Dialectical Behaviour Group Therapy for Adults With Intellectual Disabilities
Condition: Intellectual Disability
MeSH terms: Intellectual Disability
Study type: Interventional

Summary: 
      To determine the feasibility and effectiveness of a RCT of an adapted DBT group delivered to
      individuals with ID and emotional dysregulation.
    

Detailed description: 
      1.2 Introduction

      This pilot intervention attempts to deliver and evaluate an adapted Dialectical Behavior
      Therapy (DBT) in group format. It is hypothesized that the strategies taught through this
      adapted modality will increase adults with dual diagnosis skills in managing difficult
      situations and their emotional reactions, thereby decreasing risk of crisis and ultimately
      demands placed on the mental health service system.

      1.3 Research Questions:

      Four key questions are addressed within this project:

        1. Can adults with intellectual disabilities learn and retain knowledge and skills
           presented in an adapted DBT group program?

        2. Do participants report positive increases in self-esteem and greater engagement in
           social situations following group participation?

        3. Are there decreases in signs and symptoms of mental health issues i.e. anxiety and
           depression and improvements in challenging behavior following completion of the
           dialectical behavior group therapy program?

        4. Does the program provide any benefit to caregivers? (e.g., are the able to de-escalate
           "crisis" situations quicker? Do caregivers feel it provides them tools to use when the
           client experiences distress? Does it lessen the caregivers stress?)

      2. Methods

      2.1 Research Design:

      Building upon the DBT adaptation work performed in the United States by Charleton and Dykstra
      (2011), it is necessary to further refine this intervention to increase its feasibility and
      viability as a treatment modality for the adult population with dual diagnosis. Using a
      mixed-methods approach within this current intervention allows exploration of DBT group
      therapy efficacy for adult with ID and emerging mental health/behavioural issues.

      2.2 Recruitment:

      Participants and caregivers will be invited to participate through the use of local
      advertising at partnering agencies and through expression of previous interest to clinicians
      involved. Information brochures/flyers will be distributed to individuals who have expressed
      an interest in counseling services and may or may not be receiving services at the time. Once
      participants have been identified they will have the opportunity to self-select a caregiver
      who they would like to assist them in the groups. The caregivers will receive a letter of
      information and consent form requesting their participation. All participants will be
      screened for eligibility and attainment of consent for involvement will include the use of a
      multi-modality approach.

      Agencies to be recruited: Ongwanada, Providence Care MHS DDCOT, Christian Horizons, Community
      Living Kingston, Developmental Services Leeds and Grenville (DSLG), Pathways

      2.3. Procedure

        1. Recruit

        2. Screen for Eligibility

        3. Obtain Written Consent (to be confirmed at Pre-Assessment)

        4. Complete Pre-Assessment and confirm informed Consent

           a. At acceptance into the study, individuals will be assigned alpha-numeric symbols on
           all data documents to ensure patient confidentiality and ensure individuals are
           unidentifiable to research team. Individuals will be encouraged to use first names only
           during group sessions and all identifiers (name tags, sign in sheets) will be destroyed
           at the end of the treatment trial.

        5. Once have n=12 participants, Randomize into Group A Intervention or Control

        6. Send info package with date/location of group

        7. Group A (Duration: 12 weeks)

           a. Divided into 3 modules (Distress Tolerance; Emotion Regulation; Interpersonal
           Effectiveness, with Mindfulness integrated into each

        8. Post Assessment of Group A Participants (n=6) and n=6 new participants

        9. Repeat steps 4 to 8 for Group B and C 12-week intervention and control groups.

      2.6 Analysis:

      Global and individual change question analyses will be conducted within a mixed method
      approach using SPSS 22. Measures of pre-post group findings will be evaluated using paired
      t-tests and ANOVAS, if applicable. Structured interview data will be analyzed using thematic
      analysis where qualitative themes will be summarized and consolidated into possible areas
      addressing curriculum content, therapeutic process, skill application and overall group
      therapy feedback
    

Intervention name(s): Adapted Dialectical Behaviour Therapy
Intervention type(s): Behavioral
Intervention description(s): 12 weekly sessions of DBT group therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment