Intellectual disability and computers in therapy: Views of service users and clinical psychologists

Leen Vereenooghe, Lina Gega, Peter E. Langdon


Digital media have increased the accessibility of psychological therapies for the general population, but not for people with intellectual disability (ID), despite their greater mental health needs. This study explores and compares the views of service users and clinicians on how computers can be integrated in psychological therapies for people with ID who are traditionally under-represented in mainstream services. We conducted in-depth unstructured interviews with three clinicians who had experience of working with people with ID and with three adults with ID who have experienced computerised training in cognitive behaviour therapy skills. The interviews explored the a) potential functions and benefits, b) anticipated challenges and barriers, and c) required design features of computers in therapy for people with ID. We used inductive coding to identify independent themes in the responses of clinicians and service users, and then compared the emerging themes between the two sets of participants to arrive at common themes. Six common themes emerged from service user and clinician responses: confidentiality of personal information and online applications, barriers in the communication with the therapist, value of therapist and personal contact, access to computer technologies, engagement potential of computer programmes and home practice. Three further themes were specific to clinician responses: patient suitability for computerised approaches, clinician distrust of computerised interventions, and involving a third party. Computer technologies open up possibilities for psychological therapy with people with ID by helping them overcome in-session communication difficulties and practise skills at home. On-screen pictures, interactive games, symbols, sign language and touch-screen are key design features to help engagement. The main challenges are clinician-reported difficulties in their own capacity and capability to access and use computers and in fitting computers into their own defined roles.

Bibliographic citation

Vereenooghe, L., Gega, L., & Langdon, P. (2017). Intellectual disability and computers in therapy: Views of service users and clinical psychologists. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 11(1), article 11. doi:


Cognitive Behaviour Therapy; intellectual disability; technology; mental health; online interventions

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Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175-180.

Bendelin, N., Hesser, H., Dahl, J., Carlbring, P., Nelson, K. Z., & Andersson, G. (2011). Experiences of guided internet-based cognitive-beahvioural treatment for depression: A qualitative study. BioMed Central Psychiatry, 11, 107–116.

Bhaumik, S., Tyrer, F. C., Mcgrother, C., & Ganghadaran, S. K. (2008). Psychiatric service use and psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 52, 986–995.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

Burke, C.-K. (2014). Feeling down: Improving the mental health of people with learning disabilities. London: Foundation for People with Learning Disabilities.

Carey, A. C., Friedman, M. G., & Bryen, D. N. (2005). Use of electronic technologies by people with intellectual disabilities. Mental Retardation, 43, 322–333.[322:UOETBP]2.0.CO;2

Chadwick, D., Wesson, C., & Fullwood, C. (2013). Internet access by people with intellectual disabilities: Inequalities and opportunities. Future Internet, 5, 376–397.

Chinn, D., Abraham, E., Burke, C.-K., & Davies, J. (2014). IAPT and Learning Disabilities. London: Foundation for People with Learning Disabilities.

Cooper, S., Smiley, E., Morrison, J., Williamson, A. W., & Allan, L. (2007). Mental ill-health in adults with intellectual disabilities: Prevalence and associated factors. British Journal of Psychiatry, 190, 27–36.

Cuijpers, P., Donker, T., Johansson, R., Mohr, D. C., van Straten, A., & Andersson, G. (2011). Self-guided psychological treatment for depressive symptoms: A meta-analysis. PLoS ONE, 6(6).

Dagnan, D., Mellor, K., & Jefferson, C. (2009). Assessment of cognitive therapy skills for people with learning disabilities. Advances in Mental Health & Learning Disabilities, 3(4), 25–30.

Dattilo, J., Williams, R., & Cory, L. (2003). Effects of computerized leisure education on knowledge of social skills of youth with intellectual disabilities. Therapeutic Recreation Journal, 37, 142–155.

Department of Health. (2009). Learning Disabilities: Positive Practice Guide. London: Department of Health.

Emerson, E., & Hatton, C. (2007). Mental health of children and adolescents with intellectual disabilities in Britain. The British Journal of Psychiatry, 191, 493–499.

Gega, L., Smith, J., & Reynolds, S. (2013). Cognitive behaviour therapy (CBT) for depression by computer vs. therapist: Patient experiences & therapeutic processes. Psychotherapy Research, 23, 218–231.

Hind, D., O’Cathain, A., Cooper, C. L., Parry, G., Isaac, C. L., Rose, A., … Sharrack, B. (2010). The acceptability of computerised cognitive behavioural therapy for the treatment of depression in people with chronic physical disease: A qualitative study of people with multiple sclerosis. Psychology and Health, 25, 699–712.

Hurley, A. D., Tomasulo, D. J., & Pfadt, A. G. (1998). Individual and group psychotherapy approaches for persons with mental retardation and developmental disabilities. Journal of Developmental and Physical Disabilities, 10, 365–386.

Joyce, T., Globe, A., & Moody, C. (2006). Assessment of the component skills for cognitive therapy in adults with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 19, 17–23.

Knowles, S. E., Toms, G., Sanders, C., Bee, P., Lovell, K., Rennick-Egglestone, S., … Gilbody, S. (2014). Qualitative meta-synthesis of user experience of computerised therapy for depression and anxiety. PLoS One, 9(1), e84323.

Mayo-Wilson, E., & Montgomery, P. (2013). Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. The Cochrane Database of Systematic Reviews, 9(9), CD005330.

Mesa, S., & Tsakanikos, E. (2014). Attitudes and self-efficacy towards adults with mild intellectual disability among staff in acute psychiatric wards: An empirical investigation. Advances in Mental Health and Intellectual Disabilities, 8, 79–90.

Newby, J. M., Twomey, C., Li S. Y. & Andrews, G. (2016). Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders, 199, 30–41.

Oathamshaw, S. C., & Haddock, G. (2006). Do people with intellectual disabilities and psychosis have the cognitive skills required to undertake cognitive behavioural therapy? Journal of Applied Research in Intellectual Disabilities, 19, 35–46.

Palmer, S. B., Wehmeyer, M. L., Davies, D. K., & Stock, S. E. (2012). Family members’ reports of the technology use of family members with intellectual and developmental disabilities. Journal of Intellectual Disability Research, 56, 402–414.

Pennant, M. E., Loucas, C. E., Whittington, C., Creswell, C., Fonagy, P., Fuggle, P., … Williams, P. (2015). Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis. Behaviour Research and Therapy, 67, 1–18.

Reed, J., & Clements, J. (1989). Assessing the understanding of emotional states in a population of adolescents and young adults with mental handicaps. Journal of Intellectual Disability Research, 33, 229–233.

Richards, D., Richardson, T., Timulak, L., & McElvaney, J. (2015). The efficacy of internet-delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis. Internet Interventions, 2, 272–282.

Rose, J. L. (2013). A preliminary investigation into the influence of therapist experience on the outcome of individual anger interventions for people with intellectual disabilities. Behavioural and Cognitive Psychotherapy, 41, 470–478.

Rose, J. L., Loftus, M., Flint, B., & Carey, L. (2005). Factors associated with the efficacy of a group intervention for anger in people with intellectual disabilities. British Journal of Clinical Psychology, 44, 305–317.

Rose, J. L., West, C., & Clifford, D. (2000). Group interventions for anger in people with intellectual disabilities. Research in Developmental Disabilities, 21, 171–181.

Royal College of Psychiatrists. (2004). Psychotherapy and learning disability. Council report: CR116. London.

Schalock, R. L., Luckasson, R. a, Shogren, K. a, Borthwick-duffy, W. S., Bradley, V., Buntinx, W. H. E., … Yeager, M. H. (2007). The renaming of mental retardation: understanding the change to the term intellectual disability. Intellectual and Developmental Disabilities, 45, 116–124.[116:TROMRU]2.0.CO;2

Stallard, P., Richardson, T., & Velleman, S. (2010). Clinicians’ attitudes towards the use of computerised cognitive behaviour therapy (cCBT) with children and adolescents. Behavioural and Cognitive Psychotherapy, 38, 545–560.

Standen, P. J., & Brown, D. J. (2005). Virtual reality in the rehabilitation of people with intellectual disabilities: Review. CyberPsychology & Behavior, 8, 272–282.

Taylor, J. L., & Knapp, M. (2013). Mental health and emotional problems in people with intellectual disabilities. In J. L. Taylor, W. R. Lindsay, R. P. Hastings, & C. Hatton (Eds.), Psychological therapies for adults with intellectual disabilities (pp. 1–14). Oxford: John Wiley & Sons Ltd.

The United Nations. (2006). Convention on the Rights of Persons with Disabilities. Retrieved from

Twomey, C., O’Reilly, G., Byrne, M., Bury, M., White, A., Kissane, S., … Clancy, N. (2014). A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions. British Journal of Clinical Psychology, 53, 433–450.

Vereenooghe, L., Gega, L., Reynolds, S., & Langdon, P. E. (2016). Using computers to teach people with intellectual disabilities to perform some of the tasks used within cognitive behavioural therapy: A randomised experiment. Behaviour Research and Therapy, 76, 13–23.

Vereenooghe, L., & Langdon, P. E. (2013). Psychological therapies for people with intellectual disabilities: A systematic review and meta-analysis. Research in Developmental Disabilities, 34, 4085–4102.

Vereenooghe, L., Reynolds, S., Gega, L., & Langdon, P. E. (2015). Can a computerised training paradigm assist people with intellectual disabilities to learn cognitive mediation skills? A randomised experiment. Behaviour Research and Therapy, 71, 10–19.

Wangberg, S. C., Gammon, D., & Spitznogle, K. (2007). In the eyes of the beholder: Exploring psychologists’ attitudes towards and use of e-therapy in Norway. CyberPsychology & Behavior, 10, 418–423.

Wehmeyer, M. L., Buntinx, W. H., Lachapelle, Y., Luckasson, R. A., Schalock, R. L., & Verdugo, M. A. (2008). The intellectual disability construct and its relation to human functioning. Intellectual and Developmental Disabilities, 46, 311–318.[311:TIDCAI]2.0.CO;2

Wehmeyer, M. L., Smith, S. J., Palmer, S. B., & Davies, D. K. (2004). The effect of student-directed transition planning with a computer-based reading support program on the self-determination of students with disabilities. Journal of Special Education Technology, 19, 7–22.

Whitehouse, R. M., Tudway, J. A., Look, R., & Stenfert-Kroese, B. (2006). Adapting individual psychotherapy for adults with intellectual disabilities: A comparative review of the cognitive-behavioural and psychodynamic literature. Journal of Applied Research in Intellectual Disabilities, 19, 55–65.

Whitfield, G., & Williams, C. (2004). If the evidence is so good - why doesn’t anyone use them? A national survey of the use of computerized cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy, 32, 57–65.

Willner, P. (2006). Readiness for cognitive therapy in people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 19, 5–16.

World Health Organisation. (1992). ICD-10 Classifications of mental and behavioural disorder: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland.