Purpose: Unresolved trauma, emotional dysregulation, and maladaptive thinking patterns are closely related to violent offending by people with intellectual disability. Current interventions usually use either Cognitive Behavior Therapy (CBT) or Dialectical Behavior Therapy (DBT) alone, with little attention to trauma-informed modifications. The study determined the efficacy of a trauma-informed integrated CBT-DBT programme in violent behavior reduction and the enhancement of emotional regulation in violent offenders with intellectual disability.
Methods: The quasi-experimental pre- and post-intervention design was used. The participants of the study were 48 male violent offenders whose intelligence levels ranged from mild to moderate in a secure forensic rehabilitation environment. The participants were provided with a 24-week systematic trauma-informed CBT-DBT programme. Violence risk (HCR-20), emotional regulation (DERS), trauma symptoms (TSQ), and behavioral incidents were outcome measures. Paired t-tests and effect size (Cohen's d) were used to analyze data, and significance was set at p =0.05.
Findings: Post-intervention comparison of results indicated that the risk score of violence significantly decreased (mean = 28.6, t(47) = 6.12, p < 0.001, d=0.88). The scores of emotional dysregulations were reduced by 31.4 (p<0.001), and the severity of trauma symptoms was lowered by 26.9 (p=0.002). Violent incidents recorded dropped in an average of 3.4 to 1.2 violent incidents per participant per month, which is a reduction of 64.7%. The evidence endorses the application of trauma-informed, combined CBT-DBT interventions to forensic service provision to individuals with intellectual disability, as a means of providing clinicians with a framework to facilitate a flexible and evidence-based way of rehabilitating individuals.
Conclusion: The study is among the first empirical reviews of a trauma-informed CBT-DBT integrated model specifically designed to work with violent offenders who have intellectual disability to fill a major gap in forensic psychological rehabilitation.