title: Anger management for people with mild to moderate learning disabilities: study protocol for a multi-centre cluster randomized controlled trial of a manualized intervention delivered by day-service staff.
abstract: BACKGROUND
  Cognitive behaviour therapy (CBT) is the treatment of choice for common mental health problems, but this approach has only recently been adapted for people with learning disabilities, and there is a limited evidence base for the use of CBT with this client group. Anger treatment is the one area where there exists a reasonable number of small controlled trials. This study will evaluate the effectiveness of a manualized 12-week CBT intervention for anger. The intervention will be delivered by staff working in the day services that the participants attend, following training to act as 'lay therapists' by a Clinical Psychologist, who will also provide supervision.
  
  
  METHODS
  This is a multi-centre cluster randomized controlled trial of a group intervention versus a 'support as usual' waiting-list control group, with randomization at the level of the group. Outcomes will be assessed at the end of the intervention and again 6-months later. After completion of the 6-month follow-up assessments, the intervention will also be delivered to the waiting-list groups. The study will include a range of anger/aggression and mental health measures, some of which will be completed by service users and also by their day service key-workers and by home carers. Qualitative data will be collected to assess the impact of the intervention on participants, lay therapists, and services, and the study will also include a service-utilization cost and consequences analysis.
  
  
  CONCLUSIONS
  This will be the first trial to investigate formally how effectively staff working in services providing day activities for people with learning disabilities are able to use a therapy manual to deliver a CBT based anger management intervention, following brief training by a Clinical Psychologist. The demonstration that service staff can successfully deliver anger management to people with learning disabilities, by widening the pool of potential therapists, would have very significant benefits in relation to the current policy of improving access to psychological therapies, in addition to addressing more effectively an important and often unmet need of this vulnerable client group. The economic analysis will identify the direct and indirect costs (and/or savings) of the intervention and consider these in relation to the range of observed effects. The qualitative analyses will enhance the interpretation of the quantitative data, and if the study shows positive results, will inform the roll-out of the intervention to the wider community.
  
  
  BACKGROUND
  ISRCTN: ISRCTN37509773.
authors.affiliation: Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, and Dept of Psychology, Swansea University, UK. P.Willner@swansea.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Willner
authors.forename: Andrew
authors.initials: A
authors.lastname: Jahoda
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Biza
authors.initials: B
authors.lastname: Stenfert-Kroese
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.forename: Julia K
authors.initials: JK
authors.lastname: Townson
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nuttall
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.forename: David
authors.initials: D
authors.lastname: Felce
mesh_terms: D000328:Adult; D000786:Anger; D015928:Cognitive Behavioral Therapy; D003631:Day Care, Medical; D006282:Health Personnel; D006801:Humans; D007859:Learning Disabilities / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D012107:Research Design; D012720:Severity of Illness Index