Treating Learning Disabilities using Cognitive Behaviour Therapy (CBT)

Treating Learning Disabilities using Cognitive Behaviour Therapy (CBT) By: Sana Arshad

Interventions • Learning disabilities can be treated with different psychotherapies: • Psychodynamics • Cognitive Therapies • Cognitive Behaviour Therapy (CBT) CBT and learning disabilities

Historical Perspective of CBT • CBT was devised by Aaron Beck and Ellis in 1960’s-1970’s at the University of Pennsylvania • Originally devised for the treatment of depression; to get rid of the negative thoughts about themselves regarding their worth as a person based on insignificant errors CBT and learning disabilities

Cognitive Behaviour Therapy (CBT) • Cognitive behaviour therapy has been used successfully for some years to help people with emotional difficulties in the general population. It is only recently [only a decade before] that this psychological approach has been applied to people with learning disabilities (Joyce and Hardy, 2003) • Its effectiveness and accepted ness can be seen in LD population. However, the model needs to be applied differently for Learning disability group to take account of their cognitive impairment and support needs. (Brown & Marshall, 2006) CBT and learning disabilities

What is CBT? • CBT is basically a talk therapy, where the clients gets in one-to-one conversation with the therapists. • All types of CBT share 3 fundamental propositions: • Cognitive activity affects behaviour • Cognitive activity may be monitored and altered • Desired behaviour change may be affected through cognitive change (Dobson, 2001) CBT and learning disabilities

Steps involved in CBT Intervention • CBT is a relatively short-term treatment, usually ranging between 4 to 20 sessions that last for approximately an hour (Beck, 1995) • CBT is a focused therapy, which has a structured format. The first session mainly involves assessing the current situation and finding out what the difficulties are. The therapist will explain what CBT is and how it works and discuss the service user's expectations. A goal list will be drawn up and referred to during future sessions. CBT and learning disabilities

CBT goals • CBT works as the service user and therapist begin to identify and challenge the negative automatic thoughts and the underlying beliefs and change their behaviour responses to them. • In helping people to identify negative automatic thoughts the person may be asked to keep a diary, which lists these thoughts at times when they are experiencing emotional distress CBT and learning disabilities

Intervention • Diary helps the therapist to recognize some of their negative thoughts, especially those that are automatic. They can then talk extensively in therapy sessions regarding clients experience. • The therapist would help identify these through asking questions. For example, the therapist might ask: 'What do you think might happen if you stayed at the party, instead of leaving?' • They may even argue openly with clients as they try to persuade them to alter their patterns of thinking (Joyce and Hardy, 2003) CBT and learning disabilities

CBT usage • CBT has been used within various age groups of clients with LDs. Children are in significant amount receiving the treatment. • Usage of CBT on children started when the teachers noticed academic and mental problems that are being experienced by the student. • Witmer Lighter, the first one to have the children clients with learning disabilities used directive, educational and principle based perception and learning to evaluate the effectiveness of the treatment (Meyer and Craighead, 1984) • CBT interventions were also conducted on various other behaviours: -mentally retarded children -aggressive children-socially isolated children etc. CBT and learning disabilities

Putative areas of Brain involved • Superior temporal lobe • perisylvian cortex (surrounding syvian fissure) • developmental dyslexia associated with abnormalities in left planum temporale. Normal individuals have left hemispheres as high • Dyslexics have both equal size 2. Visual and auditory pathway abnormalities • Magnocellular layer of LGN (thalamus) may be damaged causes difficulties in hearing, Motion and spatial location • However, with developmental dyslexia, MGN damage in thalamus can Dyslexics often have difficulties with perception of letters and of movements in space CBT and learning disabilities

Neurobiology of Disorder During pregnancy, low iron deficiencies can lead to low brain development. The right hemisphere temporal lobe of children with learning disabilities seems to be large in size than the left temporal lobe in the left hemisphere of the brain. (Fiedorowicz, 2005) CBT and learning disabilities

Another study using MRI found that dyslexic children seems to produce more lactate and the production was located in different areas of the brain as compare to the normal individuals (Richards, 1999) LDs and lactate production CBT and learning disabilities

CBT and Neuro-imaging • Therefore increasing effectiveness and usage of these CB theraphy indicates that there must have been some kind of change that is occuring, which might have leaded to changes in different areas of the brain, that ended up having effective results for this Therapy. CBT and learning disabilities

Evaluations – Disadvantages • LDs is an umbrella term; CBT has to be modified whenever different types of LDs are diagnosed • Power and self determination issues btw client and therapists. (its better if the relation is collaborative rather than authoritarian) • Difficult to get reliable and valid self-reports from LD’s individuals esp. those with cognitive distortion problems • Waiting time to get therapists appointments are lengthy • Expensive procedure • Difficult to deal with challenging behaviours and with children CBT and learning disabilities

These behaviour interventions are just as effective as medicine in the shorter term and it produce long lasting benefits than drug treatments e.g. insomnia ( Beck, 1999) No side effects as compare to drugs In CBT, Clients also get to say in determining the therapuetic goals as oppose to before where there was no input by the clients [mismatch btw traditional view] Can be used for more than one disability, for instance, stress relief, anger management, insomnia purposes Treatments lasts only for 4-20 sessions (Beck, 1995) Can be used in group settings as well (Rose, 1999) Evaluations – Advantages CBT and learning disabilities

Conclusions • Overall, I believe that if we look at the big picture, CBT has great advantages over disadvantages. Despite of having to go through extra amount of work by the therapists, the self reports found were definitely reliable and valid. And therefore, taking all the considerations into account, Cognitive Behavioural Therapy (CBT) should be considered as the PRIME treatment for Learning Disabilities. CBT and learning disabilities

Other information • Organizations such as Best Buddies while working with Community Living Toronto (CLT) support people with intellectual/learning disabilities. • www.bestbuddies.ca CBT and learning disabilities

Treating Learning Disabilities using Cognitive Behaviour Therapy (CBT)