Paul Willner, DSc, Psychology Department, Swansea University, Swansea and Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; John Rose, PhD, School of Psychology, University of Birmingham, Birmingham and Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; Andrew Jahoda, PhD, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow; Biza Stenfert Kroese, PhD, School of Psychology, University of Birmingham, Birmingham; David Felce, PhD, Welsh Centre for Learning Disabilities, Psychological Medicine and Neurology, Cardiff University, Cardiff; David Cohen, PhD, Health Economics and Policy Research Unit, University of Glamorgan, Pontypridd; Pamela MacMahon, DClinPsy, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Aimee Stimpson, DClinPsy, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; Nicola Rose, DClinPsy, Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; David Gillespie, BSc, South East Wales Trials Unit, Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University, Cardiff; Jennifer Shead, MSc, Behavioural, Dementia and Psychological Services, Black Country Partnership NHS Foundation Trust, Stourbridge; Claire Lammie, BSc, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Christopher Woodgate, MSc, Directorate of Learning Disability Services, Abertawe Bro Morgannwg University Health Board, Neath; Julia Townson, BA, Jacqueline Nuttall, BSc, Kerenza Hood, PhD, South East Wales Trials Unit, Institute for Translation, Innovation, Methodology and Engagement (TIME), Cardiff University, Cardiff, UK.
Br J Psychiatry. 2013 Sep;203(3):288-96. doi: 10.1192/bjp.bp.112.124529. Epub 2013 Mar 21.
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 -1.7 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 self-report 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.
背景：许多智障人士难以控制自己的愤怒，这往往会导致攻击性，从而产生严重后果，例如被主流服务机构排斥，以及需要潜在的更昂贵的紧急安置。
目的：评估认知行为疗法（CBT）干预对智障人士愤怒管理的有效性。
方法：一项基于群体的为期 12 周的 CBT 小组随机对照试验，在智障人士日间服务中心进行，由护理人员使用治疗手册提供。参与者为 179 名被确定为有愤怒控制问题的服务使用者，他们被随机分配到愤怒管理组或常规治疗组。在干预前、随机分组后 16 周和 10 个月进行评估（试验注册：ISRCTN37509773）。
结果：干预对参与者在挑衅指数上的愤怒报告仅有很小且无统计学意义的影响，这是主要的结果衡量指标（10 个月时的平均差异为 2.8，95%CI-1.7 至 7.4）。然而，关键指标人员的挑衅指数在两次随访评估中均显著降低，基于个人相关触发因素的另一种自我报告愤怒测量的服务使用者评分也是如此。服务使用者和他们的关键指标人员都在两次随访评估中报告了更多的愤怒应对技能的使用，关键指标人员和家庭护理人员报告了较低的挑战性行为水平。
结论：该干预措施有效地改善了智障人士的愤怒控制。它为该客户群体的 CBT 干预有效性提供了证据，并证明与他们一起工作的员工可以接受培训和监督，以合理的保真度提供此类干预。
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