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Anger has been shown to be associated with aggression and violence in adults with learning disabilities in both community and secure settings. Emerging evidence has indicated that cognitive behavioural anger treatment can be effective in reducing assessed levels of anger in these patient populations. However, it has been suggested that the effectiveness of these interventions is significantly affected by verbal ability. In this service evaluation study the pre‐ and post‐treatment and 12‐month follow‐up assessment scores of 83 offenders with learning disabilities who received cognitive behavioural anger treatment were examined in order to investigate whether participants' responsiveness to treatment was a function of measured verbal IQ. The results indicate that, overall, the effectiveness of anger treatment was not the result of higher verbal ability as reflected in verbal IQ scores. It is concluded that cognitive behavioural therapy for anger control problems can be effective for people with moderate, mild and borderline levels of intellectual functioning and forensic histories.

Cognitive behavioural therapy (CBT) is being used increasingly with people with learning disabilities. The evidence base to support these developments comes from uncontrolled trials of CBT in a variety of psychological disorders and eight to nine controlled trials of CBT for anger (plus a single controlled study in depression). This paper reviews the evidence for the effectiveness of group‐based anger management and the acquisition of anger coping skills, and the effectiveness of individual anger treatment, with some discussion of the status of CBT for other indications and the difficulties of conducting outcome research in this area.

There is growing evidence for the efficacy of anger treatment programmes, which aim to reduce inappropriate aggression in people with learning disabilities. To date they have been provided in both group and individual formats, but the differential efficacy of these approaches is yet to be assessed. Individuals with a learning disability and inappropriately expressed anger were assigned to either group or individual treatment or a waiting list control, depending on the availability of treatment options. In this way, 23 participants completed group treatment, 18 individual treatment and 21 were included in a waiting list control. Participants were assessed both before and after treatment using an anger provocation inventory. Improvements were found in the scores obtained on the anger inventory for both the group and individual treatments compared to the control using a 2 by 3 split plot ANOVA. There was no difference between group and individual treatments. These results replicate previous findings that suggest that both group and individual cognitive behavioural interventions are effective treatment options for people with learning disabilities, but do not support either method of delivery as the preferred option. Limitations of the data are discussed.

Behavioural activation is a contemporary behavioural treatment for depression that has the potential advantages of being more readily adopted in psychiatric inpatient environments than more complex psychological treatment approaches and requiring less intensive training than these approaches. In this article the theoretical and empirical foundations of behavioural activation are described along with an outline of the therapeutic process and key interventions used. Consideration is then given to factors influencing the implementation of BA in psychiatric inpatient environments.

This study summarises the results of a cognitive‐behavioural treatment group for sexual offenders (n=14) with intellectual limitations in the community.

All participants were convicted sex offenders serving probation orders or prison licences who attended a 14‐month treatment programme designed for sex offenders with intellectual limitations. The programme comprised of five main components: sex education; cognitive distortions; offending cycle; victim empathy; and relapse prevention. All participants completed psychometric measures specifically designed for people with intellectual limitations before and immediately after completing the treatment programme. The four core measures include: Victim Empathy; Sexual Attitudes and Knowledge Assessment (SAK); Questionnaire on Attitudes Consistent with Sexual Offenders (QACSO); and Sex Offences Self‐Appraisal Scale (SOSAS).

Post assessment results reveal significant improvements in sexual offence related attitudes; reductions in attitudes relating to cognitive distortions and pro‐sexual assault beliefs; and significant improvements in victim empathy.

Although none of the participants have been reconvicted for committing new sexual offences during the follow‐up period, given that the follow‐up was restricted to 12 months post‐treatment, it is not possible to conclude this intervention was successful in reducing risk of sexual recidivism.

The results from this study support the use of cognitive‐behavioural approaches in demonstrating positive cognitive shift (reconstructing cognitive distortions and attitudes to victim empathy) for sexual offenders with intellectual limitations.

De‐institutionalisation and resettlement have had a significant impact on offenders with learning disabilities (LD) who are now more visible in the wider community than before. Perhaps because of the challenges presented by people who were previously contained in institutions, there has been a growth of interest in their characteristics, the services and clinical interventions required to support them.This narrative review presents and discusses recent developments concerning offenders with LD. It looks at the historical association between crime and low intelligence, and then examines the evidence concerning the prevalence of offending by people with LD and recidivism rates. Recent research concerning service pathways for this population is summarised and progress in the development of actuarial, dynamic and clinical assessments of the future risk of offending is outlined.The second half of the paper focuses on a review of the evidence for and recent developments in the treatment of offending behaviour (anger/aggression, sexual offending and fire‐setting), utilising broadly cognitive behaviourally‐based approaches. Finally, future directions for research and practice innovation are proposed.

This article aims to analyze and discuss the role of moral development in treatment of behavior problems and, further, to describe differences and similarities between two different methods – milieu therapy (MT) and cognitive behavioral therapy (CBT) – in terms of addressing criminogenic needs and promoting moral development.

By performing a literature review, the study shows that even though there are both pros and cons using MT and CBT in institutional care, relationships strong enough to restructure a young person's moral reasoning require time, and involves not only the young person's parents and social network members, but also a genuine therapeutic alliance with clinical staff at the institution.

These are central factors articulated in both CBT and MT, but are more explicitly expressed in MT. The results presented in this article highlight some important practical implications: in order to redevelop moral self and societal values, an overly narrow focus on criminogenic needs might exclude other components or processes of treatment and behavioral change. Together with a treatment program that views close staff‐resident interactions as of secondary importance, this could impair the possibility to obtain positive and long‐lasting treatment results.

In practice, moral development itself should be considered as an overall treatment goal, integrated into the daily life at the institution, 24 hours a day. Finally, the possibility to work with moral development in institutional settings is discussed.

For the 3.8 per cent of people with intellectual disabilities (IDs) who have offended sexually, the main form of treatment is the group-based, cognitive-behavioural, adapted sex offender treatment programme (ASOTP) that focusses on challenging cognitive distortions condoning sex offending. The purpose of this paper is to provide an evaluation of how effective the ASOTP is at reducing ID sex offenders’ cognitive distortions.

Three databases were searched systematically: PsycINFO, MEDLINE and Web of Science. Six studies met the inclusion criteria, yielding 118 participants. Using a random-effects model, effect sizes were calculated using pre- and post-treatment scores on a measure of cognitive distortions. The standardised mean difference (SMD) was 1.77 (95 per cent CI: 1.06, 2.46), which was statistically significant (p<0.001) and “large”. Sensitivity analysis demonstrated that this SMD was robust, and a check for publication bias revealed that it was unlikely that the “file drawer problem” confounded the meta-analysis.

These results indicated that the ASOTP can significantly reduce ID sex offenders’ cognitive distortions, regardless of treatment length, IQ level, language abilities, or offence type. Consistent with earlier reports, longer treatment resulted in the greatest reductions: the optimum treatment length was 24 months.

The ASOTP’s current evidence is comprised wholly of case and quasi-experimental studies, none of which employed control groups. This paper highlights how there is a dire need for high-quality experimental evaluation of the ASOTP.

Clinicians are advised to continue using the ASOTP as the main treatment for ID sex offenders until the effectiveness of the ASOTP is further examined using randomised controlled trials.

This is the first meta-analytic review of the effectiveness of the ASOTP.

The following case study describes the assessment, formulation and treatment of a man with mild learning disabilities and a history of violent behaviour. Following several years of offence‐related work, identification of chronic low self‐esteem provided an alternative approach to addressing the risk of violence by treatment based on the cognitive model of low self‐esteem. Global self‐esteem and fear of negative evaluation were assessed at baseline, middle and end of treatment and at one‐month follow‐up. Although scores improved over the course of 23 sessions and were maintained at one‐month follow‐up, the change was minimal and unlikely to be clinically significant. However, the client reported benefits from therapy and there were observable positive behaviour changes. Discharge was facilitated from secure services to supported living in the community. The results from this case study show that, with adaptation, cognitive behavioural therapy for low self‐esteem may successfully be applied to people with mild learning disabilities. Therapy to address issues underlying offending behaviour is often required in addition to offending behaviour programmes in order to reduce risk of re‐offending.

Single case experimental design (SCED) has a long, well‐respected tradition in evaluating the effectiveness of behavioural interventions for people with learning disabilities and challenging behaviours. However, shift the focus to other psychological modalities (such as psychodynamic psychotherapy) or differing presenting problems (such as interpersonal problems) and the use of SCED methodologies is severely curtailed. This paper describes the application of SCED methodologies in the evaluation of treatment of three clients: the psychodynamic psychotherapy of hypochondriasis in an A/B design, psychodynamic psychotherapy of ambulophobia in an A/B design, and cognitive‐behavioural therapy of anger and aggression in a shifting criterion design. Visual and statistical analysis of the time series data revealed that the hypochondriasis and the anger cases responded to treatment, whereas the ambulophobia case showed some deterioration during the intervention. The cases are discussed in terms of the strengths and weaknesses of the methodologies applied and the relative merits of accruing SCED evidence in the evaluation of the plethora of psychological modalities now being made available to learning disabled clients.