderly women ache for closeness, touch, and intimacy, but may be afraid to reach out to other women in this way. They have often lost control over much of their lives, and the only pleasure available to them may be self-pleasuring and fantasy, but guilt, lack of privacy, and fear of being “caught” remove this option. Their self-image and self-esteem are diminished. Women reacting to a definition imposed on them forfeit the pleasures of wholeness. The solution will be found when they assert their rights as individuals and claim their bodies as their own. Before elderly women can feel and be treated as fully human, it must be recognized that to be fully human is to be fully sexual, whatever our age.Gerontologic nurses who hold ageist views of elderly women's sexuality are not providing holistic care. It is not possible to provide care that aims at maximizing potential, independence, and control, while denying or ridiculing a “core” aspect of identity. It is not enough to care for the body; recognition of the whole person, including sexuality, must be reflected in nursing care.