1. CBT Group Programme for Adults with Intellectual with Disabilities presenting with Generalised Anxiety: Clinical Applications and Implications Dr Sabiha Azmi - Lead Clinical Psychologist & Nadia Begum- Assistant Psychologist PLD Services, BCHC NHS Trust 27 th March 2014. FLD Conference. Llandudno-Wales

2. Aims of Presentation  Introduction and Background  Procedure  Group Content  Results  Evaluation  Implications and Applications  Future Groups

3.  Generalised Anxiety -General Population prevalence at 2.5% (Bailey & Andrews 2003);  In PLD estimated to be at 16.4% (Cooper, 1997);  Challenges to detecting anxiety in PLD populations;  Diagnostic overshadowing (Reiss & Sysko, 1993);  PLD more prone to anxiety due to poor physical health problems, pain, lack of control over events in their lives (Lindsay, 1994). Introduction

4.  Good evidence base on the effectiveness of both individual/group based CBT programmes for GAD in general population (Roth & Fonagy, 96).  In PLD data is limited, though use of CBT with children and adults with LD has shown positive and beneficial outcomes (Dush et al, 89; Kroese et al, 2004).  Limited access to CBT approaches for PLD.  Groups offer a unique set of therapeutic processes separate from those offered at an Individual level. Why CBT and group Intervention?

5. Anxiety Model Trigger Stimulus (internal/external) ‏ Perceived Threat Body Sensations Interpretation of sensations as catastrophic Apprehension Clark (1986) ‏

6. Measures Used  Limited range of measures for PLD;  Self rating scales (Glasgow Anxiety Scale (GAS- ID)validated on PLD;  Levels of perceived competence and control impact on experience of anxiety (Barlow et al, 1996).  Emotion recognition thought to impact on therapy outcome (Dagnan et al, 1997).

7. Participant Referrals 15 participants over 3 group interventions. 12 males and 3 females aged 19-60 years Referrals received from wider MDT professionals. Criteria:-  Mild-Moderate Learning Disability  Recognised General Anxiety (GA) ‏  Basic speech and language communication  Identified person to support with homework tasks and transport.

8. Measures:  British Picture Vocabulary Scale (BPVS):  Glasgow Anxiety Scale-ID:  Emotion Recognition (adapted Dagnan) ‏  Perceived Competencies: Participant  Perceived Competencies: Carer

9. Group Structure:  CBT approach  Participants attended 2 hour sessions once a week for 10-12 consecutive weeks.  Two-Three Facilitators (Psychology and Nursing) ‏  Held at a health centre  Weekly homework tasks and monitoring of anxiety.  Personalised Plans

10. Group Content 1. Recognise triggers of stress and anxiety 2. Basic understanding of the Anxiety Model (Clarke, 1986) ‏ 3. Recognise psychological and physiological signs of anxiety 4. Explore current thought patterns and cognitions related to anxiety 5. Challenge negative cognitions, offer alternatives

11. Group Content Cont. u Role plays, 3 rd person perspectives, group discussions using case scenarios. u Practice relaxation techniques u Discuss current coping strategies and develop new coping styles u Develop tailored Anxiety Management Plans. u Put together personalised relaxation CDs. u Repeated Measures

12. Making The Group Accessible  Use of visual aids  Repeating information  Group Discussions: Sharing experiences  Group Dynamics: Engagement, turn taking, attendance  Involving Carers  Flexible session plans

13. Negative Cognitions I CANT DO IT I CANT COPE! I’LL BE ALONE…NO ONE CARES IM DIFFERENT IF I AVOID GOING I’LL BE OK I WILL DIE NOBODY LIKES ME PEOPLE WILL LAUGH AT ME

14. Positive Cognitions I COPED LAST TIME…I CAN COPE AGAIN ANXIETY IS NORMAL…I CAN DEAL WITH IT A DROP OF RAIN NEVER HURT ANYONE THERE IS NOTHING WRONG WITH ME THERE ARE LOTS OF PEOPLE WHO CARE ABOUT ME I NOW KNOW HOW TO RELAX

15. Results: Glasgow Anxiety Scale-ID Pre and post measures are illustrated below: Complete measures for 12 participants. 8 showed an improvement (reduced anxiety). 4 showed a slight increase in anxiety levels.

16. Emotion Recognition Ability to recognise 5 emotions from facial expressions (Happy, Sad, Angry, Worried, and Frightened) ‏ All showed an improvement in emotion recognition ability. Four participants consistently scored lower in the GAS-ID. One participant had increased emotion recognition and scored higher on the GAS-ID We have incomplete measures for one participant.

17. Perceived Competency-Participant 6 participants showed an improvement in perceived competency after group intervention 4 showed no change 2 showed reduced competency (consistent with GAS-ID scores) ‏

18. Benefits of Group Format  Opportunities to discuss and share experiences  Observational learning, role plays, and rehearsal of information  Social reinforcement and peer support  Some people may feel more comfortable in a group setting compared to individual support.

19. Difficulties With Group Interventions  Poor attendance  Not always resource efficient  Conflicts within groups  Group settings may create anxiety for some individuals  Incomplete homework diaries

20. Participant Evaluation of Group I ENJOYED MEETING NEW PEOPLE I LIKED THE RELAXATION PART I MET OTHER PEOPLE WHO HAVE ANXIETY TOO IT WAS GOOD FUN I NOW KNOW WHEN I AM ANXIOUS AND WHAT TO DO THE FACILITATORS MADE ME FEEL WELCOME IT HELPED TO DESIGN MY PLAN I TRY TO HAVE POSITIVE THOUGHTS I WOULD LIKE TO DO IT AGAIN