Facing fears together - a pilot study on peer-mentored cognitive behavioral therapy for adolescents with mild intellectual disability and anxiety

Anxiety disorders are one of the most prevalent clinical disorders in
adolescents, and even more in adolescents with mild to borderline intellectual
disability (MBID, i.e., IQ<85 and limitations in adaptive functioning).
Exposure based CBT is currently viewed as the most effective form of treatment
, however, with response rates of 30% for adolescents with MBID there is still
much to be gained by boosting efficacy. Given the risks of long-term negative
outcomes associated with anxiety disorders, the need for an (even more)
effective intervention is clear. Adolescence is known as a period in which
peers are an important social influence that greatly impacts the behaviour of
adolescents, even more so for adolescents with MBID. Based on this making use
of social learning during treatment might be a powerful port-of-entry for
adolescents with MBID and anxiety disorders.

Primary Objective:
Is the intervention model feasible and acceptable for clients,
parents/caregivers, peers and therapists?

Secondary Objective(s):
1) Establishing first evidence of efficacy of peer-mentored CBT in reducing
anxiety in adolescents with MBID.
2) Do the peer-mentors themselves also experience further anxiety reduction and
increase in self-confidence ?
3) Is it beneficial for treatment effect to include pre-treatment assessment
with a strengths and weaknesses profile for clients with MBID?

Embedded mixed methods design where the quantitative part consists of a single
case experimental design with daily measurements during a baseline and
treatment phase. Participants are randomized over two baseline lengths (2 and 4
weeks) and clients and peer-mentors keep a daily diary. In addition,
questionnaires and behavioral measures are used to assess anxiety and
self-efficacy at pre-baseline, pre-treatment, mid-treatment, post-treatment and
follow-up. Finally, clients report on client satisfaction after each session.
Measures are taken from clients, parents, therapists and peer-mentors.

In this study we will use the intensive exposure therapy model, which includes
longer exposure sessions of three hours during which clients practise with
their feared subject. The intervention starts with an anxiety analysis session,
followed by three exposure sessions, a home-work session, 4 weeks of
independent practice and an evaluation session. The new element to the
intervention in this study is that a peer-mentor with lived experience will be
present during exposure session 1 and 2. Their role is that of model,
information source and supporter. The therapist is present during all sessions.

For participants with MBID, guidelines recommend tailoring treatment to
individual cognitive strengths and weaknesses. To gather information on the
usefulness of establishing individual strength/weakness profiles prior to
treatment, we will request information on strengths/weakness profiles from the
organisation who assessed the client. For participants who have a
strength/weakness profile we will make individualised recommendations for the
therapist. For participants who do not have a strength/weakness profile, the
therapist will receive general recommendations for providing therapy for
adolescents with MBID.

All clients sought out mental healthcare for help with anxiety problems and the
core of the intervention is exposure therapy, which is the first choice
treatment for anxiety disorders. All clients receive treatment, there is no
waitlist of placebo group. The burden to participants mainly lies in time
investment in the study measurements and keeping a daily diary. We believe to
be the burden to be reasonable and have limited the number the time spend on
measurements as much as possible.