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Treating Learning Disabilities using Cognitive Behaviour Therapy CBT


... has been applied to people with learning disabilities (Joyce and Hardy, 2003) ... to evaluate the effectiveness of the treatment (Meyer and Craighead, 1984) ... – PowerPoint PPT presentation

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Title: Treating Learning Disabilities using Cognitive Behaviour Therapy CBT

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

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

Historical Perspective of CBT
  • CBT was devised by Aaron Beck and Ellis in
    1960s-1970s 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

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)

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

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

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

  • 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 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.

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

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)

LDs and lactate production
  • 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)

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.

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 LDs individuals esp. those with cognitive
    distortion problems
  • Waiting time to get therapists appointments are
  • Expensive procedure
  • Difficult to deal with challenging behaviours and
    with children

Evaluations Advantages
  • 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,
  • Can be used in group settings as well (Rose,

  • 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.

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