Group-based cognitive-behavioural anger management for people with mild to moderate intellectual disabilities: Cluster randomized controlled trial{

Paul Willner*, John Rose, Andrew Jahoda, Biza Stenfert Kroese, David Felce, David Cohen, Pamela MacMahon, Aimee Stimpson, Nicola Rose, David Gillespie, Jennifer Shead, Claire Lammie, Christopher Woodgate, Julia Townson, Jacqueline Nuttall, Kerenza Hood

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)


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. Aims To evaluate the effectiveness of a cognitive-behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities. Method 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 71.7 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 selfreport 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.

Original languageEnglish
Pages (from-to)288-296
Number of pages9
JournalBritish Journal of Psychiatry
Issue number4
Publication statusPublished - 1 Oct 2013

ASJC Scopus subject areas

  • Psychiatry and Mental health


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