Debunking the myths about talking therapies
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Debunking the myths about talking therapies

Matt Broadway-Horner Nurse consultant in Mental health and learning disability, and a cognitive behavioural psychotherapist

People with learning disabilities can benefit from cognitive behavioural therapy to treat anxiety and depression

In my work as a nurse consultant in mental health and learning disability, and as a cognitive behavioural psychotherapist, I have seen positive and significant results in using cognitive behavioural therapy (CBT) to treat anxiety and depression in people with learning disabilities. I have found it to be effective and not redundant as some healthcare professionals believe.

Mental Health Practice. 25, 4, 8-8. doi: 10.7748/mhp.25.4.8.s5

Published: 07 July 2022

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Picture credit: iStock

Data show that 40% of people with learning disabilities have mental health problems – more than double the rate of mental health problems in the general population. But it is a postcode lottery to find talking therapy for someone who has a mild learning disability. The myth that they do not have the skills, understanding or ability to engage with talking therapies, such as CBT, still exists in health services and needs to be shaken off.

Studies have shown that people with mild learning disabilities do engage and benefit from therapy.

Talking therapies should be available for people with learning disabilities

Learning disability and mental health nurses need to make therapy an item on the menu of services to refer to, or join the many nurses who have trained for accreditation to the British Association for Behavioural & Cognitive Psychotherapies.

Talking therapies, such as CBT, are effective for many people with anxiety and, according to the UK government’s own Improving Access to Psychological Therapies programme, should be made available to people with learning disabilities.

I have seen in my own practice what a difference CBT can make. Sally* and Josy* are a same sex couple with learning disabilities. Sally has chronic epilepsy and the goal for Josy (her carer) was to feel confident in letting Sally be more independent. Josy had depression and following test for reception of grammar (TROG-2) assessment received 16 sessions of CBT. Her main problem was constant excessive worry for Sally, who has several big epileptic fits a week.

Five nurse-led interventions for people with a learning disability and a mental health condition

  • 1. Use language that is accessible – instead of ‘anxiety’ or ‘depression’ try words such as ‘sad’, ‘low’, ‘angry’, ‘nervous’ or ‘not well’

  • 2. Use the TROG-2 test to assess language abilities – this helps with engagement, delivery of nursing care and in how to talk in a way that is understood by the service user

  • 3. Use pictures and symbols – this can aid conversations about thoughts and feelings

  • 4. Change locations – some people do not like having therapy in a hospital or clinic and instead may want to play basketball or go to a café

  • 5. Use support workers – support workers can join in the therapy sessions and aid engagement in therapies

Worrying about ‘what if’ scenarios

Sally manages her epilepsy well and has strategies in place, but Josy felt she had to be ‘on call’ all the time. The constant worrying about ‘what if’ scenarios led to sleep loss, tearful moments and walking out on her job.

I used a CBT technique to break the problem down into negative automatic thoughts, self-defeating behaviours and unhelpful emotions. I asked questions such as: ‘How would you like to think, feel and behave differently?’ This led to us setting goals and rethinking Josy’s core beliefs.

I helped Josy to see that her negative automatic thoughts were untrue and that she is good enough. She had neglected her hobbies to care for Sally, so began to pick these up again. Sally enjoyed being on her own and they had more to talk about when they did meet up.

*The case discussed is anonymised and an amalgamate

Read more about test for reception of grammar (TROG-2) assessment at doi: 10.7748/ldp.23.1.14.s13

Find out more

NHS: Adult Improving Access to Psychological Therapies Programme tinyurl.com/NHS-adult-IAPT

Serfaty M, Broadway-Horner M, Hassiotis A (2022) The application of CBT for adults with learning disabilities. In Todd G, Branch R (Eds) Evidence-based Treatment for Anxiety Disorders and Depression: A Cognitive Behavioral Therapy Compendium. Cambridge University Press, Cambridge.

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