The effectiveness of a CBT-based intervention for depression symptoms with a female forensic inpatient with cognitive disability and autism

ABSTRACT

This study details a female patient with a history of violent and self-harming behaviour detained in a medium secure forensic psychiatric service in the UK. She had a diagnosis of Intellectual Disability (ID) and autism spectrum disorder (ASD). She experienced emotional dysregulation and instability of mood including depression-like symptoms, cognitive rigidity and intolerance to change, possibly linked to her ASD traits. Due to the hypothesised relationship between her risk and her self-reported depression symptoms she was referred for individual intervention based upon a Cognitive Behaviour Therapy (CBT) model. Progress was assessed using self and staff-report measures of emotional and behavioural problems. The findings demonstrate potential efficacy of CBT based intervention structures for women within complex forensic mental-health settings. The case study highlights the importance of considering ASD profiles and idiosyncrasies in both the development of the formulation and the intervention. Attention is required regarding therapeutic endings, and the inclusion of a relapse-prevention period when delivering psychological interventions for depression with women with diagnoses of ID and ASD. This case study considers the potential influence of ASD traits upon forensic inpatient presentation and risk. The need to comprehensively assess, formulate, and intervene with, those with ASD within forensic contexts is discussed.

KEYWORDS:

• CBT
• autism
• cognitive deficits
• depression
• forensic

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Although not the most widely used diagnostic tool in the UK, a revised edition of the International Classification of Diseases (ICD-11) is expected and is likely to closely align with the DSM-5 (APA, 2013).