Improving anxiety in people with mild to moderate intellectual disability: Developing and testing a novel, co-produced, mental imagery intervention.

Background People with intellectual disabilities (ID) experience much higher rates of mental health disorders (including anxiety), than the general population.

Despite this, developing effective psychological interventions has been woefully slow, and co-produced interventions remain unexplored. Adapting interventions, such as cognitive behavioural therapy (CBT), for people with ID has been partially successful.

However, cognitive limitations of people with ID mean many cognitive techniques (e.g. identifying and altering core beliefs) remain inaccessible, as they require sophisticated metacognitive and verbal skills. Therefore psychological interventions in this population rely largely on behavioural exercises.

Mental images can powerfully changing cognitions through visual, rather than verbal skills, potentially providing effective and accessible routes to amending emotions (anxiety) in this population.

Research question Can a mental imagery intervention be co-produced to be acceptable to people with mild to moderate ID and reduce anxiety?

Aims Understand experiences of mental imagery in people with ID Develop an acceptable mental imagery intervention, alongside people with ID, and stakeholders Test the intervention with several people with ID and anxiety, to understand experiences of using it and mechanisms for any change Evaluate the co-production methodology Methods A 6 phase, qualitative, co-production methodology will be used.

A group of people with ID (PPI group), and of stakeholders (carers, professionals and advocates) will be recruited through self-advocacy groups, day services, carers' groups, and professional bodies (e.g. Royal College of Speech and Language Therapists). A systematic literature review synthesises evidence of mental imagery in people with ID.

Experiences of mental imagery in people with mild to moderate ID are explored through 8-10 individual semi-structured interviews, analysed using Interpretative Phenomenological Analysis (IPA).

Focus groups (3 with PPI group and 2 with stakeholders) explore the acceptability of mental imagery interventions established in other populations. Discussions are analysed using Thematic Analysis.

Results from phases 1-3 are collated, synthesised and presented in accessible formats ('information statements') at a workshop attended by PPI and stakeholder groups.

Mixed groups of people with ID and stakeholders consider existing mental imagery interventions through information statements, burden and face validity.

Groups agree on an appropriate mental imagery intervention. 2-4 people with ID experiencing anxiety use the intervention, which is evaluated using a single case experimental design, and semi-structured interviews. 10 individual interviews with PPI and stakeholder members explore experiences of engaging in the co-production methodology,analysed using Template Analysis.

The quality of the co-production methodology is evaluated using a checklist (GRIPP2-LF).

Anticipated Impact Improved understanding of mental imagery in people with ID (with implications for use in psychological interventions).

A co-produced, mental imagery intervention for people with ID experiencing anxiety which is acceptable, accessible, has been tested out, and is ready for a feasibility trial.

Understanding how people with ID can best be genuinely engaged and contribute meaningfully to developing healthcare interventions through co-production.

Dissemination Implications for current clinical practice and developing future, evidence-based, psychological interventions will be widely disseminated.

Stakeholder and PPI groups, and the researcher will disseminate results in accessible and meaningful formats, through publications, conference presentations, professional networks and a short film.