Narrative Exposure Therapy for Traumatic Stress in Adults With Intellectual Disabilities: A Sequential Measurement Single Case Study Series
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 主要终点
- Change across the Impact of Events Scale-Intellectual Disabilities (IES-ID).
研究概览
简要总结
The purpose of the study is to identify how Narrative Exposure Therapy (NET) can be adapted for delivery with adults with mild Intellectual Disability (ID) and to explore whether NET can reduce symptoms of traumatic stress in this population.
The first phase of the research involves working with a speech and language therapist to make adaptations to the therapy and research materials for adults with mild ID. This work will then be triangulated by gaining feedback from a service user focus group on the accessibility of materials for adults with mild ID.
The second phase of the research consists of a 'sequential measurement single case studies series' to explore the effectiveness of Narrative Exposure Therapy (NET) in reducing symptoms of PTSD or prominent symptoms. Questionnaires will be completed before, during and after the therapy by both the adult with ID and a carer if possible and consenting. Electrodermal activity of participants will be measured throughout sessions (using an unobtrusive device) as an indicator of physiological arousal. All measures will be visually analysed using established criteria and statistical methods where possible. The impact of NET on a person's memory of events in their life will be explored by examining how coherent participants' accounts of traumatic experiences are before and after NET using coding systems developed by previous studies. An interview will take place approximately six weeks after therapy with the participant by an independent researcher. This will aim to collect qualitative data about the participants' experiences of NET and will be analysed using content analysis.
Participants will be recruited primarily from Intellectual Disability services in Nottinghamshire Healthcare NHS Foundation Trust. This will be extended to Derbyshire Healthcare NHS Foundation Trust and Lincolnshire Partnership NHS Foundation Trust if necessary (Secondary care). The investigators intend to recruit six participants and six carers to the study.
详细描述
People with ID have a substantially higher prevalence of mental health conditions when compared to the general population and are at greater risk of exposure to adverse life events. In a survey of 177 people with mild to moderate ID, 75% had experienced at least one traumatic event. It is therefore not surprising that, when compared to the general population, people with ID are more vulnerable to the development of post-traumatic stress disorder (PTSD).
Whilst the research suggests that people with ID have an increased risk of developing PTSD, there is a lack of research into trauma-focused interventions for this population. This is despite evidence that people with an ID within the mild range have been found to have the necessary skills to engage in the cognitive component of cognitive behavioural therapy (CBT) and the existence of a manual of CBT for people with mild ID and mood disorders.
The National Institute for Health and Care Excellence (NICE) recommends individual trauma-focused cognitive behavioural therapy (TFCBT) as a first line treatment for PTSD in adults and specifies Narrative Exposure Therapy (NET) as an example treatment. There appears to be no evidence to date of attempts to adapt NET for adults with ID and establish whether the therapeutic benefits described in the general population, in terms of reducing symptoms of trauma, are transferable to this population. This study would therefore be a first attempt in doing so.
The potential clinical benefit of the research is that a NICE recommended treatment for PTSD would be adapted for adults with mild ID and, if found to be effective, would increase the evidence base for trauma specific interventions for adults with ID. This would mean a better understanding of which therapies could help to reduce symptoms of traumatic stress in this population. At a service level, research into the effectiveness of different types of therapies guides best practice meaning resources are directed at therapies most likely to yield positive outcomes for service users.
The first phase of the research requires the lead investigator (Katie Marlow) to work with a speech and language therapist (SALT) to make general adaptations to the therapy and research materials for delivery with adults with mild ID. It is expected that the investigator and SALT will meet on multiple occasions. During these meetings, it is anticipated that:
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Participants must be:
- •18 or over (no upper age limit due to ID services being lifelong).
- •deemed to meet criteria for a mild intellectual disability, according to the clinical psychologist supporting recruitment.
- •Experiencing traumatic stress, as assessed by their clinical psychologist using the Impact of Events Scale - Intellectual Disabilities. Traumatic stress will be a feature of their presenting problems but they are not required to have a diagnosis of PTSD (NET recommended to treat prominent symptoms also).
- •English speaking.
- •Able to travel to one of the therapy centres.
- •Able to consent to the research, as assessed by both the clinical psychologist supporting recruitment and the student delivering NET.
- •Carer participants must be:
- •18 or over (no upper age limit).
- •English speaking to undertake informant questionnaires.
- •Able to comment on the symptoms of traumatic stress experienced daily by the participant.
排除标准
- •Participants will be excluded if they are:
- •Substance dependent (NET requires participants to process traumatic experiences in detail; often substances are used as a way to block out these memories and therefore may impact on the therapy).
- •Experiencing psychosis as assessed by both the clinical psychologist supporting recruitment and the student delivering NET.
- •Currently an inpatient (NET at this time would be inappropriate due to challenging behaviour/level of illness).
- •Currently engaging in a trauma-focused therapy with their psychologist (it would not be appropriate to interrupt potentially beneficial treatment).
- •Currently engaging in other research projects (this would burden the participant and depending on the nature may affect results of this project).
- •Carer participants will be excluded if:
- •They lack capacity to consent to take part in the research, as assessed by both the clinical psychologist supporting recruitment and the student delivering NET.
结局指标
主要结局
Change across the Impact of Events Scale-Intellectual Disabilities (IES-ID).
时间窗: Through study completion, up to 24 weeks - at baseline, at each NET session and six weeks after NET has been completed.
The IES-ID is a 22-item questionnaire scored on a three-point scale. It is designed for use with people with mild ID and measures symptoms of traumatic stress; higher scores indicate higher levels of traumatic stress. The authors found the scale to have excellent internal consistency, good to excellent test-retest reliability and good correlation with self-report measures of anxiety and depression.
次要结局
- Change across the Lancaster and Northgate Trauma Scales - Informant Version (LANTS-IV).(Through study completion, up to 24 weeks - at baseline, at final session of NET and six weeks after NET has been completed.)
- Change across the Clinical Outcome Routine Evaluation-Learning Disabilities (CORE-LD).(Through study completion, up to 24 weeks - at baseline, at each NET session and six weeks after NET has been completed.)