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

Research output: Contribution to journalArticlepeer-review


  • Paul Willner
  • Andrew Jahoda
  • David Felce
  • David Cohen
  • Pamela MacMahon
  • Aimee Stimpson
  • Nicola Rose
  • David Gillespie
  • Jennifer Shead
  • Claire Lammie
  • Christopher Woodgate
  • Julia Townson
  • Jacqueline Nuttall
  • Kerenza Hood

Colleges, School and Institutes

External organisations

  • University of Glasgow
  • Gloucestershire Hospital's NHS Foundation Trust
  • Cardiff University
  • Science and Sport, University of Glamorgan
  • Technische Universität
  • Institute of Health and Wellbeing
  • Health Economics and Policy Research Unit Faculty of Health Sport and Science University of South Wales Pontypridd UK
  • Directorate of Learning Disability Services Abertawe Bro Morgannwg University Health Board Bridgend UK
  • Swansea University
  • College of Medical
  • Veterinary and Life Sciences
  • Welsh Centre for Learning Disabilities
  • Psychological Medicine and Neurology
  • University of Glamorgan
  • Abertawe Bro Morgannwg University Health Board
  • DClinPsy, Behavioural
  • Dementia and Psychological Services
  • Black Country Partnership NHS Foundation Trust
  • South East Wales Trials Unit
  • Institute for Translation
  • Methodology and Engagement (TIME)
  • Behavioural


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

Sustainable Development Goals