title: Group-based cognitive-behavioural anger management for people with mild to moderate intellectual disabilities: cluster randomised controlled trial.
abstract: BACKGROUND
  Many people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a cognitive-behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities.
  
  
  METHODS
  A cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773).
  
  
  RESULTS
  The intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% CI -1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour.
  
  
  CONCLUSIONS
  The intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.
authors.affiliation: Paul Willner, DSc, Psychology Department, Swansea University, Swansea and Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; John Rose, PhD, School of Psychology, University of Birmingham, Birmingham and Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; Andrew Jahoda, PhD, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow; Biza Stenfert Kroese, PhD, School of Psychology, University of Birmingham, Birmingham; David Felce, PhD, Welsh Centre for Learning Disabilities, Psychological Medicine and Neurology, Cardiff University, Cardiff; David Cohen, PhD, Health Economics and Policy Research Unit, University of Glamorgan, Pontypridd; Pamela MacMahon, DClinPsy, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Aimee Stimpson, DClinPsy, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; Nicola Rose, DClinPsy, Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; David Gillespie, BSc, South East Wales Trials Unit, Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University, Cardiff; Jennifer Shead, MSc, Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; Claire Lammie, BSc, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Christopher Woodgate, MSc, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; Julia Townson, BA, Jacqueline Nuttall, BSc, Kerenza Hood, PhD, South East Wales Trials Unit, Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University, Cardiff, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Willner
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Andrew
authors.initials: A
authors.lastname: Jahoda
authors.forename: Biza Stenfert
authors.initials: BS
authors.lastname: Kroese
authors.forename: David
authors.initials: D
authors.lastname: Felce
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Pamela
authors.initials: P
authors.lastname: Macmahon
authors.forename: Aimee
authors.initials: A
authors.lastname: Stimpson
authors.forename: Nicola
authors.initials: N
authors.lastname: Rose
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shead
authors.forename: Claire
authors.initials: C
authors.lastname: Lammie
authors.forename: Christopher
authors.initials: C
authors.lastname: Woodgate
authors.forename: Julia
authors.initials: J
authors.lastname: Townson
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nuttall
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000786:Anger; D016000:Cluster Analysis; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000191:economics / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome