The effectiveness of cognitive behavioural therapy for individuals with an intellectual disability and anxiety: a systematic review.

INTRODUCTION: Individuals with intellectual disability (ID) are at higher risk of experiencing difficulties with anxiety than the general population. However, there are major barriers for individuals to receive appropriate services. There is a growing understanding of the importance of developing appropriate psychological interventions for this group. The objective of the current review was to systematically evaluate the findings of studies investigating the effectiveness of cognitive behavioural therapy (CBT) for individuals with ID and anxiety. Another aim was to explore which adaptions to CBT and treatment components were currently being utilised within the field. METHOD: The electronic databases of CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection and Scopus were searched to identify relevant studies. The methodological quality of these studies was assessed using established quality assessment tools by the National Institutes of Health for pre and post studies and case series. RESULTS: Nine studies were included in this systematic review, all of which reported improvements in anxiety severity for some participants (25%-100%; N = 60) following CBT. Only three studies reported moderate effect sizes for CBT interventions on anxiety for individuals with ID. DISCUSSION AND CONCLUSIONS: There is emerging literature supporting the effectiveness of CBT for individuals with mild ID. Findings highlight that CBT for individuals with anxiety and mild ID, including cognitive components, may be feasible and tolerable. While the field is gradually receiving more attention, there are significant methodological flaws present, which limit the conclusions that can be drawn regarding the effectiveness of CBT for individuals with ID. However, there is emerging evidence for techniques such as cognitive restructuring and thought replacement and modifications such as visual aids, modelling and smaller groups based on this review. Future research is warranted to investigate whether individuals with more severe ID can benefit from CBT, as well as further exploring what are the necessary components and modifications.

Quantitative analysis of formate in solutions containing phosphate.

Standard colorimetric methods based on the initial reduction of formate to formaldehyde were found to yield erratic results when applied to the analysis of millimolar concentrations of formate in a microbial culture medium. The source of interference was identified as inorganic orthophosphate inhibition of the magnesium/hydrochloric acid reduction stage. Passivation of magnesium by millimolar concentrations of phosphate is known to occur at low pH and it is proposed that this phenomenon is responsible for the inhibition of the reduction process. The presence of orthophosphate in biological extracts is almost universal and would lead to acceptance of spuriously low values for formate concentration if the previously unreported inhibitory effect is not recognized. The colorimetric method of Barker and Somers in which formate is reacted directly with 2-thiobarbituric acid to form the chromophore was evaluated and proved to be entirely free from interference by orthophosphate and other medium components. This method although less sensitive than the formate reduction methods is therefore suggested as the method of choice for the determination of formate in biological or other solutions containing phosphate.

Adenine nucleotide pool and energy charge during growth of a tyrothricin-producing strain of Bacillus brevis.

The adenine nucleotide levels and derived energy charge value of a tyrothricin-producing strain of Bacillus brevis under aerobic conditions were in good agreement with published values for other bacteria. When growing cultures of B. brevis underwent a transition from aerobic to anaerobic conditions, cyclic variations in the level of adenine nucleotides were observed and the energy charge value oxcillated between 0.87 and 0.70. The significance of these changes is considered in relation to antibiotic production as a possible regulatory mechanism in energy metabolism. It is concluded that tyrothricin is not directly involved in the observed changes in energy charge value.