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Soles of the Feet: A mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness
Abstract
Uncontrolled low frequency, high intensity aggressive behavior is often a barrier to community living for individuals with developmental disabilities. Aggressive behaviors are typically treated with psychotropic medication, behavioral interventions or their combination; but often the behaviors persist at a level that is problematic for the individual as well as care providers. We developed a mindfulness-based, self-control strategy for an adult with mental retardation and mental illness whose aggression had precluded successful community placement. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. After practice he applied this technique fairly consistently in situations that would normally have elicited an aggressive response from him. The data show that he increased self-control over his aggressive behaviors, met the community provider's requirement for 6 months of aggression-free behavior in the inpatient facility before being transitioned to the community, and then successfully lived in the community without readmission to a facility. No aggressive behavior was seen during the 1-year follow-up after his community placement. Mindfulness-based intervention may offer a viable alternative to traditional interventions currently being used to treat behavioral challenges in children and adults with mild mental retardation.
... Soles of the Feet (SoF; Felver & Singh, 2020) is a brief, simple, structured, individually administered MBP that promotes self-awareness and teaches a self-control strategy to reduce disruptive behavior. The SoF protocol involves directing attention to a neutral part of the body (i.e., the soles of the feet) when aggression-triggering emotions or thoughts occur (Singh et al., 2003). SoF may have particular utility in school settings because it is focused on observable behaviors, effective with individuals with and without intellectual disabilities, easy to use across a variety of settings and contexts, and short-term and resource-non-intensive (lasting only 5 days), which makes it time-and cost-efficient (Felver et al., 2014). ...
... SoF was originally developed as a brief treatment for aggression in adults with developmental and psychiatric disabilities (Singh et al., 2003), and has also been effective in reducing aggressive and disruptive behavior in adults with developmental and psychiatric disabilities in a randomized controlled community trial (Singh et al., 2013), youth with conduct disorder in a school setting (Singh et al., 2007), adolescents with ASD in home and community settings (Singh et al., 2011a, b), adolescents with Prader-Willi syndrome in home and community settings (Singh et al., 2017a), individuals with Alzheimer's disease in a home setting (Singh et al., 2019), and Chinese adolescents with ASD in the home setting (Ahemaitijiang et al., 2020). A recent meta-analysis of 15 high-quality single-case research design clinical trials of SoF found that the protocol is moderately effective at Content courtesy of Springer Nature, terms of use apply. ...
... These results extend previous research on SoF in schools with both general and special education students (Felver et al., 2014(Felver et al., , 2017 to students with ASD, as well as bridge the research between SoF in adolescents and adults with ASD in non-school settings (Singh et al., 2003(Singh et al., , 2007(Singh et al., , 2011a(Singh et al., , b, 2013 and SoF in schools with non-ASD populations (Felver et al., 2014(Felver et al., , 2017. Furthermore, since most of the SoF literature has focused on the effectiveness of SoF in adults and adolescents, this research helps to extend these results to elementary-age children. ...
Objectives
To examine whether a brief mindfulness-based program (MBP) reduces observable challenging behavior in elementary students with autism spectrum disorder (ASD), when delivered one-on-one by a natural intervention agent.
Methods
Using a concurrent multiple baseline design, we examined whether Soles of the Feet (SoF) reduces challenging behavior in children with ASD when delivered by a school staff member in an elementary school setting. Three 9-to-10-year-old children with ASD, presenting with high rates of challenging behavior and IQ scores above 85, were recruited from a private special education school. The school mental health counselor (MHC) was trained on SoF over 8 h and deemed competent after receiving 100% on a fidelity checklist. Following baseline data collection, the MHC implemented SoF across five 20–30-min sessions, one-on-one with each student, and fidelity of implementation was monitored.
Results
Results found that, from baseline to post-treatment, all three students showed a stable and decreasing trend of observed challenging behavior in individually identified problematic contexts, representing a strong effect (NAP = 100%). Teacher social validity ratings indicated the acceptability, feasibility, and effectiveness of SoF for use in school settings, while two of three students indicated that the treatment was socially valid. Although teacher-rated overall challenging behavior did not decrease for all students, SoF reduced individually defined observable challenging behavior for each student in specific targeted contexts.
Conclusions
MBPs may provide a way for children with ASD to self-manage challenging behaviors, which may ameliorate the need for more intensive individual interventions in schools.
... We examined 30 studies that evaluated the effects of components of ACTraining on a wide range of behavioral targets with individuals with ASD/DDs, their parents, and their staff. Overall, according to a PND analysis, ACTraining components that were found to be minimally effective and above for improving target behaviors included present moment attention/mindfulness (e.g., Brazeau et al., 2017;Chancey et al., 2019;Raulston et al., 2019;Singh et al., 2003;Singh et al., 2004;Singh, Lancioni, Winton, Curtis, et al., 2006;Singh, Lancioni, Winton, Adkins, et al., 2007;Singh, Lancioni, Manikam, et al., 2011;Singh, Lancioni, Singh, et al., 2011b;Singh, Lancioni, Singh, et al., 2011c;Singh et al., 2014;Singh et al., 2015;Singh et al., 2017;Singh et al., 2018) and intervention packages that used multiple components of ACTraining (e.g., Castro et al., 2016;Gould et al., 2017;Little et al., 2020;Pingo et al., 2019;Singh, Lancioni, Winton, et al., 2011d;Singh et al., 2013;Szabo, 2019). It should be noted that the PND analysis compared baseline with intervention data only and did not include generalization and maintenance data because not all studies measured generalization and maintenance. ...
... A variety of intervention delivery formats, including individual (e.g., Brazeau et al., 2017;Gould et al., 2017;Little et al., 2020;Singh et al., 2003;Singh et al., 2004;Singh et al., 2018;Singh, Lancioni, Winton, Adkins, et al., 2007;Singh, Lancioni, Winton, et al., 2011d;Szabo, 2019), group (e.g., Castro et al., 2016;Chancey et al., 2019;Pingo et al., 2019;Singh, Lancioni, Winton, Curtis, et al., 2006;Singh et al., 2013;Singh et al., 2015), pyramidal (e.g., Singh et al., 2014;Singh et al., 2017;Singh, Lancioni, Manikam, et al., 2011;Singh, Lancioni, Singh, et al., 2011b;Singh, Lancioni, Singh, et al., 2011c), and telehealth (e.g., Singh et al., 2017;Singh, Lancioni, Singh, et al., 2011c), was also found to be efficacious; thus, clinicians have o p t i o n s f o r h o w t o i m p l e m e n t c o m p o n e n t s o f ACTraining. Variables to consider when choosing such formats include the contextual variables associated with the individuals needing to be trained, as there are advantages and disadvantages of each. ...
... Another positive outcome of the reviewed literature is that 17 (57%) studies measured maintenance, and in all cases, the results maintained, including in nine studies that assessed maintenance a year or more after the formal intervention phase (e.g., Singh et al., 2003;Singh et al., 2017;Singh, Lancioni, Manikam, et al., 2011;Singh, Lancioni, Singh, et al., 2011b;Singh, Lancioni, Singh, et al., 2011c;Singh, Lancioni, Winton, Adkins, et al., 2007;Singh, Lancioni, Winton, et al., 2011d;Singh, Lancioni, Winton, et al., 2011e;Singh, Lancioni, Winton, Fisher, et al., 2006). This is particularly interesting because in some cases, PND scores suggested that the interventions were below minimally effective (i.e., Singh, Lancioni, Winton, et al., 2011e;Singh, Lancioni, Winton, Fisher, et al., 2006). ...
Acceptance and commitment therapy (ACT) is a contemporary approach to dealing with unhelpful private events and improving psychological flexibility (Hayes et al., 2006) that is often used in psychotherapy (Szabo, 2019). Nonpsychotherapeutic uses of ACT have been referred to as acceptance and commitment training (ACTraining; Moran, 2011, 2015; Szabo, 2019), which refers to the use of one or more of six processes—present moment attention or mindfulness, values clarification, committed action, self-as-context, defusion, and acceptance (Hayes et al., 2006)—implemented outside of psychotherapeutic settings. There has been a recent increase in interest in ACTraining within the behavior-analytic community, which has led behavior analysts to question whether ACTraining is useful to the field of applied behavior analysis (ABA) and whether it is within the scope of practice of behavior analysts. Tarbox et al. (2020) proposed that the use of ACTraining is within the scope of practice of behavior analysts and aligns with the seven dimensions of ABA as outlined by Baer et al. (1968). The purpose of the current study was to provide a systematic review of single-case research designs that measure the behavioral effects of ACTraining components conducted with
individuals with autism spectrum disorder or developmental disorders, their parents, and their staff, and to inform clinicians and researchers about what variables have been evaluated and what gaps still exist.
... Bisher gibt es wenige Studien, die die Wirksamkeit von achtsamkeitsbasierten Interventionen bei Menschen mit intellektueller Beeinträchtigung untersucht haben. Ein Großteil der Interventionsstudien untersuchte die Wirksamkeit des Programms "Soles of the Feet" von Singh et al. [22,23]. Durch das Training sollen Teilnehmende ihren Ärger und ihre Aggressionen lernen zu kontrollieren, indem sie ihre Aufmerksamkeit von negativen Gedanken, Ereignissen oder Situationen zu neutralen Körperteilen lenken [22,23]. ...
... Ein Großteil der Interventionsstudien untersuchte die Wirksamkeit des Programms "Soles of the Feet" von Singh et al. [22,23]. Durch das Training sollen Teilnehmende ihren Ärger und ihre Aggressionen lernen zu kontrollieren, indem sie ihre Aufmerksamkeit von negativen Gedanken, Ereignissen oder Situationen zu neutralen Körperteilen lenken [22,23]. In einer Review-Studie mit 18 Studien (v. ...
Zusammenfassung
Hintergrund
Menschen mit intellektueller Beeinträchtigung sind vulnerabler für psychische Erkrankungen als die Allgemeinbevölkerung. Bisher gibt es nur wenig Forschung, inwieweit achtsamkeitsbasierte Interventionen bei Menschen mit intellektueller Beeinträchtigung zur Gesundheitsförderung beitragen können. Ziel der Studie ist die Entwicklung und Evaluation einer Achtsamkeitsintervention für Personen mit intellektueller Beeinträchtigung.
Methodik
Es wurde eine achtsamkeitsbasierte Gruppenintervention durchgeführt und anhand eines Kontrollgruppendesigns mit Prä- und Postinterviews evaluiert. Die aktive Kontrollgruppe umfasste eine Musikintervention. Die Interventionen umfassten jeweils 8 Sitzungen. Es nahmen insgesamt 21 Personen mit leichter und mittelgradiger intellektueller Beeinträchtigung teil. Im Rahmen der Interviews wurden Angst- und Depressionssymptome, Aggressivität, Besorgtheit und Anspannung erhoben. Zum Beginn und Ende der jeweiligen Sitzung wurde das Wohlbefinden der Teilnehmenden erfasst.
Ergebnisse
Die Achtsamkeitsintervention im Gruppensetting führte über die Zeit zu einer signifikanten Reduzierung von Angst- und Depressionssymptomen und Aggressivität, während in der aktiven Kontrollgruppe die Aggressivität und Anspannung abnahm. Darüber hinaus zeigte sich deskriptiv für die Interventionsgruppe ein gleichbleibendes Wohlbefinden während der Sitzungen. Dagegen ergab sich für die aktive Kontrollgruppe im Mittel eine positive Veränderung des Wohlbefindens.
Schlussfolgerung
Achtsamkeitsbasierte Interventionen sollten im Rahmen einer multimodalen Behandlung bei psychischen Erkrankungen bei Personen mit intellektueller Beeinträchtigung einbezogen werden. Eine aktivere Gestaltung der Sitzungen und die Verwendung von Musik bei Achtsamkeitsinterventionen erscheinen lohnenswert.
... This enables the person to stop and choose how to react to the event, situation or thought. The steps involved in teaching the Soles of the Feet technique and examples of role-play originally outlined in Singh et al. (2003) are expanded upon in a recently published manual (Singh, 2012). Cost-benefit (USA setting) has also been evaluated (Singh et al., 2008a). ...
... Several studies have shown positive outcomes when the Soles of the Feet technique has been taught to people with intellectual disabilities (either as a standalone intervention or in conjunction with other strategies) to help control physical and verbal aggression (Singh et al., 2003(Singh et al., , 2007a(Singh et al., , 2011a, reduce smoking and weight (Singh et al., 2008b(Singh et al., , 2011b(Singh et al., , 2011c(Singh et al., , 2014 and to modify inappropriate sexual arousal amongst adult offenders (Singh et al., 2011d). ...
... Mindfulness didefinisikan sebagai kualitas kesadaran diri (consciousness), yang mencakup keadaan sadar terjaga (awareness) dan perhatian (attention) (Brown & Ryan, 2003). Dari hasil penelitian yang dilakukan, mindfulness mampu untuk mengurangi agresivitas pada remaja (Schonert-Reichl & Lawlor, 2010;Singh, Wahler, Adkins, & Myers, 2003). ...
... Hasil penelitian yang dilakukan mendukung penelitian terdahulu yang menyatakan bahwa mindfulness berpengaruh terhadap agresivitas (Singh, et al., 2003). Semakin tinggi mindfulness pada individu maka semakin rendah agresivitas pada diri individu tersebut. ...
Mindfulness berpengaruh terhadap agresivitas pada remaja. Pengaruh tersebut diduga terjadi secara tidak langsung melalui regulasi emosi. Tujuan dilakukannya penelitian ini adalah untuk mengetahui pengaruh tidak langsung variabel mindfulness terhadap agresivitas melalui regulasi emosi. Penelitian ini melibatkan 115 orang narapidana yang ada di Lembaga Pembinaan Khusus Anak (LPKA) Kelas I Kota Blitar. Pengambilan data menggunakan instrumen Toronto Mindfulness Scale (TMS) untuk mengukur mindfulness, Difficulties in Emotion Regulation Scale (DERS-16) untuk mengukur kesulitan dalam meregulasi emosi dan Agression scale untuk mengukur agresivitas. Hasil penelitian menunjukkan bahwa mindfulness dan regulasi emosi berpengaruh secara signifikan terhadap agresivitas. Mindfulness berkontribusi mempengaruhi regulasi emosi, dan secara tidak langsung mindfulness berpengaruh terhadap agresivitas melalui regulasi emosi dengan nilai koefisien lebih kecil daripada pengaruh langsung.
... 2009; Kabat-Zinn, 2009) and mindfulness-based cognitive therapy (MBCT; Teasdale et al., 2000) are commonly used MBIs found to significantly improve outcomes such as depressive symptoms, anxiety, stress, and physical functioning for patients with cancer, chronic pain, cardiovascular disease, somatic diseases, and depression (Duarte et al., 2019). There are other variations of MBIs that have also shown a positive impact on health, such as mindfulness-based positive behavior support training (MBPBS; Singh et al., 2015), meditation on the soles of the feet (a component of MBPBS; Felver & Singh, 2020;Singh et al., 2003), and mindfulness-based art therapy (MBAT; Prioli et al., 2017). With respect to the mental health challenges resulting from the COVID-19 global pandemic (Yao et al., 2020), meditation can serve as a protective factor against psychological distress (Conversano et al., 2020) and has been associated with more engagement in COVID-19 preventive health behavior (Haliwa et al., 2020). ...
... About the specific types of MBIs included in the study, MBSR (Irving et al., 2009;Kabat-Zinn, 2009), MBCT (Teasdale et al., 2000), MBPBS (Singh et al., 2015), meditation on the soles of the feet (Singh et al., 2003), MBAT (Prioli et al., 2017), and non-standarded formats of MBIs (Müller et al., 2019;Saha et al., 2020;van Dongen et al., 2016) were presented in the analyses. ...
Objectives
This study includes a systematic review of cost-effectiveness analyses (CEAs) and cost–benefit analyses (CBAs) of mindfulness-based interventions (MBIs).MethodsA literature search was conducted using PubMed, Web of Science, JSTOR, and CINAHL for studies published between January 1985 and September 2021, including an original cost-related evaluation of an MBI. A qualitative assessment of bias was performed using the Drummond checklist.ResultsTwenty-eight mindfulness-based intervention studies (18 CEAs and 10 CBAs) were included in this review. Mindfulness-based stress reduction (MBSR) was less costly and more effective when compared with the usual care of cognitive behavioral therapy among patients with chronic lower back pain, fibromyalgia, and breast cancer. MBSR among patients with various physical/mental conditions was associated with reductions in healthcare costs. Mindfulness-based cognitive therapy (MBCT) was also less costly and more effective than the comparison group among patients with depression, medically unexplained symptoms, and multiple sclerosis. MBCT’s cost-effectiveness advantage was also identified among breast cancer patients with persistent pain, non-depressed adults with a history of major depressive disorder episodes, adults diagnosed with ADHD, and all cancer patients. From a societal perspective, the cost-saving property of mindfulness training was evident when used as the treatment of aggressive behaviors among persons with intellectual/developmental disabilities in mental health facilities.Conclusions
Based on this review, more standardized MBI protocols such as MBSR and MBCT compare favorably with usual care in terms of health outcomes and cost-effectiveness. Other MBIs may result in cost savings from both healthcare and societal perspectives among high-risk patient populations.
... conducted a systematic review of 11 studies that evaluated the effectiveness of mindfulness-based therapy for individuals with intellectual disabilities. A large proportion of these studies used the "Soles of the Feet" meditation (Singh et al., 2003). This is a mindfulness programme which encourages people to shift their attention from their negative thoughts to a neutral point on their body-soles of their feet. ...
... Idusohan-Moizer et al. (2015) found that their participants still maintained reduced anxiety and depression and improved self-compassion and compassion for others after a 6week follow-up. Singh et al. (2003) reported that the effects of their mindfulness-based therapy intervention were maintained after a 2- ...
Accessible summary
• Mindfulness helps people focus on the present instead of worrying about the past or future.
• We carried out an 8-week Mindfulness-Based Stress Reduction group for young adults with intellectual disabilities.
• We learned that practising mindfulness can help people when they feel stressed.
• After the 8 weeks, everyone in the group gave positive feedback about the group.
Abstract
Background
People with intellectual disabilities face increased levels of psychological distress compared with the general population and broadly present with fewer coping strategies. There is emerging evidence of the positive effectiveness of mindfulness in the treatment of various mental health issues such as depression and anxiety amongst people with intellectual disabilities. A pilot group was run to determine the effectiveness of a Mindfulness-Based Stress Reduction (MBSR) group on well-being and self-esteem amongst a nonclinical group of young adults with intellectual disabilities.
Methods
Seven participants with mild intellectual disabilities attended an 8-week MBSR group. Qualitative and quantitative measures were used pre- and post-group: the Clinical Outcomes in Routine Evaluation-Learning Disability (CORE-LD) and the Rosenberg Self-Esteem Scale-Adapted. A visual stress measure was used to monitor weekly stress levels and to facilitate group discussion. The effectiveness of the mindfulness-based group was evaluated.
Findings
A mixed methodology using quantitative and qualitative analysis of group outcomes was used. Participants’ feedback was analysed thematically; participants found the group to be beneficial and taught them mindfulness strategies to manage their stress levels. Scores from the CORE-LD showed a significant improvement between pre- and post-group scores on participants’ overall well-being. Scores from the Rosenberg Self-Esteem Scale-Adapted showed an improvement between pre- and post-group scores on participants’ self-esteem, but not at a significant level.
Conclusion
Mindfulness emerged as a self-care tool that was used independently by some participants. We conclude that mindfulness seems to be a suitable therapeutic option for managing stress in young adults with mild intellectual disabilities. Future research opportunities are evident in relation to adapting mindfulness to suit the needs of people with intellectual disabilities.
... Mindfulness exercises for those with ID include the 'Soles of the Feet' exercise (Singh et al., 2003), which involves individuals shifting their attention from distressing thoughts to a neutral body part -the soles of their feet. This exercise has been found to be beneficial in helping those with moderate ID to manage their distress, thus avoiding placement breakdown (Singh et al., 2007). ...
... An adapted soles of the feet exercise (Singh et al., 2003) was used in the group to make it more accessible, with participants being asked to focus on the palms of their hands instead. The emotional response focused on was anxiety. ...
This study explores the experiences and personal effects of service user (SU) involvement in clinical psychology training. A critical realist stance was adopted throughout the research process. Extant literature has predominantly focused on evaluating and optimising SU involvement for the benefit of clinical psychology trainees. Only recently has research started to consider the effects involvement may have on SUs. The research exploring SUs’ experiences in clinical psychology training has derived samples from singular training programmes. Exploring SUs’ experiences from multiple programmes seemed the logical next step. The deductive application of psychological theory allowed further exploration into power, recovery, identity and group development (concepts highlighted as important in the SU involvement literature). Purposive sampling was utilised, with advertisements disseminated via course staff who oversee SU involvement. Fourteen SU representatives, from eight different courses were recruited (with two also identifying as carers). Each participant took part in either a face-to-face or telephone semi-structured interview which was audio recorded and transcribed by the researcher. A deductive thematic analysis was used to analyse the data. Five themes were identified, some with subthemes: Environment determines sense of safety (subthemes: Supportive relationships, Group dynamics); Meeting challenges; Sense of purpose, worth and value (subthemes: Feeling listened to and valued, A positive way to feed back into the system); The person you see now is not the person I was (subthemes: A game changer for personal growth and development, Relating to difficulties in a different way, Reengaging with skills that I thought had gone); and Wanting to break the glass ceiling. Findings are considered and discussed in relation to theories of social identity, power, group development and mental health recovery. Identified benefits for SUs included a positive change in self-perception, including re-engaging with lost skills. Findings suggest involvement can offer an opportunity to further develop recovery. However, there were reported difficulties in joining a new SU group including group dynamics and power imbalances. Findings also suggest that there is a glass ceiling to involvement which SUs have a desire to break. The findings suggest it is important that the environment in clinical psychology training fosters psychological safety for SUs, via positive and supportive relationships with trainees and staff, in which SUs are treated as equal colleagues and financially reimbursed as such. Additionally, the intricacies and nuances of managing and sharing power need to be explored to enable SUs to feel valued and reap benefits from involvement, including developing a positive sense of identity. There are also implications for professionals in mental health services who should look to share theoretical knowledge with SUs who reportedly found that having access to psychological theory via their involvement was enlightening in better understanding their difficulties. A limitation is only two participants identified as carers (and they also identified as SUs) therefore carers experiences are under-represented. The research also failed in attempts to recruit SUs who were no longer involved, and thus whose experiences might differ. Future research should focus on these areas.
... Efforts to integrate mindfulness-based training into brief addiction treatments have yielded positive results in adults (Appel & Kim-Appel, 2009;Bowen et al., 2009;Dimeff, Rizvi, Brown & Linehan, 2000;Singh et al., 2003). Although researchers recommend that mindfulness-based training be implemented as an adjunctive treatment for addictions (Breslin, et al., 2002;Marcus et al., 2009;Vidrine et al., 2009), only one study to date (de Dios et al., 2012) has explored the relative benefits of incorporating mindfulness-based training into the treatment of problematic substance use among transition-age youth (Beitchman et al., 2001). ...
Mindfulness training has increasingly been implemented in substance abuse treatment regimes with the goal of relapse prevention. Among the available treatments, Motivational Interviewing (MI) is reported to be the most effective form of treatment for transitional-age youths. However, there is a paucity of research investigating the effects of mindfulness skills training on sobriety maintenance in this population. Objectives: The goal of the current study was to assess the effects of MI with the addition of mindfulness skills training on substance use behaviours and clinical outcomes in outpatient youths between the ages of 16 and 24. Methods: Sixty-six eligible participants were randomly assigned to a Treatment-as-usual (TAU) group or a TAU plus mindfulness training (TAU+M) group. Substance use days, impulse/addictive behaviors, confidence to resist urges, emotion regulation, psychiatric symptom severity, and mindfulness was assessed at baseline, post-treatment and at 3-month follow-up. Results: Days of substance-use did not change across group; however, both treatment groups reported decreased severity of psychiatric symptoms at 3-month follow-up. Participants in the TAU+M group further displayed decreased impulsive/addictive behaviors and increased confidence to resist urges at follow-up compared to the TAU group. Interestingly, the TAU group displayed greater changes in mindfulness than the TAU+M group. Conclusions and Implications: Overall, adding mindfulness to MI seems to provide benefits in the treatment of substance abusing youths. Acknowledgments:
... Individuals learn to develop the ability to let such feelings arise and subside without having to react to them, thus changing patterns of behaviour. An intervention based on mindfulness called 'Meditation on the Soles of the Feet' teaches individuals with aggressive behaviour to identify behaviours or emotions that give rise to anger or aggression and then to alter the focus of their attention from these precursors to a neutral part of their body, in this case, the soles of the feet (Singh 2003). ...
Background:
Outwardly directed aggressive behaviour in people with intellectual disabilities is a significant issue that may lead to poor quality of life, social exclusion and inpatient psychiatric admissions. Cognitive and behavioural approaches have been developed to manage aggressive behaviour but the effectiveness of these interventions on reducing aggressive behaviour and other outcomes are unclear. This is the third update of this review and adds nine new studies, resulting in a total of 15 studies in this review.
Objectives:
To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly directed aggressive behaviour compared to usual care, wait-list controls or no treatment in people with intellectual disability. We also evaluated enhanced interventions compared to non-enhanced interventions.
Search methods:
We used standard, extensive Cochrane search methods. The latest search date was March 2022. We revised the search terms to include positive behaviour support (PBS).
Selection criteria:
We included randomised and quasi-randomised trials of children and adults with intellectual disability of any duration, setting and any eligible comparator.
Data collection and analysis:
We used standard Cochrane methods. Our primary outcomes were change in 1. aggressive behaviour, 2. ability to control anger, and 3. adaptive functioning, and 4.
Adverse effects:
Our secondary outcomes were change in 5. mental state, 6. medication, 7. care needs and 8. quality of life, and 9. frequency of service utilisation and 10. user satisfaction data. We used GRADE to assess certainty of evidence for each outcome. We expressed treatment effects as mean differences (MD) or odds ratios (OR), with 95% confidence intervals (CI). Where possible, we pooled data using a fixed-effect model.
Main results:
This updated version comprises nine new studies giving 15 included studies and 921 participants. The update also adds new interventions including parent training (two studies), mindfulness-based positive behaviour support (MBPBS) (two studies), reciprocal imitation training (RIT; one study) and dialectical behavioural therapy (DBT; one study). It also adds two new studies on PBS. Most studies were based in the community (14 studies), and one was in an inpatient forensic service. Eleven studies involved adults only. The remaining studies involved children (one study), children and adolescents (one study), adolescents (one study), and adolescents and adults (one study). One study included boys with fragile X syndrome. Six studies were conducted in the UK, seven in the USA, one in Canada and one in Germany. Only five studies described sources of funding. Four studies compared anger management based on cognitive behaviour therapy to a wait-list or no treatment control group (n = 263); two studies compared PBS with treatment as usual (TAU) (n = 308); two studies compared carer training on mindfulness and PBS with PBS only (n = 128); two studies involving parent training on behavioural approaches compared to wait-list control or TAU (n = 99); one study of mindfulness to a wait-list control (n = 34); one study of adapted dialectal behavioural therapy compared to wait-list control (n = 21); one study of RIT compared to an active control (n = 20) and one study of modified relaxation compared to an active control group (n = 12). There was moderate-certainty evidence that anger management may improve severity of aggressive behaviour post-treatment (MD -3.50, 95% CI -6.21 to -0.79; P = 0.01; 1 study, 158 participants); very low-certainty evidence that it might improve self-reported ability to control anger (MD -8.38, 95% CI -14.05 to -2.71; P = 0.004, I2 = 2%; 3 studies, 212 participants), adaptive functioning (MD -21.73, 95% CI -36.44 to -7.02; P = 0.004; 1 study, 28 participants) and psychiatric symptoms (MD -0.48, 95% CI -0.79 to -0.17; P = 0.002; 1 study, 28 participants) post-treatment; and very low-certainty evidence that it does not improve quality of life post-treatment (MD -5.60, 95% CI -18.11 to 6.91; P = 0.38; 1 study, 129 participants) or reduce service utilisation and costs at 10 months (MD 102.99 British pounds, 95% CI -117.16 to 323.14; P = 0.36; 1 study, 133 participants). There was moderate-certainty evidence that PBS may reduce aggressive behaviour post-treatment (MD -7.78, 95% CI -15.23 to -0.32; P = 0.04, I2 = 0%; 2 studies, 275 participants) and low-certainty evidence that it probably does not reduce aggressive behaviour at 12 months (MD -5.20, 95% CI -13.27 to 2.87; P = 0.21; 1 study, 225 participants). There was low-certainty evidence that PBS does not improve mental state post-treatment (OR 1.44, 95% CI 0.83 to 2.49; P = 1.21; 1 study, 214 participants) and very low-certainty evidence that it might not reduce service utilisation at 12 months (MD -448.00 British pounds, 95% CI -1660.83 to 764.83; P = 0.47; 1 study, 225 participants). There was very low-certainty evidence that mindfulness may reduce incidents of physical aggression (MD -2.80, 95% CI -4.37 to -1.23; P < 0.001; 1 study; 34 participants) and low-certainty evidence that MBPBS may reduce incidents of aggression post-treatment (MD -10.27, 95% CI -14.86 to -5.67; P < 0.001, I2 = 87%; 2 studies, 128 participants). Reasons for downgrading the certainty of evidence were risk of bias (particularly selection and performance bias); imprecision (results from single, often small studies, wide CIs, and CIs crossing the null effect); and inconsistency (statistical heterogeneity).
Authors' conclusions:
There is moderate-certainty evidence that cognitive-behavioural approaches such as anger management and PBS may reduce outwardly directed aggressive behaviour in the short term but there is less certainty about the evidence in the medium and long term, particularly in relation to other outcomes such as quality of life. There is some evidence to suggest that combining more than one intervention may have cumulative benefits. Most studies were small and there is a need for larger, robust randomised controlled trials, particularly for interventions where the certainty of evidence is very low. More trials are needed that focus on children and whether psychological interventions lead to reductions in the use of psychotropic medications.
... Early pilot studies provide evidence that, with appropriate adaptations, DBT (Morrissey & Ingamells, 2011), ACT (Pankey & Hayes, 2003), MBCT (Idusohan-Moizer et al., 2015) and CFT (Clapton et al., 2018) can be acceptable to adults with ID. In fact, Singh et al. (2003) developed a mindfulnessbased approach specifically for people with intellectual disabilities, called 'Soles of the Feet'. This intervention teaches people with intellectual disabilities to shift their attention from aversive internal experiences to neutral sensations in the soles of their feet. ...
Background:
In recent years, third-wave therapies have risen to prominence. Research into adapting and evaluating third-wave therapies for adults with intellectual disabilities has identified that third-wave therapies are accessible, acceptable, and effective (improving a range of symptoms and skills).
Method:
This meta-ethnography followed Noblit and Hare's approach to synthesising findings from qualitative studies to examine how adults with intellectual disabilities experience third-wave therapy groups. A systematic review of three databases identified 13 studies that met our inclusion criteria.
Results:
We identified that third-wave therapy groups can be a 'Transformational' process for adults with intellectual disabilities that involves three stages: 'Concealment', 'Opening up' and 'Flourishing'.
Conclusion:
Findings highlight the importance of therapeutic processes; especially, working with defences, and developing and maintaining safety/trust. Recommendations include the development of an objective measure of group safety/trust.
... Intellectual Disability Singh et al. (2003) created a self-control strategy based on mindfulness to help an adult with mental retardation and aggressive behavior. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. ...
The purpose of the current review study is to provide representative evidence regarding the effectiveness of mindfulness training strategies on the development of metacognitive skills for people with special education needs. In addition, we explore the role of virtual reality in the efficacy of mindfulness interventions among people with learning disabilities, neurodevelopmental disorders, intellectual disabilities, and behavioral disorders. In addition, we present innovative mindfulness training strategies, appropriate for metacognitive skills training in special education. Finally, we seek the features that possibly make virtual reality a fertile ground for the implementation of mindfulness training. The results showed that mindfulness training improves the metacognitive skills needed for the inclusion of people with disabilities. Virtual reality constitutes an effective assistive technology that can facilitate mindfulness training in various contexts, accelerating positive outcomes in mental and physical health, academic performance, and well-being.
... The antidote is a shift in attention from a negative emotional arousal situation to a neutral point on the body, the soles of the feet. Individuals are provided instructions by a trained mindfulness instructor using a taskanalyzed sequence of steps until mastery is achieved (Felver & Singh, 2020;Singh et al., 2003). A recent meta-analytic study reported that SoF is an effective evidence-based practice for reducing challenging behaviors across different populations and settings (Felver et al., 2022). ...
Objectives
This paper describes and integrates self-determination and mindfulness research in intellectual and developmental disability, with a focus on how both approaches shift the focus to intervening from the “inside out” rather than from the “outside in.”
Methods
A targeted overview of self-determination and mindfulness research in intellectual and developmental disabilities is provided. Parallels and areas of divergence are described, with implications derived for the integration of the two approaches to promote positive outcomes for people with intellectual and developmental disabilities.
Results
There is a synergistic relationship between self-determination and mindfulness-based interventions. Promoting internal resources, self-awareness, and emotion regulation through mindfulness may provide the foundation on which to build specific self-determination skills.
Conclusions
There is a need for ongoing work to develop and test, in partnership with disabled people, the impacts and outcomes of integrated approaches to promoting mindfulness and self-determination. This will require changes across multiple levels, and issues related to diversity and equity must be at the forefront.
... A SAR intervention is designed to guide the user through the "Soles of the Feet" mindfulness exercise [27], where the SAR tutor teaches the user about how to shift attention flexibly to focus on the present moment, instead of overthinking about the negative past experience or uncertainty of the future. ...
Affect-aware socially assistive robotics (SAR) tutors have great potential to augment and democratize professional therapeutic interventions for children with autism spectrum disorders (ASD) from different socioeconomic backgrounds. However, the majority of research on SAR for ASD has been on teaching cognitive and/or social skills, not on addressing users' emotional needs for real-world social situations. To bridge that gap, this work aims to develop personalized affect-aware SAR tutors to help alleviate social anxiety and foster social grit-the growth mindset for social skill development-in children with ASD. We propose a novel paradigm to incorporate clinically validated Acceptance and Commitment Training (ACT) with personalized SAR interventions. This work paves the way toward developing personalized affect-aware SAR interventions to support the unique and diverse socio-emotional needs and challenges of children with ASD.
... Contemporary psychological approaches have adopted mindfulness as a tool for managing emotional distress and maladaptive behaviours through the promotion of increased awareness and the ability to respond skilfully to individual thought processes (Bishop et al., 2004) showing potential for use with people with intellectual disabilities. MBPs can also be empowering for people with intellectual disabilities, offering a degree of meaningful involvement in their treatment (Singh et al., 2003) and supporting the development of skills and resilience necessary to manage their own environment (Hastings, 2013). Furthermore, as a skills-based, positive and non-blaming approach (Lew et al., 2006) mindfulness asks the individual to work on accepting the present moment as it is, which includes how we are in that present moment. ...
Accessible summary
Mindfulness helps us to “slow down” and notice how we are thinking and how we are feeling. When we notice our thoughts and our feelings, we can choose to do the things that help us to feel better. We wanted to know what people with learning disabilities thought of mindfulness. Nine people with learning disabilities told us what they thought about mindfulness.
We found out that:
• People enjoyed mindfulness activities and the chance to socialise with other people
• People showed some understanding of mindfulness
• People could do the mindfulness activities
Abstract
1.1 Background
A growing body of research supports the efficacy of mindfulness‐based intervention programmes (MBPs) for people with intellectual disabilities. Existing literature calls for focus on the experiences of people with intellectual disabilities participating in MBPs.
1.2 Materials and Methods
This study explored the experiences of nine adults with intellectual disabilities attending an eight‐week group MBP delivered within the community. Two audio‐recorded group discussions and seven semi‐structured interviews were thematically analysed.
1.3 Results
Themes were as follows: participants’ experience of the group as a meaningful and enjoyable activity; opportunities for socialisation, sharing, friendship and support; the significance of participant–facilitator relationships; and how participants understood and experienced the mindfulness exercises and concepts.
1.4 Conclusions
Some understanding of mindfulness was evident, and participants demonstrated an ability to engage in mindfulness exercises. Findings inform the development of effective MBPs for people with intellectual disabilities.
... Flook et al., 2010;Kuyken et al., 2013;Viafora et al., 2014). Positive outcomes, such as decreased stress (Mendelson et al., 2010) and increased self-acceptance (Abrams, 2007), relaxation and focus (Singh et al., 2003), and optimism (Schonert-Reichl and Lawlor, 2010) have been identified in mindfulness interventions with children and youth. ...
Youth wellbeing is a pressing international problem, and it is a key concern of educational institutions, considering the substantial amount of time that youth spend in school. Educators require empirically validated and theoretically sound methods to support students’ wellbeing. This article critically examines the literature on youth wellbeing and interventions in positive education and proposes an innovative, social ecological approach to promoting wellbeing in education. Personal Projects Analysis is a complementary approach addressing several gaps identified in existing interventions (e.g. lack of consideration of ecological and cultural contexts, need for a person-centred approach to support unique goals of diverse students). Implications and applications are discussed to demonstrate how school leadership and educators can apply Personal Projects Analysis to promote the wellbeing of all students.
... The effectiveness of these stand-alone interventions has been demonstrated in the treatment of aggression in individuals with mild to moderate ID in a group setting (Singh et al., 2003(Singh et al., , 2008(Singh et al., , 2011a, in the care of sex offenders (Singh et al., 2011b) and as a ward-based program for medium-secure attack care in women (Chilvers et al., 2011). The goal of the MBCT program for people with ID is to draw on existing research and clinical studies that indicate that mindfulness-based approaches and strategies can lead to behavioural improvements, psychological well-being, behaviours, and quality of care and help people ID (Hwang and Kearney, 2013). ...
The objective of this paper was to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in decreasing depressive symptoms and intellectual disabilities (ID) among individuals with depression in Nigeria. In this randomized controlled trial, 101 participants with depression and ID, aged 18–60 years, who obtained 14 scores in the Beck Depression Inventory (BDI-II), scores 4 and above on Shaheen Disability Scale (SDS), were randomly assigned into the interventions (n = 50) and active control group (n = 51). The MBCT group has shown a statistically significant effect on the SDS and BDI-II variables by decreasing depressive symptoms and disabilities following MBCT (p<0.05). The assessment revealed that participants reported an improvement in their experience of depression and ID. The most significant impact was in the reduced levels of ID reported. The results of the evaluation suggest that depressed people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 2-months follow-up.
... There is evidence that mindfulness is a promising treatment approach for people with intellectual disabilities, e.g. in the reduction of aggression [39][40][41]. However, in a review by Chapman et al. [42] on the effectiveness of mindfulness-based interventions in people with intellectual disabilities, these investigations were criticised for being subject to methodological shortcomings. ...
Background:
Boys with mild to borderline intellectual disabilities (MBID) are at particular risk to drink in harmful ways once they start to consume alcohol. Interventions based on mindfulness have been proven to be effective in preventing substance use, but mostly for adults with MBID. A mindfulness oriented intervention targeting 11-17 years old boys will be tested in a randomised controlled trial. Study aim is to investigate the benefits of this new intervention compared to an active control condition within a 12 months follow-up.
Methods:
In this randomised controlled proof of concept study, 82 boys with MBID who consumed any alcohol during the last year will be randomised either to the 6 week mindfulness oriented intervention or the control group receiving a control intervention equal in dose and length. The intervention group undergoes mindfulness training combined with interactive drug education, while the control group completes a health training combined with the same education. In the intention-to-treat analysis the primary outcome is the self-reported delay of first post-intervention drunkeness within a 12 months follow-up time span, measured weekly with a short app-based questionnaire. Secondary outcome is the use of alcohol, tobacco and other drugs within 30 days post-intervention. Changes in neurobiological behavioural parameters, such as impulse control, reward anticipation, and decision making, are also investigated. Other secondary outcomes regard trait mindfulness, emotion regulation, psychopathological symptoms, peer networks, perceived stress, and quality of life. In addition, a prospective registry will be established to record specific data on the population of 11-17 year old boys with MBID without any alcohol experience.
Discussion:
This study offers the opportunity to gain first evidence of the effectiveness of a mindfulness-oriented program for the prevention of substance use for boys with MBID.
Trial registration:
German Clinical Trials Register, DRKS00014042 . Registered on March 19th 2018.
... 389 Mindfulness skills may decrease impulsive thought and aggressive behavior through improved awareness of internal experience, reduction of experiential avoidance, and attentional shifting. [390][391][392] An RCT with 58 patients with borderline personality disorder found decreased impulsive behavior after DBT versus treatment as usual. 393 An RCT with 101 adults with recent partner aggression comparing ACT versus support group reported ACT was more efficacious in reducing physical and psychological aggression. ...
Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.
... A number of small-scale studies have demonstrated the success of SoF with people with ID who have aggressive behavior with reductions or elimination of aggressive behaviors at long-term follow-up (Adkins et al. 2010;Singh et al. 2007;Singh et al. 2008a;Singh et al. 2011b). Singh's SoF intervention (Singh et al. 2003) has primarily been researched in the USA, involves extensive training, and includes little in terms of a taught psychoeducational component regarding emotional problems or about mindfulness (Griffith et al. 2016). Additionally, SoF delivery in the USA demonstrated significant cost savings as a result of a reduction in staff absenteeism (Singh et al. 2008a). ...
Objectives
Mindfulness-based programs (MBPs) such as the ‘Soles of the Feet’ (SoF) meditation have been shown to be effective for reducing aggressive behavior in people with intellectual disabilities (ID). Research on SoF has shown promising results in the USA but there is an absence of evidence for the approach in the United Kingdom (UK). The aim of this research was to adapt SoF for the UK and to assess the feasibility and cost of implementing the SoF intervention in a UK healthcare setting (UK SoF).Methods
The UK SoF intervention consisted of a manualized protocol delivered over a six-week period by National Health Service staff to people with ID and their carers. This was a single-arm study with three measurement time points (baseline and 2- and 6-month follow-ups).ResultsThe UK SoF intervention was shown to be feasible, with recruitment, retention, and adherence figures exceeding the minimum cut-off of 50%. Costs were £2426 per participant, or £2766 when including set-up costs such as therapist training. Although not a primary aim, data suggest that at 6-month follow-up, there was a reduction in scores for anger and aggressive behavior, and depression and anxiety showed improvement. In addition, people with ID were able to self-report on their health-related quality of life.Conclusions
This study has indicated areas where the protocol could be further improved, and it is recommended that the research should move to a pilot trial before the development of a full randomized control trial.
Students with emotional and behavioral disorders often need behavioral supports to facilitate their success in the classroom. One commonly used intervention involves taking brief breaks at targeted times during the day to return to the classroom better prepared for participation. However, research is limited on what should happen while a student is on break. Two potential strategies were evaluated using an alternating treatment design with three students at an urban charter school in 1st and 5th grades. Following a baseline phase, breaks alternated between a mindfulness-based intervention (MBI) involving awareness of breath, body, and self and a relationship-based intervention (RBI) involving a “would you rather” get-to-know-you game. Results suggest both interventions improved behavioral outcomes for all participants compared to baseline. For two students, no clear break type had a more profound impact. For one participant, data suggest that MBI was a superior intervention for increasing academic engagement. Both interventions were implemented with acceptable fidelity and social validity. Limitations and future directions are discussed.
Challenging behavior is prevalent and persistent in people with intellectual and developmental disabilities and is considered a public health concern. Challenging behavior in general, and aggressive behavior in particular pose problems in behavioral management, which are the main reasons for emergency and hospital admissions and have a significant negative impact on people’s health and quality of life. This chapter reviews the definition, prevalence, and diverse etiology of challenging behavior and its assessment and treatment across the lifespan, including information on service models, direct care staff, and the latest directions and research findings on the topic.
Objectives
Experiences of difficulty (e.g., anxiety, difficult emotions) can occur during mindfulness practice. This study characterized the occurrence of such difficulties, defined as abnormal distress, dysregulation, or agitation, among high-suicide-risk participants during a mindfulness-based intervention. The study also evaluated whether mindfulness difficulties were associated with baseline differences or poorer outcomes during follow-up.
Method
Participants (n = 50; mean age = 49 years, 84% male, 24% Latinx) were from the Mindfulness-Based Cognitive Therapy for Suicide Prevention (MBCT-S) trial. Occurrences of mindfulness difficulties were identified via systematic review of progress notes. Serious clinical outcomes (suicidal events, suicide attempts, and psychiatric hospitalizations) were tracked over 12 months follow-up. Participants experiencing difficulties during MBCT-S were compared to those who did not on baseline characteristics and serious clinical outcomes. Incidence density sampling and Cox proportional regression analyses tested whether experiencing difficulties during mindfulness increased the risk of subsequent serious clinical outcomes.
Results
Eighteen percent of participants had difficulty during mindfulness practice, which mostly included experiences of anxiety or hallucinations. Those experiencing difficulty showed several diagnostic differences at baseline, but were not at significantly greater risk of a suicidal event, HR 0.62 (95% confidence interval [CI], 0.14–2.71) or an acute psychiatric hospitalization, HR 0.85 (95% CI, 0.19–3.82). There were no suicide attempts among the nine participants who experienced mindfulness difficulty, compared to five suicide attempts in those without mindfulness difficulty.
Conclusions
Difficulties during mindfulness practice were common, but did not show increased risk of serious clinical outcomes in participants at high risk of suicide.
Preregistration
This study reports findings from a secondary analyses of a randomized clinical trial that was preregistered at clinicaltrials.gov (NCT01872338).
This chapter begins by exploring the traditional Buddhist interpretation of mindfulness and then shifts to highlighting the increased interest in Eastern meditation techniques starting from the 1960s. It also covers the development of secular mindfulness-based programs, beginning with the implementation of mindfulness-based stress reduction initiatives in healthcare settings. From there, it expanded into mindfulness-based cognitive therapy aimed at preventing major depression relapses and gradually began to accommodate various populations and contexts. This chapter underscores the fact that over four decades of studies producing concrete scientific evidence on health outcomes have laid the foundation for mindfulness-based programs. Additionally, it provides extensive roadmaps on program adaptation by discussing principles and models. These inform how research can be utilized to refine a program, refining it to suit specific populations and environmental factors accordingly.
The present study investigated how trait mindfulness is related to anxiety and aggression by considering the mediating role of resilience with the longitudinal data among Chinese college students with left‐behind experience. A total of 391 Chinese college students with left‐behind experiences completed the Mindful Attention Awareness Scale, the Connor‐Davidson Resilience Scale, the Chinese college students’ version of the Buss‐Perry Aggression Questionnaire, and the Depression Anxiety Stress Scales at two‐time points. Structural equation modeling was used to analyze the data, and the results indicated that resilience (T1) mediated the relationship between trait mindfulness (T1) and anxiety (T2) (indirect effect = −0.053, 95% confidence interval [CI] = [−0.119, −0.005]) as well as aggression (T2) (indirect effect = −0.070, 95% CI = [−0.127, −0.029]). Therefore, trait mindfulness had direct and indirect negative associations with anxiety and aggression, and resilience mediated the relationship between trait mindfulness and both anxiety and aggression. The findings of the study provide valuable insights into the potential benefits of trait mindfulness and resilience in improving mental health outcomes and suggest clinical potential in the improvement of mental health among college students with left‐behind experiences.
Intellectual disability (ID) is a lifelong impairment of cognition and adaptive behavior that emerges in the development period. ID is a differentiated disability, whose severity differs from mild to profound. People with ID all have unique strengths and deficits, and while some can live autonomously, others may need significant levels of support. Many people with ID are affected by cancer in their lifetime, and depression and anxiety are psychiatric syndromes that have been receiving the most attention in people with cancer. The chapter provides an overview of how exercise and psychotherapy can help people with ID to manage cancer and depression.
Externalizing disorders characterized by behavioral problems manifest in the children's outward behaviors such as poor impulse control, impulsivity, and inattention may result in children negatively acting out on the external environment. When untreated, these problematic behaviors are associated with a wide range of negative outcomes for children and adolescents. In recent years, mindfulness-based interventions have become increasingly popular and have been shown to improve the ability to sustain attention and concentration, decrease impulsivity, help calm down and relax, increase frustration tolerance, and reduce stress; which enables the individual to respond with greater choice and solve problems and daily difficulties with greater skill. This chapter makes use of a narrative review format to describe the intervention procedure, duration, and process of each of the therapies along with existing research evidence in support of these therapies, and concludes with recommendations for further research.
International psychiatry is facing major challenges due to the rapid increase in mental health issues. The forthcoming mental health crisis has opened the debate about the need to broaden the therapeutic horizons with the implementation of digitally assisted mindfulness practices within psychotherapeutic interventions. Mindfulness training is developing into a promising intervention for a variety of health problems and a booster of well-being. At the same time, virtual reality (VR) and especially immersive technologies are increasingly being used as assistive tools in the training of people with special education needs and disabilities (SEND). Μeta-competences refer to a set of self-development skills that incorporate meta-cognitive and meta-emotional attributes, enabling individuals to be self-conscious, self-regulated, and flexible in every aspect of human life. The current review aims to investigate (i) the efficacy of mindfulness strategies in meta-competence training for SEND and (ii) the role of VR as an assistive technology in mindfulness training. The PRISMA 2020 methodology was utilized to respond to the objectives and research questions. The database search provided 1380 records, and 29 studies met the inclusion criteria. The results showed that mindfulness training has the potential to train meta-cognitive and meta-emotional competences among people with different mental disorders, including Attention Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Intellectual Disability (ID), Depressive Disorder, Stress Disorder, and Specific Learning Disorder. VR was found to be an effective assistive technology, providing significant advantages compared to conventional mindfulness interventions. Mindfulness training assisted by immersive technologies was found to significantly improve a wide range of cognitive and socio-emotional meta-competences, including self-awareness, inhibition control, attention regulation, flexibility, positive thinking, and emotional regulation. The results of this systematic review may provide positive feedback for creating inclusive digital training environments.
This chapter focuses on what is known about the science of character strengths for people with intellectual/developmental disabilities (IDD) and outlines a myriad of practices emerging in the field, stemming from the science. Seven core insights integrating character strengths and IDD help to foster an optimal strengths-based mindset. These involve character strengths as a language of inclusiveness, a focus on ability, an equalizer, a balancer of extremes, a growth mindset approach, a path for managing adversity, and facilitating belonging. There is an emerging science using character strengths for IDD, which includes a range of assessment approaches, examination of the character strengths of staff, the character strengths of the individuals themselves, and outcomes. This leads to practical strategies involving creative adaptations to assessing character strengths, interventions, strengths-spotting, and individualized planning involving character strengths-infused IEPs and ISPs (individualized strengths plans). These scientific and practical advancements in character strengths are part of a movement in the disability field we refer to as Strengths-Based: Phase 2 (where Strengths-Based: Phase 1 refers to focusing on individuals' interests, resources, skills, and abilities). These character strengths areas of Phase 2 are discussed along with multiple examples.KeywordsCharacter strengthsIntellectual/developmental disabilityAutismGrowth mindsetInclusionBelongingCharacter strengths interventionsStrengths-spottingIndividualized education plan (IEP)Individualized strengths plan (ISP)
This chapter focuses on the special topic of spirituality as evidenced and expressed in the lives of people with intellectual/developmental disability (IDD). It reflects the nascent exploration of this integration in the research and practice that exists and the offering of resulting extrapolations, insights, and practices therein. Emphasis in the literature on spirituality and people with IDD has emphasized the influential role of spirituality, the importance of involving planning and support, the central role of spiritual community and connection, and spiritual practices. Two pathways to deepen the integration of character strengths and spirituality are described—the grounding path and the sanctification path. Application areas emphasized include assessment, community, service, mindfulness, and daily life integration.KeywordsCharacter strengthsSpiritualityIntellectual/developmental disabilityThe grounding pathThe sanctification pathSpiritual communitySpiritual practicesSpiritual growthMindfulness
The purpose of this literature review was to examine the state of research on the use of self‐management procedures in reducing problem behaviors in adults diagnosed with an intellectual disability. Studies were located by conducting a systematic search of literature across various journals. Seventeen studies were included in the review and were evaluated along the dimensions of adherence to quality research design and outcomes. Results showed that self‐management techniques were associated with decreased levels of challenging behaviors across adults with intellectual disability and autism spectrum disorder. However, the quality of research design was inconsistent, decreasing confidence in a causal relationship between self‐management and reduction in challenging behaviors. This review should encourage more research in using self‐management procedures with individuals having intellectual disability, especially with adults.
Introduction
A community cannot avoid the frustrating problem of antisocial behavior, which consists of actions that violate traditions or standards. To deal with the antisocial behavior and aggression in children, a variety of techniques and interventions have been proposed and applied throughout the world. Teachers can overcome antisocial behavior in educational institutions through professional development programs. In Pakistan, there are few studies that focus on teachers’ professional development in behavior management, which should be investigated.
Methods
A qualitative research study examined teacher professional development courses aimed at improving classroom management skills and controlling antisocial behaviors by collecting information from instructors. This approach was taken because this study aims to identify teacher educators’ experiences related to antisocial and aggression control training in the school setting. In addition, the limitations and challenges associated with such development programs are revealed through semi-structured interviews.
Results
Researchers reported major challenges related to such trainings include resistance and unwillingness of school authorities and teachers to participate in such trainings, as well as lack of resources and finances.
Discussion
To ensure that teacher training is effective and leads to the development of teacher skills and improvement of student behavior, researchers recommend implementing evidence-based intervention programs with ongoing monitoring by a trained teacher specialist. It is also recommended that curricula be standardized and in-service training results be empirically verified.
Mindfulness helps people focus on what is happening right now. It can help people to have good mental health.
A group of researchers from the USA created a mindfulness-based therapy for people with intellectual disabilities, called Soles of the Feet.
Soles of the Feet teaches people with intellectual disabilities to focus on the soles of their feet, instead of focusing on difficult thoughts and feelings.
This paper thinks about how Soles of the Feet works for people with intellectual disabilities.
This article reviews two conferences on ‘mindfulness’, a quality of awareness that arises when the attention is purposefully and non-judgementally focused upon present moment events (Kabat-Zinn, 2003). This unique quality of consciousness is developed by cultivating an attitude of curiosity, acceptance and openness and then focusing this on events in the immediate present (Bishop et al., 2004; Brown, Ryan & Creswell, 2007). The synthesis of compassion and awareness has a broad range of therapeutic implications including to reduce levels of stress or ruminative thoughts that may lead to depression and to increase levels of attention and general well-being (Siegel et al., 2009). Firstly, there was the University of East London (UEL) conference, entitled ‘Mindfulness and Well-Being: From Neuroscience to Spirituality’ held in Stratford at UEL on 21–22 November 2009. Secondly, the Tonbridge, ‘Mindfulness in Schools’, conference was held in Tonbridge, at Tonbridge School, on 11 March 2010. Both were the first of their kind in the country to focus on mindfulness. The UEL conference took a more theoretical approach and considered applications for adults, in a range of settings, while the Tonbridge conference focused on the practical application of mindfulness in a school-based setting with adolescent boys. The article discusses these events and offers a range of possible implications for educational psychologists.
One solution to treatment of violence and aggression is to treat the individual aggressor or at least take the individual aggressor as the starting point for therapy. This chapter reviews cognitive behavior therapy (CBT), behavior modification, applied behavior analytic, and third wave behavioral interventions, such as acceptance and commitment therapy, dialectical behavior therapy, functional analytic psychotherapy, and mindfulness interventions. There is a very large quantity of research evaluating individual psychological treatments for many populations. This chapter focuses on these approaches which have very long histories, and so, informed by outcome data over the years, researchers have revised and refined these approaches and modified them for specific populations and contexts. Thus, the treatments with the best available support and that permit the most informed treatment and economic decisions are CBT and behavioral treatments. Although other approaches may be effective there may be much less evidence or they often lack evidence, and some approaches, such as catharsis, are known to be harmful.KeywordsAggressionViolencePsychotherapyCognitive behavior therapyBehavior modificationBehavior therapyApplied behavior analysisThird wave psychotherapyAcceptance and commitment therapyDialectical behavior therapyFunctional analytic psychotherapyMindfulness
The present study aims to examine the effects of the MindfulTEA program, an Mindfulness-based Interventions (MBIs) specifically designed for adults with Autism Spectrum Disorder (ASD) and Intellectual Disability, to reduce behavioural problems. MBIs are effective in improving well-being in people with high-functioning ASD, but little is known about the impact of the MBIs on people with ASD and intellectual disability associated. Fourteen adults (age 18 to 44) with ASD and intellectual disability participated in the program. Results showed a significant decrease in self-injurious and aggressive/destructive behaviours after the MBI. Stereotyped behaviour did not show significant change. Results suggest that the MindfulTEA program could effectively reduce some types of behaviour problems in people with ASD and intellectual disability. MBIs could be a useful alternative to traditional behaviour management interventions for reducing behaviour problems in this population.
Mindfulness-based programs are a promising intervention modality for reducing disruptive behavior, and Soles of the Feet (SOF) is one program that teaches internal awareness of personal events (e.g., unpleasant emotions) and a self-regulation strategy to decrease disruptive behaviors. This study conducted a meta-analysis of single-case research design (SCRD) studies that implemented SOF to decrease disruptive behaviors. Existing SOF studies were evaluated using high-quality SCRD standards, resulting in 15 studies included in the analysis (49 participants; mean age 23.12 years ( SD = 15.87); highly heterogeneous backgrounds). Studies were analyzed to calculate effect sizes using Tau-U, an innovative non-parametric statistical approach for estimating effect sizes in SCRD studies. The aggregated weighted Tau-U effect size of SOF across all studies was −0.87. Moderator analyses indicated SOF’s effectiveness was robust across participant characteristics and delivery formats. This meta-analysis suggests that SOF is a moderately effective evidence-based practice for reducing disruptive behavior.
The current study used an ABAB design to evaluate the effects of a school-based mindfulness-based intervention (MBI) on the classroom academic engagement of three elementary school students. Specifically, the study investigated the Soles of the Feet MBI delivered in a small group format at the Tier 2 level. Findings were mixed, as one student failed to demonstrate improvements in academic engagement and two exhibited small to moderate improvements. Results from this study offer a cautionary tale to school psychologists looking for evidence-based Tier 2 interventions. Although MBIs might be appealing, more research is likely needed to establish them as evidence-based when targeting academic engagement at the Tier 2 level.
Accessible Summary
• Sometimes people find it hard to notice what is going on in their mind, body and feelings. Mindfulness can help us with this. Some studies show that mindfulness might help people with intellectual disabilities.
• We asked people to play a mindfulness computer game to see whether it helped them to notice their mind, bodies and feelings more easily. People who work with people with intellectual disabilities helped to play the game too.
• We asked people what they thought about the game.
• People seem to enjoy playing the game and said it helped them be more mindful.
• We think that learning mindfulness in a computer game might be helpful for people with intellectual disabilities.
Abstract
Background
This paper evaluates the user experience of a newly developed mindfulness and relaxation game designed to teach mindfulness skills to people with intellectual disabilities. Computer-assisted mindfulness programs have gained considerable attention among researchers in both adult and child populations. However, less is known about the experiences of people with intellectual disabilities who engage in computerised mindfulness programs. The present study aimed to explore the experiences of adults with intellectual disabilities and clinicians in using a computerised mindfulness and relaxation game.
Method
Twelve adults (with a mild or moderate intellectual disability) and sixteen clinicians were individually interviewed. Thematic analysis was used to analyse and generate themes within the data.
Findings
Three main themes with a number of subthemes were generated for people with intellectual disabilities including the following: (1) The Process of Mindful Island; (2) Fostering Relationships Through the Computer; and (3) The Impact of the Game. Three themes from clinician interviews were also generated including the following: (1) A Good Concept but More to Do; (2) Uncertainties Around Players’ Understanding of Mindfulness; and (3) The Computer as a Tool to Build Relationships. The findings indicated that participants found the game an enjoyable experience and saw a number of benefits to engaging in it including perceived improved confidence and perceived reduction of worries.
Conclusions
Mindfulness can be adapted to computer-assisted technology for use among people with intellectual disabilities and may foster a number of benefits.
В статье раскрывается феномен медитации осознанности как инструмент психотерапевтических интервенций в отношении взрослых индивидов с нарушениями умственного развития (умственной отсталостью). Также рассматриваются некоторые наиболее распространенные техники данного подхода, чья эффективность применительно к данной группе популяции была доказана в приведенных в статье результатах экспериментальных исследований за последние годы.
The article describes the phenomenon of mindfulness meditation as a possible tool for psychotherapeutic interventions toward adult individuals with disorders of intellectual development (mental retardation). It also reviews some of the most common techniques of this approach, whose effectiveness for the considered group of the population has been proven by the results of experimental studies within recent years.
Purpose
The purpose of this paper is to determine the effectiveness of an adapted dialectical behaviour therapy (DBT) treatment programme for individuals with an intellectual disability, via completion of a service evaluation.
Design/methodology/approach
Outcome measurements were competed at pre-, post- and 12 months follow-up, and the effectiveness of the intervention was assessed using a Friedman analysis.
Findings
Findings demonstrated that the treatment group showed significant differences in their “psychological distress” scores, but no significant differences were found in their “psychological well-being”, “anxiety” or “quality of life” (WHO-QOL) scores over time.
Originality/value
Overall, the current study adds to the small but growing literature that supports using the skills training group part of DBT as a stand-alone psychological intervention when working with people with an intellectual disability.
Background: The present study examined the psychometric properties of the Anger Bodily Sensations Interview – intellectual disabilities (ABSI-id), an adapted instrument to measure anger-related interoceptive awareness (IA) in individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF).
Method: The ABSI-id was individually administered to 208 clients (51% male) with MID-BIF in residential facilities.
Results: An EFA and CFA showed a two-factor structure of the ABSI-id, including nine items. The ABSI-id had moderate to good reliability, with an internal consistency ranging from acceptable to good, a test–retest reliability ranging from moderate to good and an adequate convergent validity. There was no significant difference in ABSI-id scores between individuals with MID and BIF.
Conclusion: The ABSI-id is a promising instrument for measuring anger-related IA, additional research is needed on validity and sensitivity of change.
The present study explored the longitudinal relationship between college students' inferiority and maladjustment, as well as the mediating role of dispositional mindfulness and the moderating role of left-behind experience. A total of 313 Chinese college students in Chongqing reported their levels of inferiority and whether they had left-behind experience at base-line (T1), and reported their levels of dispositional mindfulness and maladaptive problems three months later (T2). The current study found that dispositional mindfulness played a mediating role between inferiority and maladjustment (stress, anxiety and aggression), and left-behind experience moderated the second half of the model (i.e., the link between dispositional mindfulness and maladjustment). Furthermore, the mediating effect of dispositional mindfulness was weaker for college students who had left-behind experience compared to those without such experience. Findings highlight the beneficial effects of dispositional mindfulness on the maladjustment of college students, and the adverse impact of childhood left-behind experience on individuals’ psychological resources and mental health in adulthood. The implications of the results and mindfulness interventions targeting college students were discussed.
Accessible Summary
• This paper reflects on a group for adults with learning disabilities.
• The group taught the adults some mindfulness‐informed and relaxation techniques.
• These techniques can help when people feel angry, anxious or upset.
• The adults provided really useful comments that will help us when we plan future groups.
Abstract
1.1 Background
Mindfulness‐informed interventions are increasingly being offered to individuals with learning disabilities. The current paper aims to reflect on the provision and effectiveness of a group intervention incorporating mindfulness‐informed techniques and relaxation strategies.
1.2 Method
Nine group attendees with mild learning disabilities were invited to attend the 8‐week group intervention, incorporating mindfulness‐informed techniques and relaxation strategies. The Glasgow Anxiety Scale for Intellectual Disabilities (GAS‐ID) and the Cognitive and Affective Mindfulness Scale—Revised (CAMS‐R) were used as a pre‐ and post‐measure, to evaluate the effectiveness of the group intervention.
1.3 Results
The mean scores from the above measures revealed a decrease in anxiety symptoms and an increase in mindful qualities. Qualitative data gathered post‐intervention, illustrated reductions in challenging behaviour, greater use of the techniques learned and social benefits of participating in the group. A need for a training session for carers and family members was recommended as beneficial to support and assist the individuals to consolidate the techniques learned.
1.4 Conclusions
Mindfulness‐informed techniques and relaxation strategies are useful tools that can be adapted for individuals with learning disabilities to yield positive outcomes. However, further research to contribute to this evidence base is required. Recommendations for future practice are also identified.
This paper describes the development of anger management groups for people with moderate to severe mental retardation. The
group was based on work developed by Novaco (1976) and extended to people with mild mental retardation. Modifications to group
techniques, such as participants being accompanied by a support worker in the group and more effort to help participants label
emotions, were required for this more disabled group. An evaluation of the group is described and it was found that a reduction
in aggressive behavior occurred after group treatment. Suggestions are made for future efforts in this area.
A components analysis of a cognitive-behavioral anger management program was conducted with mentally retarded adults attending vocational training programs. Self-control training was given in one of four groups: relaxation training, self-instruction, problem solving, or a combined anger management condition. The dependent measures included self-reports, ratings of videotaped roleplays, and supervisor ratings. The results revealed decreases in aggressive responding over time and no significant between-group differences. The study suggests that anger management training with groups of mentally retarded adults may be effective.
The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then introduced mindfulness-based mentoring successively across the treatment teams. Following intervention, four follow-up assessments at 3-month intervals were undertaken to assess the durability of the enhanced treatment team functioning levels in the absence of mentoring. Results showed that with the introduction of mindfulness-based mentoring, treatment team performance was enhanced, patients'attendance at therapeutic groups and individual therapy sessions was maximized, and patient and staff satisfaction with treatment team functioning was substantially increased, with patient satisfaction showing greater gains than staff satisfaction. Mindfulness-based mentoring may be an efficient and effective intervention for enhancing and maintaining the performance of treatment teams in adult psychiatric hospitals.
Therapeutic interventions for anger and aggression have progressed significantly in the past decade, yet the treatment of this very problematic emotion/action complex remains neglected among seriously disordered populations. Recent work by Howells and his colleagues (Howells, 1989; Howells & Hollin, 1989; Levey & Howells, 1991) has certainly provided an impetus to addressing problems of anger, aggression, and violence among institutionalized patients.1 Most assuredly, the management of patients’ aggressive behavior presents formidable challenges to clinical staff who must be concerned with risks to themselves and to the welfare of other patients. Moreover, a patient’s inability to control aggressive behavior will certainly forestall discharge and perpetually remain a liability for social adaptation. Because assaultive behavior is often mediated by anger, treatment procedures that aim to provide clients with anger-control capabilities are important therapeutic resources, especially be-cause they seek to promote anger regulatory competency through the development of coping skills that have larger implications for psychosocial adjustment.
Of those who suffer from obsessive-compulsive disorder (OCD), a substantial number do not respond well to the standard treatment of two trials of serotonin reuptake inhibitors and cognitive-behavioral therapy. In addition to being refractory to current treatments, these individuals often have comorbid disorders that contribute to a compromised quality of life. The authors present the case of such an individual who was assisted to improve her quality of life by accepting her OCD as a strength and enhancing her mindfulness so that she was able to incorporate her OCD in her daily life. Results showed that she successfully overcame her debilitating OCD and was taken off all medication within 6 months of intervention. Three years of postintervention follow-up showed that she was well adjusted, had a full and healthy lifestyle and that although some obsessive thoughts remained, they did not control her behavior.
This article describes two studies that evaluated training intended to improve the family friendliness of five components of the admissions treatment team process (Introduction, Meeting Management, Case Presentation and Discussion, Service Plans, and Tact and Technicalities) at an inpatient child and adolescent psychiatric hospital. In Study 1, we observed 18 case presentations and found that the ratings on family friendliness were low on Service Plans and Tact and Technicalities. Following three role-play training sessions, we found no statistically significant improvement. In Study 2, we used a multiple-baseline design across treatment team process components and enhanced the family friendliness of each component through mindfulness training. Follow-up observations at monthly intervals for 6 months showed continued high rates of family friendly services. Our study suggests that the mindful delivery of mental health services can produce long-term gains in the family friendliness of admissions treatment teams.
address the right to programs that teach functional skills / discuss three developments that are changing the manner in which teachers build curricula: (a) the move to measure broader response classes (often termed life-style changes), rather than frequency counts of limited numbers of narrowly defined behaviors; (b) the recognition that activities (more comprehensive response classes) constitute a more sensitive measure of progress than discrete skills; and (c) recent developments in functional analysis research that help to define curricula / stress the need to expand the measures of program success / discuss the means of moving from skills-based to activity-based curricula (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A substantial literature now exists that indicates that cognitive-behaviour therapies are effective for a wide range of psychological problems (See Hawton, Salkovskis, Kirk, & Clark, 1989). However, it is only very recently that cognitive-behaviour therapists have considered people with learning disabilities as suitable clients for this particular approach. The present paper describes some of the challenges that are encountered when applying cognitive-behaviour therapy to this client group.
A course on anger management of eight weeks duration for six people with learning disabilities (in the mild-moderate range), and their keyworkers, is described. The programme drew on a range of techniques to assist in the exploration and control of difficult emotions, including relaxation, role-play, problem-solving and sharing in a group. With reference to the information we received from the participants (clients and staff) about their experience of being in the group, we discuss what appeared to have been helpful to group members in learning how to express angry feelings in appropriate ways, and to keyworkers in supporting clients in the management of aggressive behaviour.
This paper examines the link between a self-report Anger Inventory (Benson & Ivins, 1992) and incidents of challenging behaviour by people with intellectual disabilities. Records of challenging behaviour were kept by significant others while the people with intellectual disabilities themselves were asked to complete the Anger Inventory on a number of different occasions. The inventory was used to evaluate and follow up the impact of an anger management group, and in some cases other associated interventions. Data are presented on five individuals for time periods of between two and three years. Visual inspection of the data suggests a degree of correspondence between the levels of challenging behaviour reported by staff and scores reported on the Anger Inventory by participants and this relationship is confirmed statistically. The implications of these results are discussed.
To the Editor. —
Hogarty and colleagues1 have conducted an extremely important study on the treatment of schizophrenia. Their results shed considerable light on the potential impact of psychosocial interventions, and underscore the need for longitudinal evaluations of outcome. We find little to fault in the research design and data analysis; however, we disagree with what appears to be the overly pessimistic conclusion1(p346) that the effects of psychosocial treatments in general, and social skills training (SST) in particular, dissolve once treatment ends. Based solely on examination of the final point in their 2-year survival analysis, SST does appear to provide little more than medication alone.However, as eloquently pointed out by Hogarty et al, this analysis provides a limited and misleading view of the overall effects of the intervention. The SST condition was as effective as either of the family treatment conditions until month 21 of the intervention. Had
This paper describes an evaluation of a group intervention for reducing inappropriately expressed anger (as aggression) in people with intellectual disabilities. Group intervention was compared to a treatment as usual group consisting of people referred to the group but who had to wait to participate. The intervention used was based on the work of Novaco (1976; 1978) and Benson (1994). However, further modifications to the group that emphasized the contextual perspective of anger, such as the participants being accompanied by a support worker and more collaborative recording procedures, were devised. A reduction in expressed anger and measured levels of depression occurred after group treatment. Reductions in expressed anger were maintained at 6 and 12 months follow up. However, scores on the depression scale tended to increase on follow up. While caution must be expressed when considering these results, this type of intervention shows promise for reducing inappropriately expressed anger in people with intellectual disabilities Suggestions are made for future research and clinical practice.
Individuals with developmental disabilities often have a concomitant psychiatric disorder severe enough to require treatment. The behavioral endpoint of psychiatric disorders may require integrated behavioral and psychopharmacological treatments to stabilize their condition and enhance their quality of life. We used a mindfulness-based mentoring model to facilitate the integration of behavioral and psychopharmacological treatments at the treatment team level. Using a multiple baseline design across treatment teams, we assessed the degree of integration of these two treatment modalities using a 23-item rating scale, and then introduced mentoring successively across the three treatment teams. Following mentoring, six follow-up assessments at monthly intervals were undertaken to assess functioning of the treatment teams in the absence of mentoring. The low levels of integration of behavioral and psychopharmacological treatments occurring during baseline improved significantly within each team commensurate with the mentoring. Further, the enhanced treatment team functioning was maintained during a 6-month follow-up period. Mentoring of treatment teams may be an effective first step in integrating behavioral and psychopharmacological treatments that are deemed essential in the care and treatment of individuals with developmental disabilities and mental illness.
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