Relaxation reduces disruption in mentally handicapped adults. Assertiveness and problem-solving training for mildly mentally retarded persons with dual diagnoses. Individual cognitive-behavioural anger treatment for people with mild-borderline intellectual disabilities and histories of aggression: a controlled trial.
To assess the effects of modified relaxation training on subsequent disruptive behaviour, two groups of six non-institutionalized mentally handicapped adults were compared. At the end of 3 weeks training, those given relaxation training showed 71% more relaxation after relaxation sessions and 74% less disruptive behaviour later in the day, whereas controls who were only told stories showed no decrease; aggression and verbal disruption showed the most consistent effects. This suggests that modified relaxation is rapidly effective in inducing relaxation and in reducing disruption. This study investigated the differential effectiveness of assertiveness and problem-solving training on dually diagnosed patients' adaptive social behavior, distress and psychiatric symptoms, anger control, and problem-solving coping skills using a counterbalanced design. Assessments were conducted at pretreatment, midphase, posttreatment, and a 3-month follow-up examination. A combined assertiveness and problem-solving training package was effective for treatment of individuals with mild mental retardation with dual psychiatric diagnoses. Specifically, improvements occurred regarding both self-report measures of distress and caregiver ratings of adaptive functioning; however, no essential differences were found between these two treatment protocols. The importance of using self-regulatory models of therapy with this population is highlighted, and recommendations were made for future research. Anger is a significant predictor and activator of violent behaviour in patients living in institutional settings. There is some evidence for the value of cognitive-behavioural treatments for anger problems with people with intellectual disabilities. In this study, a newly designed treatment targeted at anger disposition, reactivity, and control was provided to intellectually disabled offenders with aggression histories living in secure settings.
                About forty detained patients with mild-borderline intellectual disabilities and histories of serious aggression were allocated to specially modified cognitive-behavioural anger treatment (AT group) or to routine care waiting-list control (RC group) conditions.
                AT group participants received 18 sessions of individual treatment. The AT and RC groups were assessed simultaneously at 4 time points: screen, pre- and post-treatment, and at 4-month follow-up using a range of self- and staff-rated anger measures. The effectiveness of the treatment was evaluated using ANCOVA linear trend analyses of group differences on the main outcome measures.
                The AT group's self-reported anger scores on a number of measures were significantly lower following treatment, compared with the RC wait-list condition, and these improvements were maintained at follow-up. Limited evidence for the effectiveness of treatment was provided by staffs' ratings of patient behaviour post-treatment.
                Detained men with mild-moderate intellectual disabilities and histories of severe aggression can successfully engage in, and benefit from, an intensive individual cognitive-behavioural anger treatment that also appears to have beneficial systemic effects.
The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwardly directed aggression in children and adults with learning disabilities is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.