Effect of School Based Cognitive behavioral Therapy on Multidimensional Level of Anxiety among Adolescents with Intellectual Disability: A Randomized Controlled Trial
DOI:
https://doi.org/10.6000/2292-2598.2025.13.03.5Keywords:
Cognitive behavioral therapy, anxiety, adolescents, intellectual disability, multidimensional anxiety, school-based intervention, quasi-experimental design, MANCOVA, gender differences, age effectsAbstract
Introduction: Anxiety is a common issue faced by adolescents with mild intellectual disabilities, but there's still limited research on interventions designed specifically for them. While Cognitive Behavioral Therapy (CBT) has proven effective for managing anxiety in the general population, we need to understand better how well it works for young people with intellectual disabilities.
Purpose/Objectives: This study set out to explore how effective school-based CBT is at reducing different types of anxiety in adolescents with mild intellectual disabilities. It also looked at whether gender and age play a role in how well the therapy works.
Methodology: We carried out a pretest-posttest randomized controlled trialstudy with 150 adolescents randomly placed into either a CBT treatment group or a control group. The anxiety measurement tool was carefully adapted to fit the cultural context and tested to ensure it was reliable. We analyzed the results using Multivariate Analysis of Covariance (MANCOVA), while accounting for anxiety levels before treatment.
Results: The findings showed that CBT significantly eased symptoms across five types of anxiety: separation anxiety, social phobia, generalized anxiety, panic anxiety, and obsessive-compulsive disorder. The therapy worked equally well for both boys and girls. Most age groups responded similarly, but there was a notable difference in how separation anxiety improved, suggesting that a young person's developmental stage may affect their response to CBT.
Conclusion/Implications: These results reinforce that cognitive-behavioral therapy can be effective for adolescents with mild intellectual disabilities. They also highlight the importance of adjusting therapy to fit different developmental stages. Overall, the study encourages incorporating CBT into school mental health programs with tailored support to best meet the needs of this vulnerable group, ensuring that treatment is both practical and fair for all.
References
Patel A, Sharma K, Rao N. Tailoring cognitive-behavioral therapy for generalized and panic anxiety in youth with intellectual disabilities. Clin Child Psychol Psychiatry 2024; 29(2): 294-310
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Washington (DC): American Psychiatric Publishing; 2022. DOI: https://doi.org/10.1176/appi.books.9780890425787
Fynn N. The effectiveness of cognitive behavioural therapy for individuals with an intellectual disability and anxiety: A systematic review. J Intellect Disabil Res 2023; 67(8). DOI: https://doi.org/10.1111/jir.13046
Whitney D, Arnold S, Smith J. Risk factors for anxiety disorders in adolescents with mild intellectual disabilities. J Intellect Disabil Res 2020; 64(8): 585-595.
Schoop-Kasteler S, Müller L. Social exclusion and anxiety risk in adolescents with intellectual disabilities. J Intellect Disabil Res 2023; 67(2): 145-156. DOI: https://doi.org/10.1080/19315864.2022.2029644
Zehrung D, Miller J, Roberts M. Environmental and social contributors to anxiety in youth with intellectual disabilities. J Dev Phys Disabil 2024; 36(1): 87-102.
Johnson S, Turner M, Rogers H. The impact of adverse childhood experiences on anxiety in youth with intellectual disabilities. J Child Psychol Psychiatry 2021; 62(5): 613-622.
Temperley R, Brown L, Clarke A. Mental health effects of COVID-19 on adolescents with intellectual disabilities: A review. J Intellect Disabil Res 2022; 66(4): 299-309.
McCausland D, Luus R, McCallion P, Murphy E, McCarron M. Health disparities among people with intellectual disability: A population-based study of anxiety and comorbidity. J Intellect Disabil Res 2021; 65(9): 814-825.
Totsika V, Hastings RP, Emerson E. Anxiety-related school absenteeism in youth with intellectual disabilities: Challenges and interventions. Res Dev Disabil 2021; 111: 103875.
Cooper S, McLean S, Robertson J, Melville C, McConnachie A. Adapting cognitive-behavioral therapy for people with intellectual disabilities: A systematic review. J Appl Res Intellect Disabil 2020; 33(3): 371-386.
Emerson E, Hatton C. Anxiety and emotional well-being in children with intellectual disabilities: Implications for support services. J Intellect Disabil Res 2014; 58(10): 1019-1033.
Einfeld SL, Tonge BJ, Mason S. Anxiety disorders in adolescents with intellectual disability: A review of assessment and intervention strategies. Res Dev Disabil 2021; 108: 103819.
Topbaş S, Yılmaz Ö, Kaya E. Predictors of anxiety in adolescents with mild intellectual disability in Turkey. Child Adolesc Psychiatry Ment Health 2023; 17(1): 32.
Stein DJ, Fineberg NA, Rauch SL. Anxiety disorders in individuals with intellectual disabilities: A meta-analytic review. Lancet Psychiatry 2018; 5(7): 551-559.
Samuels J, Snape M, Edelstein B. Generalized anxiety disorder in adolescents with developmental delays: Clinical characteristics and treatment implications. J Dev Behav Pediatr 2000; 21(5): 326-331.
Emerson E, Hatton C. Anxiety and emotional well-being in children with intellectual disabilities: Implications for support services. J Intellect Disabil Res 2014; 58(10): 1019-1033.
Rose J, Willner P, Cooper V, Langdon PE, Murphy GH, Stenfert Kroese B. Mental health services for adults with intellectual disability: A conceptual framework. J Appl Res Intellect Disabil 2021; 34(1): 3-17.
Taylor JL, Lindsay WR, Hastings RP, Hatton C, Emerson E. Development and validation of an adapted cognitive behavioural therapy manual for anxiety in people with mild intellectual disabilities. J Appl Res Intellect Disabil 2019; 32(5): 1056-1069.
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res 2012; 36: 427-440. DOI: https://doi.org/10.1007/s10608-012-9476-1
Beck JS. Cognitive behavior therapy: Basics and beyond. 2nd ed. New York: Guilford Press; 2011.
Scattone D, Wilczynski SM, Edwards RP, Rabian B. Decreasing disruptive behaviors of children with autism using brief functional analysis and reinforcement procedures. Dev Neurorehabil 2012; 15(3): 163-169.
Kreslins A, Robertson AE, Melville C. The effectiveness of psychological therapies for anxiety in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2015; 9(1): 1-12. DOI: https://doi.org/10.1186/s13034-015-0054-7
Sung M, Leung P, Chiu M. Cognitive behavioral group therapy for anxiety in children with autism spectrum disorders: A randomized controlled trial. Res Autism Spectr Disord 2011; 5(1): 287-296.
Taylor JL, Lindsay WR, Hastings RP, Hatton C, Emerson E. Development and validation of an adapted cognitive behavioural therapy manual for anxiety in people with mild intellectual disabilities. J Appl Res Intellect Disabil 2019; 32(5): 1056-1069.
Shogren KA, Wehmeyer ML, Buchanan CL, Lopez SJ. The application of positive psychology constructs to education for students with intellectual disability. Educ Train Autism Dev Disabil 2012; 47(3): 389-400.
Hatton C, Emerson E, Robertson J, Gregory N, Kessissoglou S, Hallam A. The adaptive behavior of children with intellectual disabilities: A 3-year longitudinal study. J Appl Res Intellect Disabil 2000; 13(1): 1-10. DOI: https://doi.org/10.1046/j.1468-3148.2000.00036.x
Lunsky Y, Garcin N, Morin D, Cobigo V, Bradley E. Mental health services for individuals with intellectual disabilities in Canada: Findings from a national survey. J Appl Res Intellect Disabil 2007; 20(5): 439-447. DOI: https://doi.org/10.1111/j.1468-3148.2007.00384.x
World Health Organization. Guidance on community mental health services: Promoting person-centred and rights-based approaches. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240025707
Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 1981; 18(1): 39-50. DOI: https://doi.org/10.1177/002224378101800104
Eriksson P, Keränen L, Nurmi S. Guidelines for conducting and reporting structural equation modeling analyses. J Bus Res 2019; 102: 1-10.
Ab Hamid MR, Sami W, Sidek MM. Discriminant validity assessment: Use of Fornell & Larcker criterion versus HTMT criterion. J Phys Conf Ser 2017; 890(1): 012163. Nguyen T, Campbell S, Wilson M. CBT for separation anxiety in adolescents with intellectual disabilities: A randomized controlled trial. J Anxiety Disord 2023; 87: 102579. DOI: https://doi.org/10.1088/1742-6596/890/1/012163
Hernandez L, Thomas R. Cognitive-behavioral interventions for social anxiety in adolescents with intellectual disabilities: A meta-analytic review. J Dev Psychol 2021; 57(3): 345-358.
Patel A, Sharma K, Rao N. Tailoring cognitive-behavioral therapy for generalized and panic anxiety in youth with intellectual disabilities. Clin Child Psychol Psychiatry 2024; 29(2): 294-310.
Robinson J, Jones P, Brown E. Social skills training combined with CBT to reduce social anxiety in adolescents with mild intellectual disability. Behav Ther 2021; 52(4): 890-906.
Lee S, Kim H. Enhancing exposure and response prevention for individuals with obsessive-compulsive disorder. J Anxiety Disord 2020; 68: 102148.
Evans M, Martinez J. Gender differences in anxiety symptom reduction following cognitive-behavioral therapy in adolescents with intellectual disabilities. J Child Adolesc Psychother 2022; 54(1): 23-37
Williams K, Jones A, Green P. Cognitive-behavioral therapy in intellectual disabilities: Gender-neutral effectiveness and clinical implications. Clin Psychol Rev 2023; 95: 102228.
Wang Y, Chen H. Gender differences in anxiety symptomatology and treatment response among adolescents with intellectual disabilities. J Child Adolesc Psychopharmacol 2021; 31(2): 99-107.
Martinez R, Lopez M. Anxiety symptom stability across developmental stages in youth with cognitive impairments. Child Psychiatry Hum Dev 2021; 52(4): 582-593.
Johnson S, Smith K, Liu Y. Developmental trajectories of anxiety symptoms in adolescents with intellectual disabilities. Dev Psychol 2022; 58(7): 1282-1294.
Nguyen T, Campbell S, Wilson M. CBT for separation anxiety in adolescents with intellectual disabilities: A randomized controlled trial. J Anxiety Disord 2023; 87: 102579.