Psychological interventions in forensic learning disability services:a focus on anger and aggression

Difficulties with emotion regulation are reported as commonly experienced by people with intellectual disabilities (PWID). These difficulties can lead to the involvement of PWID with forensic services, and the requirement for them to undertake psychological therapies aimed at improving their regulation of emotion. This thesis firstly provides a critical review of the quantitative evidence for the effectiveness of interventions addressing the most prevalent form of emotion dysregulation for PWID in community-based and inpatient forensic services: anger and outwardly-directed aggression. Sixteen studies met the inclusion criteria and offered promising evidence for the effectiveness of a range of psychological approaches in improving anger and reducing aggression. However, firm conclusions and generalisability of findings were precluded due to the pervasive methodological shortcomings across studies, and accordingly, recommendations for future research and service providers were made. Second, this thesis empirically explores the process of engagement and perceived change for PWID in forensic services attending dialectical behaviour therapy (DBT). The perspectives on “what works” in DBT are gathered via interviews with nine participants and analysed using a constructivist grounded theory-informed methodology. The resultant model highlighted a temporal process within which participants encounter a difficult and coercive journey from compliance and avoidance, to acceptance and integration of change. The model was discussed in relation to current theory on the process of change, and clinical implications were made in respect of improving the support provided to PWID attending DBT in forensic settings. Future research is encouraged to explore and address perceived coercion and aversive elements within psychological interventions for PWID, to enhance treatment experience, effectiveness and evaluation. Finally, reflections were offered in the critical appraisal section of this thesis on the potential challenges of conducting research with PWID in forensic settings and the recurrent theme of coercion noted in respect of this population