Prevention and Intervention Programs Targeting Sexual Abuse in Individuals with Mild Intellectual Disability:A Systematic Review

Introduction: Compared to their non-disabled peers, individuals with mild intellectual disability (MID) are at higher risk of becoming a victim of sexual abuse and more vulnerable to its disruptive effects. This review provides an overview of content and effectiveness of prevention and intervention programs targeting sexual abuse in individuals with MID. Methods: PRISMA guidelines were followed and quality and effectiveness of the programs were evaluated taking into account the rating of the Quality Assessment Tool for Quantitative Studies (QATQS). Results: Twelve studies were included. In prevention programs role-play prevailed, whereas the content of intervention programs varied. All studies received a "weak" QATQS rating. By consequence, effectiveness of the program was downgraded to "unclear" in ten, and "ineffective" in two studies. Conclusion: Further development of programs and higher quality of research is needed to investigate whether they are effective in preventing sexual abuse or reducing its consequences in individuals with MID

The protocol for positive body experience (PBE); introducing a psychomotor therapy intervention based on positive body exposure targeting negative body image in eating disorders

Negative body experience is a core characteristic of eating disorders, and poses a serious risk factor for its development, maintenance and relapse. This underlines the importance of specific therapeutic attention to body experience. In the past ten years a body-oriented treatment protocol with the focus on positive body exposure, called 'Protocol Positive body experience' has been developed. The aim of this paper is to describe the scientific basis of the protocol and to give an impression of its content and structure, illustrated by clinical case vignettes. An important and innovative aspect of the protocol is to enhance not only aesthetic, but also functional and tactile body experience. The protocol enables body-oriented therapists and psychomotor therapists to treat negative body experience in an evidence-based way and facilitates further research to validate the effect of positive body exposure

Measuring body satisfaction in women with eating disorders and healthy women:appearance-related and functional components in the Body Cathexis Scale (Dutch version)

Purpose Differentiating the concept of body satisfaction, especially the functional component, is important in clinical and research context. The aim of the present study is to contribute to further refinement of the concept by evaluating the psychometric properties of the Dutch version of the Body Cathexis Scale (BCS). Differences in body satisfaction between clinical and non-clinical respondents are also explored. Method Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate whether functional body satisfaction can be distinguished as a separate factor, using data from 238 adult female patients from a clinical sample and 1060 women from two non-clinical samples in the Netherlands. Univariate tests were used to identify differences between non-clinical and clinical samples. Results EFA identified functionality as one of three factors, which was confirmed by CFA. CFA showed the best fit for a three-factor model, where functionality, non-weight, and weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes. Conclusions The three factors of the BCS may be used as subscales, enabling researchers and practitioners to use one scale to measure different aspects of body satisfaction, including body functionality. Use of the BCS may help to achieve a more complete understanding of how people evaluate body satisfaction and contribute to further research on the effectiveness of interventions focussing on body functionality

The Body Experience Questionnaire for adults with mild intellectual disability or borderline intellectual functioning (BEQ-mb):Development and initial evaluation

Background: Body experience is an important facet of psychosocial functioning and health. However, to date no test exists to measure body experience in adults with mild intellectual disability and borderline intellectual functioning (MID-BIF). We therefore adapted the Body Experience Questionnaire (BEQ) to this group, resulting in the BEQ-mb, and evaluated its usability, comprehensibility, and reliability. Method: The BEQ-mb was developed in five stages: concept development, focus group, verbal reports, pilot testing, and evaluation. Results: The BEQ-mb is applicable in, and comprehensible by, adults with MID-BIF. Internal consistency is good for the total scale and the body awareness and body satisfaction subscales, but low for the body attitude subscale. Test-retest reliability is excellent for the total scale and the subscales. Conclusion: The BEQ-mb unlocks new opportunities for clinical examination and research on body experience. Future research is needed to investigate its structural validity

Clinical characteristics of individuals with intellectual disability who have experienced sexual abuse. An overview of the literature

Background: Sexual abuse in individuals with average IQ or above is associated with a wide range of behavioural, psychological and body-related characteristics. It is unknown whether individuals with intellectual disability (ID) and a history of sexual abuse suffer from similar clinical characteristics. Objective: The aim of the review is to provide an overview of the literature on the clinical characteristics of individuals with ID who have experienced sexual abuse. Method: PubMed, Embase, PsycInfo, CINAHL, Cochrane Library and Web of Sciences were searched for relevant publications using terms related to concepts of “intellectual disability” and “sexual abuse”. Two independent reviewers screened and selected articles for inclusion in the study, resulting in seven studies. Results: The studies mostly reported behavioural and psychological characteristics such as aggression, self-injury, or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with ID. None mentioned body-related characteristics. Conclusions: Similar to individuals with average IQ or above, sexual abuse in individuals with ID is associated with a broad range of behavioural and psychological characteristics. Conduct disorders, self-injury, inappropriate sexualised talk and poor feelings of personal safety seem to be more indicative for the ID population. Anxiety, depression and PTSD are prevalent in individuals with and without ID who both have experienced sexual abuse. Whether individuals with ID experience body-related characteristics is unclear

Shifting the Focus:A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders

One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE

Policy on sexual abuse:A survey study amongst managers of care facilities for individuals with intellectual disability in the Netherlands

Individuals with intellectual disability living in a care facility are at high risk of sexual abuse. Formal policies on sexual abuse within these care facilities and their effective implementation are a prerequisite to reducing the risk of sexual abuse in this group. The present study aimed to determine the state of affairs in this regard in the Netherlands and identify areas of improvement regarding both policy formulation and implementation. An online survey was sent to the management boards of 129 Dutch care facilities for individuals with intellectual disability. Sixty-nine managers completed the survey on behalf of their care facility. Descriptive statistics were used to characterize the state of affairs regarding policies on sexual abuse. Areas of improvement reported by the managers were examined qualitatively by thematic analysis. Most care facilities complied with the national legal requirements on sexual abuse, which include the availability of a protocol on sexual abuse and mandatory reporting. It varied across the care facilities to what extent the protocols on sexual abuse are brought to the staff's attention and used in practice. About half of them provided no staff training on the protocol on sexual abuse, while nearly one-third of the care facilities provided no organizational protective factors on sexual abuse, such as a special-task official on sexual abuse, sexuality or sexual abuse department, or cooperation with the vice squad. Most areas of improvement reported by the managers pertained to the need for staff training and the improvement of practical use of policies and protocols on sexual abuse. In conclusion, the availability of policies and protocols on sexual abuse in care facilities for individuals with intellectual disability does not guarantee a caring culture in which these policies and protocols are implemented effectively, and in which sexual abuse is prevented and detected in a timely way.</p

Burnout, Moral Distress and Posttraumatic Stress in Intensive Care Staff: A Dangerous Cocktail?

Background: Resources to administer evidence-based care for PTSD and trauma-related complications are scarce, especially in particular geographical areas, during mass casualty situations and for individuals with subclinical symptoms as clinics prioritize more severe cases. Effective interventions for PTSD through technical platforms could disseminate information and self-management strategies to decrease individual suffering and societal costs. Assessment at multiple time points can elucidate which aspects of an intervention that are effective, in addition to the evolution of intervention use and well-being over time.  Objective: Evaluate an app-administered self-help intervention (PTSD Coach Sweden) aiming to reduce and manage PTSD symptoms and other related complications.  Method: In this trial, 200 participants from Sweden who have experienced a traumatic event in the past two years and who report posttraumatic stress symptoms will be randomized to three months use of the app or waitlist. The primary endpoint is self-rated PTSD symptom severity at three months, with follow-up at six and nine months. Secondary outcomes include depressive symptoms, physical symptoms, functional impairment and health care use. Ecological momentary assessment of health status and use of strategies corresponding to app content is used for 21 days during the first three months. Results: Lessons learned and recommendations from the preparations of app-based intervention trials are presented. Available data from the primary endpoint are presented.  Conclusions: App-based interventions hold promise to increase outreach, but further trials are needed. Several challenges introduced when preparing an app-based intervention are discussed

Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities:A systematic review

Background: Poor anger regulation is considered a risk factor of aggression in individuals with mild or borderline intellectual disabilities. Psychomotor therapy (PMT) targets anger regulation through body- and movement-oriented interventions. This study aims to inform practitioners on efficacy and research-base of PMT in this population. Method: This systematic review evaluated nine studies which met inclusion criteria in terms of participants, intervention procedures, outcomes and certainty of evidence. Results: Seven studies revealed a substantial reduction of aggressive behaviour or anger. Certainty of evidence was rated inconclusive in most cases due to absence of experimental control. Conclusions: We can conclude that body-oriented PMT, involving progressive relaxation and meditation procedure "Soles of the Feet", is a promising approach. However, the paucity of studies and methodological limitations preclude classifying it as an evidence-based practice. This suggests stronger methodological research and research aimed at PMT's mechanisms of action (e.g., improved interoceptive awareness) is warranted.</p

Psychometric properties of the Dresden Body Image Questionnaire:A multiple-group confirmatory factor analysis across sex and age in a Dutch non-clinical sample

Body image has implications for psychosocial functioning and quality of life and its disturbance is reported in a broad range of psychiatric disorders. In view of the lack of instruments in Dutch measuring body image as a broad concept, we set out to make an instrument available that reflects the multidimensional character of this construct by including more dimensions than physical appearance. The Dresden Körperbildfragebogen (DBIQ, Dresden Body Image Questionnaire) particularly served this purpose. The DBIQ consists of 35 items and five subscales: body acceptance, sexual fulfillment, physical contact, vitality, and self-aggrandizement. The main objective of the present study was to evaluate the psychometric properties of the Dutch translation of the Dresden Body Image Questionnaire (DBIQ-NL) in a non-clinical sample.The psychometric properties of the DBIQ-NL were examined in a non-clinical sample of 988 respondents aged between 18 and 65. We investigated the subscales' internal consistency and test-retest reliability. In order to establish construct validity we evaluated the association with a related construct, body cathexis, and with indices of self-esteem and psychological wellbeing. The factor structure of the DBIQ-NL was examined via confirmatory factor analysis (CFA). The equivalence of the measurement model across sex and age was evaluated by multiplegroup confirmatory factor analyses.Confirmatory factor analyses showed a structure in accordance with the original scale, where model fit was improved significantly by moving one item to another subscale. Multiple group confirmatory factor analysis across sex and age demonstrated partial strong invariance. Internal consistency was good with little overlap between the subscales. Temporal reliability and construct validity were satisfactory.Results indicate that the DBIQ-NL is a reliable and valid instrument for non-clinical subjects. This provides a sound basis for further investigation of the DBIQ-NL in a clinical sample