Learning Disability-Adapted Cognitive Behavioural Therapy for Phobia
Abstract
Background: Research suggests cognitive-behavioural therapy (CBT) constitutes an effective intervention for phobia. However, literature investigating the effectiveness of CBT for phobia in people with learning disabilities (LDs) is sparse. This case study reports the outcomes of LD-adapted CBT for phobia.
Method: Following examination of the patient’s developmental history, assumptions, triggers, cognitions, emotions, physiological symptoms, safety-seeking behaviours and secondary cognitions, behavioural experiments were used to reduce a patient’s fear of falling when walking outside. Single case experimental design methodology was used to analyse improvements in the frequency with which the patient walked outside across therapy.
Results: Across therapy, the frequency with which the patient walked outside increased, and her phobia symptoms decreased. By the end of therapy, she regularly walked outside on dry roads, hills, stairs, wet grassy fields, cobbled paths, muddy paths and drains.
Conclusions: This case study provides tentative evidence that LD-adapted CBT attenuates phobias. These results highlight the potential for further research into adapting CBT to meet the unique needs of individuals with LDs.
Keywords
Full Text:
PDFReferences
Altarac, M., & Saroha, E. (2007). Lifetime Prevalence of Learning Disability Among US Children. Pediatrics, 119(Supplement_1), S77–S83. https://doi.org/10.1542/peds.2006-2089L
APA. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, Texas: American Psychiatric Pub. https://doi.org/10.1176/appi.books.9780890425596
Ausín, B., Muñoz, M., Castellanos, M. Á., & García, S. (2020). Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life. International Journal of Environmental Research and Public Health, 17(6). https://doi.org/10.3390/ijerph17061915
Bahr, R., & Silliman, E. (2015). Routledge handbook of communication disorders. Routeledge.
Bang, M., Kim, B., Lee, K. S., Choi, T. K., & Lee, S.-H. (2021). Effectiveness of Mindfulness-Based Cognitive Therapy for Positive Clinical Outcome in Panic Disorder: A 5-year Longitudinal Study. Mindfulness, 12(9), 2149–2160. https://doi.org/10.1007/s12671-021-01667-9
Boyd, J. H., Rae, D. S., Thompson, J. W., Burns, B. J., Bourdon, K., Locke, B. Z., & Regier, D. A. (1990). Phobia: Prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 25(6), 314–323. https://doi.org/10.1007/BF00782887
BPS. (2012). Defining Learning Disability. https://www.bps.org.uk/psychologist/defining-learning-disability
Burton, P., Palicka, A., & Williams, T. I. (2017). Treating specific phobias in young people with autism and severe learning difficulties. The Cognitive Behaviour Therapist, 10, e21. https://doi.org/10.1017/S1754470X17000241
Cowdrey, F. A., & Walz, L. (2015). Exposure therapy for fear of spiders in an adult with learning disabilities: A case report. British Journal of Learning Disabilities, 43(1), 75–82. https://doi.org/10.1111/bld.12106
Altarac, M., & Saroha, E. (2007). Lifetime Prevalence of Learning Disability Among US Children. Pediatrics, 119(Supplement_1), S77–S83. https://doi.org/10.1542/peds.2006-2089L
APA. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington, Texas: American Psychiatric Pub. https://doi.org/10.1176/appi.books.9780890425596
Ausín, B., Muñoz, M., Castellanos, M. Á., & García, S. (2020). Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life. International Journal of Environmental Research and Public Health, 17(6). https://doi.org/10.3390/ijerph17061915
Bahr, R., & Silliman, E. (2015). Routledge handbook of communication disorders. Routeledge.
Bang, M., Kim, B., Lee, K. S., Choi, T. K., & Lee, S.-H. (2021). Effectiveness of Mindfulness-Based Cognitive Therapy for Positive Clinical Outcome in Panic Disorder: A 5-year Longitudinal Study. Mindfulness, 12(9), 2149–2160. https://doi.org/10.1007/s12671-021-01667-9
Boyd, J. H., Rae, D. S., Thompson, J. W., Burns, B. J., Bourdon, K., Locke, B. Z., & Regier, D. A. (1990). Phobia: Prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 25(6), 314–323. https://doi.org/10.1007/BF00782887
BPS. (2012). Defining Learning Disability. https://www.bps.org.uk/psychologist/defining-learning-disability
Burton, P., Palicka, A., & Williams, T. I. (2017). Treating specific phobias in young people with autism and severe learning difficulties. The Cognitive Behaviour Therapist, 10, e21. https://doi.org/10.1017/S1754470X17000241
Cowdrey, F. A., & Walz, L. (2015). Exposure therapy for fear of spiders in an adult with learning disabilities: A case report. British Journal of Learning Disabilities, 43(1), 75–82. https://doi.org/10.1111/bld.12106
Craske, M., Antony, M., & Barlow, D. (1997). Mastery of your specific phobia: Therapist guide. OUP.
Craske, M., Wittchen, H., Bogels, S., Stein, M., Andrews, G., & Lebeu, R. (2013). Severity Measure for Specific Phobia Adult. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Severity-Measure-For-Specific-PhobiaAdult.pdf
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555
Cronen, V. E., Pearce, W. B., & Changsheng, X. (1989). The meaning of ‘meaning’in the CMM analysis of communication: A comparison of two traditions. Research on Language & Social Interaction, 23(1-4), 1-40. https://doi.org/10.1080/08351818909389315
Erostarbe-Pérez, M., Reparaz-Abaitua, C., Martínez-Pérez, L., & Magallón-Recalde, S. (2022). Executive functions and their relationship with intellectual capacity and age in schoolchildren with intellectual disability. Journal of Intellectual Disability Research, 66(1–2), 50–67. https://doi.org/10.1111/jir.12885
Faizah, M., Ramdhani, N., & Utami, M. S. (2024, January 1). Conquer Fear Of Heights Using Virtual Reality Exposure Therapy With Cognitive Restructuring. | Gadjah Mada Journal of Professional Psychology (GamaJPP) | EBSCOhost. https://doi.org/10.22146/gamajpp.89156
Greenberger, D., & Padesky, C. A. (1995). Mind over mood: A cognitive therapy treatment manual for clients (pp. xi, 215). Guilford Press.
Guilfoyle, M. (2015). The Person in Narrative Therapy: A Post-structural, Foucauldian Account. Springer.
Hawton, K., Salkovskis, P. M., Kirk, J., & Clark, D. M. (1989). Cognitive behaviour therapy for psychiatric problems: A practical guide (pp. xii, 456). Oxford University Press.
Hiermeier, U. M., & Mofrad, L. (2020). Feasibility of one-session treatment for specific needle phobia in an adult IAPT service – a case series. The Cognitive Behaviour Therapist, 13, e51. https://doi.org/10.1017/S1754470X2000046X
Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of clinical psychiatry, 69(4), 621.
Hussey, I. (2019). The SCED package for R: Simple and robust visualization, analysis, and meta analysis of A-B Single Case Experimental Design. https://github.com/ianhussey/SCED
Jennett, H. K., & Hagopian, L. P. (2008). Identifying Empirically Supported Treatments for Phobic Avoidance in Individuals With Intellectual Disabilities. Behavior Therapy, 39(2), 151–161. https://doi.org/10.1016/j.beth.2007.06.003
Jurinec, N., & Schienle, A. (2022). Effects of placebos vs. SMS reminders on homework compliance in cognitive behavioral therapy for depression: A randomized trial. Mediterranean Journal of Clinical Psychology, 10(3). https://doi.org/10.13129/2282-1619/mjcp-3458
Kaloeti, D. V. S., Yuniarti, K. W., Siswandi, A. G. P., & Tuapattinaja, J. M. R. (2021). Adaptation and psychometric properties of Severity Measure for Specific Phobia-Adult in an Indonesian sample. Health Psychology Report, 10(4), 319–326. https://doi.org/10.5114/hpr.2021.110789
Kirk, J., & Rouf, K. (2004). Specific phobias. In Oxford guide to behavioural experiments in cognitive therapy.
Korh, P. E., & Giuliani, F. (2016). CBT of a Person Living in a Situation of Mental Handicap and Presenting an Anxiety Disorder Coupled with a Specific Phobia. Clinical Psychiatry, 2(2). https://doi.org/10.21767/2471-9854.100020
Mackintosh, N. J. (1975). A theory of attention: Variations in the associability of stimuli with reinforcement. Psychological Review, 82, 276–298. https://doi.org/10.1037/h0076778
MacLeod, S., Schneider, L. H., & McCabe, R. E. (2022). Investigating the Psychometric Properties of the Severity Measure for Specific Phobia. Journal of Psychopathology and Behavioral Assessment, 44(3), 826–835. https://doi.org/10.1007/s10862-022-09976-6
McNally, R. J. (2016). The Legacy of Seligman’s ‘Phobias and Preparedness’ (1971). Behavior Therapy, 47(5), 585–594. https://doi.org/10.1016/j.beth.2015.08.005
McNally, R. J., & Foa, E. B. (1986). Preparedness and resistance to extinction to fear-relevant stimuli: A failure to replicate. Behaviour Research and Therapy, 24(5), 529–535. https://doi.org/10.1016/0005-7967(86)90033-1
Morley, S. (2017). Single Case Methods in Clinical Psychology: A Practical Guide. Routledge.
Myles, L. A., & Jones, E. (2024). Single Case Experimental Design Examining Cognitive Behavioural Therapy for Post-Stroke Depression. Journal of Mind and Medical Sciences, 11(1), 233–241.
Myles, L. A. M. (2021). Opinion Article: The Emerging Role of Computational Psychopathology in Clinical Psychology. Mediterranean Journal of Clinical Psychology, 9(1). https://doi.org/10.6092/2282-1619/mjcp-2895
Myles, L. A. M., Connolly, J., & Stanulewicz, N. (2020). The Mediating Role of Perceived Control and Desire for Control in the Relationship between Personality and Depressive Symptomology. Mediterranean Journal of Clinical Psychology, Vol 8, No 3 (2020). https://doi.org/10.6092/2282-1619/mjcp-2589
Myles, L. A. M., & Johnson, P. G. B. (2023). Parsimony: A Forgotten Principle in Clinical Psychology and Classics. Mediterranean Journal of Clinical Psychology, 11(1). https://doi.org/10.13129/2282-1619/mjcp-3715
Myles, L. A. M., & Merlo, E. M. (2022). Incongruities between Perceived Control and Desire for Control: A Mechanistic Account of Depression in Adolescence. 22(1), 40–44. https://doi.org/10.15557/PiPK.2022.0005
Myles, L. A., Merlo, E., & Obele, A. (2021). Desire for Control Moderates the Relationship between Perceived Control and Depressive Symptomology. Journal of Mind and Medical Sciences, 8(2), 299–305. https://doi.org/10.22543/7674.82.P299305
NICE. (2011, January 26). Recommendations | Generalised anxiety disorder and panic disorder in adults: Management | Guidance | NICE. NICE. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations
NICE. (2016, September 14). Recommendations | Mental health problems in people with learning disabilities: Prevention, assessment and management | Guidance | NICE. NICE.https://www.nice.org.uk/guidance/ng54/chapter/Recommendations#psychological-interventions
Odgers, K., Kershaw, K. A., Li, S. H., & Graham, B. M. (2022). The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behaviour Research and Therapy, 159, 104203. https://doi.org/10.1016/j.brat.2022.104203
Öhman, A., Eriksson, A., Fredriksson, M., Hugdahl, K., & Olofsson, C. (1974). Habituation of the electrodermal orienting reaction to potentially phobic and supposedly neutral stimuli in normal human subjects. Biological Psychology, 2(2), 85–93. https://doi.org/10.1016/0301-0511(74)90017-9
Öhman, A., Eriksson, A., & Olofsson, C. (1975). One-trial learning and superior resistance to extinction of autonomic responses conditioned to potentially phobic stimuli. , 88(2), 619. Journal of Comparative and Physiological Psychology, 88(2), 619.
Ollendick, T. H., Raishevich, N., Davis III, T. E., Sirbu, C., & Öst, L.-G. (2010). Specific Phobia in Youth: Phenomenology and Psychological Characteristics. Behavior Therapy, 41(1), 133–141. https://doi.org/10.1016/j.beth.2009.02.002
Ovanessian, M. M., Fairbrother, N., Vorstenbosch, V., McCabe, R. E., Rowa, K., & Antony, M. M. (2019). Psychometric Properties and Clinical Utility of the Specific Phobia Questionnaire in an Anxiety Disorders Sample. Journal of Psychopathology and Behavioral Assessment, 41(1), 36–52. https://doi.org/10.1007/s10862-018-9687-1
Padhy, S. K., Goel, S., Das, S. S., Sarkar, S., Sharma, V., & Panigrahi, M. (2016). Prevalence and Patterns of Learning Disabilities in School Children. The Indian Journal of Pediatrics, 83(4), 300–306. https://doi.org/10.1007/s12098-015-1862-8
Paul, R., & Elder, L. (2019). The Thinker’s Guide to Socratic Questioning. Rowman & Littlefield.
Penn, P. (1982). Circular Questioning. Family Process, 21(3), 267–280. https://doi.org/10.1111/j.1545-5300.1982.00267.x
Powers, A. R., Mathys, C., & Corlett, P. R. (2017). Pavlovian conditioning–induced hallucinations result from overweighting of perceptual priors. Science, 357(6351), 596–600. https://doi.org/10.1126/science.aan3458
Rescorla, R. A. (2000). Experimental Extinction. In Handbook of Contemporary Learning Theories. Psychology Press.
Rescorla, R. A., & Wagner, A. R. (1972). A theory of Pavlovian conditioning: Variations in the effectiveness of reinforcement and nonreinforcement. Current Research and Theory, 64–99.
Riddle-Walker, L., Veale, D., Chapman, C., Ogle, F., Rosko, D., Najmi, S., Walker, L., Maceachern, P., & Hicks, T. (2016). Cognitive behaviour therapy for specific phobia of vomiting (Emetophobia): A pilot randomized controlled trial. Journal of Anxiety Disorders, 43, 14–22. https://doi.org/10.1016/j.janxdis.2016.07.005
Ruscio, J. (2008). A probability-based measure of effect size: Robustness to base rates and other factors. Psychological Methods, 13(1), 19–30. https://doi.org/10.1037/1082-989X.13.1.19
Sancassiani, F., Romano, F., Balestrieri, M., Caraci, F., Di Sciascio, G., Drago, F., Hardoy, M. C., Moro, M. F., Roncone, R., Piras, M., Preti, A., Dell’Osso, L., Faravelli, C., & Carta, M. G. (2019). The Prevalence of Specific Phobia by Age in an Italian Nationwide Survey: How Much Does it Affect the Quality of Life? Clinical Practice and Epidemiology in Mental Health : CP & EMH, 15, 30–37. https://doi.org/10.2174/1745017901915010030
Seligman, M. E. (1970). On the generality of the laws of learning. Psychological Review, 77(5), 406–418. https://doi.org/10.1037/h0029790
Seligman, M. E., & Hager, J. L. (1972). Biological boundaries of learning (pp. xi, 480). Appleton-Century-Crofts.
Silvestro, O., Vicario, C. M., Costa, L., Sparacino, G., Lund-Jacobsen, T., Spatola, C. A., Merlo, E. M., Viola, A., Giorgianni, C. M., Catalano, A., Fries, W., Lo Coco, G., & Martino, G. (2025). Defense mechanisms and inflammatory bowel diseases: a narrative review. Research in Psychotherapy: Psychopathology, Process and Outcome. Advance online publication. https://doi.org/10.4081/ripppo.2025.854
Stans, S. E. A., Dalemans, R. J. P., de Witte, L. P., & Beurskens, A. J. H. M. (2019). Using Talking Mats to support conversations with communication vulnerable people: A scoping review. Technology and Disability, 30(4), 153–176. https://doi.org/10.3233/TAD-180219
Tangarife, M. A. C., & Martínez, D. A. L. (2024). Effect of cognitive training on executive functions and anxiety in patients with mild cognitive impairment: A systematic review. Mediterranean Journal of Clinical Psychology, 12(2). https://doi.org/10.13129/2282-1619/mjcp-4092
van Dis, E., van Veen, S., Hagenaars, M., Batelaan, N., Bockting, C., van den Heuvel, R., Cuijpers, P., & Engelhard, I. (2020). Long-term Outcomes of Cognitive Behavioral Therapy for Anxiety-Related Disorders A Systematic Review and Meta-analysis. Jama Psychiatry, 77(3), 265–273. https://doi.org/10.1001/jamapsychiatry.2019.3986
Wardenaar, K. J., Lim, C. C. W., Al-Hamzawi, A. O., Alonso, J., Andrade, L. H., Benjet, C., Bunting, B., Girolamo, G. de, Demyttenaere, K., Florescu, S. E., Gureje, O., Hisateru, T., Hu, C., Huang, Y., Karam, E., Kiejna, A., Lepine, J. P., Navarro-Mateu, F., Browne, M. O., … Jonge, P. de. (2017). The cross-national epidemiology of specific phobia in the World Mental Health Surveys. Psychological Medicine, 47(10), 1744–1760. https://doi.org/10.1017/S0033291717000174
Wechsler, T. F., Kümpers, F., & Mühlberger, A. (2019). Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?—A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01758
Welsh, J. P., Munson, J., St John, T., Meehan, C. N., Tran Abraham, E., Reitz, F. B., Begay, K. K., Dager, S. R., & Estes, A. M. (2023). Relationship of Impairments in Associative Learning With Intellectual Disability and Cerebellar Hypoplasia in Autistic Children. Neurology, 100(6), e639–e650. https://doi.org/10.1212/WNL.0000000000201496
Westbrook, D., Kennerley, H., & Kirk, J. (2011). An Introduction to Cognitive Behaviour Therapy: Skills and Applications. SAGE.
Westerinen, H., Kaski, M., Virta, L., Almqvist, F., & Iivanainen, M. (2007). Prevalence of intellectual disability: A comprehensive study based on national registers. Journal of Intellectual Disability Research, 51(9), 715–725. https://doi.org/10.1111/j.1365-2788.2007.00970.x
Wolitzky-Taylor, K., Horowitz, J., Powers, M., & Telch, M. (2008). Psychological approaches in the treatment of specific phobias: A meta-analysis. Clinical Psychology Review, 28(6), 1021–1037. https://doi.org/10.1016/j.cpr.2008.02.007
Wolpe, J. (1968). Psychotherapy by reciprocal inhibition. Conditional Reflex : A Pavlovian Journal of Research & Therapy, 3(4), 234–240. https://doi.org/10.1007/BF03000093
Ximenes, V. M., Manolov, R., Solanas, A., & Quera, V. (2009). Factors Affecting Visual Inference in Single-Case Designs. The Spanish Journal of Psychology, 12(2), 823–832. https://doi.org/10.1017/S1138741600002195
DOI: https://doi.org/10.13129/2282-1619/mjcp-4581
Refbacks
- There are currently no refbacks.