title: Measures of readiness for cognitive behavioural therapy in people with intellectual disability: A systematic review.
abstract: OBJECTIVE
  Cognitive behavioural therapy (CBT) is a promising treatment for mental health problems in people with intellectual disabilities but some may not be suited or ready. This review critically evaluates the quality and utility of measures of CBT readiness in people with intellectual disabilities.
  
  
  METHODS
  Twelve studies of six measures based on three aspects of CBT readiness were identified through systematic review.
  
  
  RESULTS
  Across measures, measurement quality was largely poor or un-assessed. Only one study evaluated measurement change over the course of CBT. Not all participants with intellectual disabilities could 'pass' readiness measures and performance may be affected by levels of language and cognitive functioning. There was some evidence that CBT readiness is trainable with brief interventions.
  
  
  CONCLUSIONS
  Before using readiness measures in a clinical context, further work is needed to extend initial evidence on recognising cognitive mediation as a CBT readiness ability. Given the lack of consensus as to the definition of CBT readiness and the heterogeneity of CBT interventions, future research could also focus on developing readiness measures using a bottom up approach, developing measures within the context of CBT interventions themselves, before further refining and establishing their psychometric properties.
  
  
  CONCLUSIONS
  This paper is the first to systematically review measures of skills thought necessary to be ready for cognitive behavioural therapy in intellectual disabilities. The findings suggest that while readiness skills may be trainable with brief interventions, the available measures of these skills have not been fully evaluated for quality. Levels of functioning on these measures have yet to be established relative to those without intellectual disabilities and critically, there is very little evidence as to whether these skills are important in cognitive behavioural therapy process and outcome. We suggest that future research could focus on those constructs where there is preliminary evidence for utility such as recognising cognitive mediation and also on developing the concept of readiness perhaps by developing measures within the context of specific CBT interventions. Until this is done, clinicians should exercise caution in using these measures to assess readiness for cognitive behavioural therapy in people with intellectual disabilities.
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom. Electronic address: j.stott@ucl.ac.uk.
authors.forename: Joshua
authors.initials: J
authors.lastname: Stott
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom.
authors.forename: Georgina
authors.initials: G
authors.lastname: Charlesworth
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom.
authors.forename: Katrina
authors.initials: K
authors.lastname: Scior
mesh_terms: D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D009042:Motivation
keywords: CBT; Cognitive behavioural therapy; Intellectual disabilities; Measures; Readiness; Suitability