EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
Coping With Criticism and Praise Lynn Esdale, Andrew Jahoda, and Carol Pert
Abstract Through experiencing stigma and discrimination, people with intellectual disability may become more sensitive to criticism from others and be less likely to believe praise. This study compared how people with and without intellectual disability viewed praise and criticism, using a vignette task developed for the study. Participants were asked to imagine someone saying something praiseworthy or critical and were then asked about their emotions, beliefs, and thoughts. People with intellectual disability were more likely to believe and be distressed by criticism. Contrary to predictions, this group were also more likely to believe praise and experience positive affect. The results suggest that the selfperceptions of people with intellectual disabilities is more dynamic and reliant on the views of others. Key Words: intellectual disability; social cognition; compassion; criticism; praise; self-perceptions
In the general adult population, self-critical beliefs have been associated with a vulnerability to depression and other mental health difficulties. One construct thought to help explain how people cope with self-criticism, deal with negative life events and promote resilience, is self-compassion (Gilbert, 2005). Both self-criticism and selfcompassion can be viewed as internal ways of relating to oneself, which may be indicative of the beliefs we hold about ourselves. Self-criticism is a harsh, self-blaming style of thinking about oneself, and is thought to develop from experiences of being treated negatively by others. Interpersonal experiences, and our experience of relationships, are considered important in terms of how we think about ourselves. Hence, a self-blaming style of thinking might be linked to sensitivity to social put- down, that is, being sensitive to criticism from others. Moreover, it has been suggested that those who are more sensitive to criticism from others are more likely to internalise the criticism (Gilbert, Durrant, & McEwan, 2006). Gilbert et al. (2006) propose that being sensitive to criticism originates from negative social experiences, such as being bullied or subordinated. Once established, self-critical 258
beliefs can become self-maintaining; with a tendency not only to put oneself down but to believe others’ criticisms. Self-compassion is an ability to be kind to oneself. The literature on self-compassion suggests that adopting a kind, nonjudgmental approach to oneself at times of suffering can be an important coping strategy that can reduce distress (Gilbert, 2005). It may also help to promote positive mental well-being. Neff (2009) suggests that accepting both the positive and negative aspects of one’s self can help develop a balanced view of one’s emotional experience. Therefore, being selfcompassionate does not involve denying or rejecting one’s negative characteristics, but means accepting them as aspects of oneself, no matter how they compare with those of other people. The constructs of self-criticism and selfcompassion seem relevant to the emotional wellbeing of people with intellectual disability (ID), because this group is often subject to negative interpersonal experiences, such as bullying and discrimination (Emerson, 2010). Negative interpersonal experiences have been found to be more prevalent and cause greater stress than other negative events for people with intellectual Coping With Criticism and Praise
EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
disabilities (Bramston, Fogerty & Cummins, 1999; Hartley & McLean, 2005). Therefore, it may be that people with intellectual disabilities are sensitised to and, consequently, vulnerable to the effects of negative interpersonal experiences. In a study with adults with intellectual disabilities, Dagnan and Waring (2004) found that discriminatory views can be internalized and that being treated negatively was associated with viewing oneself as inferior to others (negative social comparison). In a study of young people with intellectual disabilities, Schivos-Bach (1993) found that those with the greatest awareness of stigma had the lowest self-esteem and felt the most different from others and their siblings. However, other research has failed to find such direct effects and has pointed to the ability of people with intellectual disabilities to reject a stigmatised identity (Jahoda & Markova, 2004). People with intellectual disability may also be vulnerable to emotional distress if they cannot benefit from positive and supportive interpersonal experiences. Supportive comments or praise may be discrepant with the self-views of people with intellectual disability, and therefore may not be accepted or given significance. MacMahon and Jahoda (2008) found that people with an intellectual disability who were depressed may recognize their strengths, but fail to attach significance to these strengths. It is possible that a vulnerability to low mood may be created through a lack of recognition of one’s positive characteristics. People with intellectual disability may internalize and believe criticism from others if it matches with their own self-view. However, it is unclear whether praise and positive interpersonal experiences are rejected if they are discrepant with negative self-views. Cognitive behavior therapy (CBT) has been developed and adapted for a range of mental health difficulties for people with intellectual disabilities, including depression and anxiety (Whitehouse, Tudway, Look, & Kroese, 2006). CBT aims to challenge negative and distorted views of reality that trigger and maintain distress and is proving to be a useful psychological intervention for people with intellectual disabilities (Jahoda, Dagnan, Kroese, Pert, & Trower, 2009). However, this approach may be less effective when used to tackle real life difficulties which these individuals face, including discriminatory treatment (Jahoda et al, 2009). Compassion focused therapy (CFT) takes a different stance and teaches the skills of self-compassion L. Esdale, A. Jahoda, and C. Pert
as a way of coping with distress and self-criticism (Gilbert, 2009). This approach aims to help people find a way of coping with negative feelings without denying their experiences. This involves encouraging people to recognize their strengths and positive characteristics and may be a valuable tool in promoting resilience. Self-criticism and self-compassion have been identified and studied in clinical and student populations in the general adult population. As a first step towards understanding these processes in people with intellectual disabilities, this study set out to investigate the reactions of a group of participants with intellectual disabilities and a group of participants without intellectual disabilities to criticism and praise. Due to their cognitive impairments and experience of social stigma (Jahoda & Markova, 2004), people with intellectual disabilities may be likely to have more experience of criticism than their non-disabled peers. Therefore, compared to their non disabled peers, it was anticipated that they would be more likely to believe criticism and feel upset. In contrast, it was expected that those with intellectual disabilities would be less likely to believe praise and feel positive. This study also aimed to explore the ability of people with and without intellectual disabilities to generate self-supportive responses when faced with criticism.
Materials and Methods Participants Twenty-five adults with intellectual disability (with mild to moderate levels of impairment) and 21 adults without intellectual disability over 18 years of age were recruited to the study from further education colleges. Participants who were included in the study all met the following criteria: (a) were aged 18–65 years of age, (b) had the ability to provide informed consent, and (c) had sufficient receptive and expressive verbal ability to describe everyday events. Participants were excluded from taking part in the study if they (a) had a severe visual or hearing impairment that would make it difficult to engage with the study materials and (b) had a diagnosis of autistic spectrum disorder because the social deficits associated with this diagnosis would be likely to make the research tasks challenging. Participants from both groups were recruited from Further Education colleges in the West of Scotland, providing courses for people with 259
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
intellectual disabilities. Senior staff from interested college departments identified classes of students who had sufficient receptive and expressive language to describe everyday events. To assist with this, the following items from the Adaptive Behavior Scale (ABS-RC:2) (Nihira, Leland, & Lambert, 1993) were used: (a) talks to others about sports, family, group activities, (b) sometimes uses complex sentences containing ‘‘because’’ or ‘‘but,’’ and (c) answers simple questions such as ‘‘What is your name?’’ or ‘‘What are you doing?‘‘ The researcher then presented information regarding the study to these classes for 5–10 min and provided written information. Six participants were excluded from the sample of recruited participants. Of these, four participants recruited to the intellectual disability group were excluded because their Wechsler Abbreviated Scale of Intelligence (WASI-IQ) scores fell within the low average or average range of cognitive functioning; therefore, it was unclear whether they had an intellectual disability. Another participant was excluded because he struggled to engage with the study materials, which appeared to result from a lack of understanding. One participant in the control group was excluded because his WASI-IQ score was within the borderline range of cognitive functioning. Therefore, the final sample consisted of 20 participants with intellectual disability (12 men, eight women, mean age 28.2 years, SD 5 12.06, range 18–54 years) and 20 participants without intellectual disability (nine men, 11women, mean age 26.8 years, SD 5 13.18, range 18–63 years).
Measures The following measures were delivered to each participant in the order presented here: 1. Demographic information: Information was gained from each participant on their age, gender, living situation, employment, and postcode. Deprivation was determined by their post code, using an index neighbourhood deprivation as a measure of socioeconomic status (Carstairs & Morris, 1991). The Carstairs Index is composed of four indicators judged to represent material disadvantage in the population and is collated from Census data. The four indicators are social class (as defined by the Census), lack of car ownership, overcrowding, and male unemployment. Deprivation categories (DepCats) range from 1 (affluent) to 7 (severe deprivation). 2. Glasgow Depression Scale for People With a Learning Disability (GDS-LD; Cuthill, Espie, & Cooper, 2003): The GDS-LD is a 20-item questionnaire used to measure depression in people with intellectual disability. This was used to ensure that there were no significant differences in
260
EAAIDD DOI: 10.1352/1944-7558-120.3.258
low mood between the two study groups, which could potentially be a confounding factor in terms of response to criticism and praise. The GDS-LD shows a strong correlation (r 5 0.88) with the Beck Depression Inventory II (BDI- II; Beck, Steer, & Brown, 1996) and good testretest reliability (r 5 0.97). There is also excellent criterion validity. The GDS-LD scores of a nonlearning disability depressed group were highly correlated with their scores on the BDI-II (r 5 0.94, p , 0.001). 3. Praise and Criticism Task (PACT): This task was devised for the purposes of this study. An existing body of work has used hypothetical vignettes to investigate the socialcognitive responses of people with intellectual disability to threat in interpersonal situations (Pert & Jahoda, 2008). This method was successful in engaging people with intellectual disability, and in eliciting their responses to social threat. Therefore, a similar method was considered appropriate in this study to ascertain responses to criticism and praise.
In the PACT, participants were presented with a self-referent scenario in which they were asked to imagine encountering a person who praises or criticizes them. Each hypothetical scenario was illustrated using three photographs and was presented in a story board format. The photographs depicted the unfolding sequence of events in each scenario, and the researcher read the narratives to the participants as the photographs were presented. Development and pilot. The PACT required careful development and piloting to ensure that the content of the scenarios had resonance in the lives of people both with and without intellectual disabilities. The Sensitivity to Social Putdown Scale (SPD; Gilbert & Miles, 2000) was used to help identify the social criticism scenarios to be included in the PACT. The SPD scale is an assessment tool developed for a general adult population, which measures responses to common social criticisms. Storyboards were produced for the 12 written scenarios and the scenes were illustrated using photographs taken by the researcher. Participants were presented with a selfreferent scenario in which they were asked to imagine encountering a person who says something positive (praise) or negative (criticism) about them. Each hypothetical scenario was illustrated using three photographs and the narratives were read to the participants by the researcher. The photographs show the scene from the perspective of the protagonist, thereby preventing any confusion caused by the participant being asked to identify with a picture of someone else. These 12 scenarios were then piloted with three individuals (two with intellectual disability and one without) before the main study commenced. The Coping With Criticism and Praise
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
pilot established the following: (a) which of the scenarios were salient to both groups and (b) the benefits of using opened-ended exploratory questions to assess emotions and thoughts. . Two scenarios were excluded because they lacked relevance to both groups. This resulted in 10 scenarios being deemed suitable for use in the research study, each ending with interactions involving criticism or praise. Final version of the PACT. Two sets of scenarios were developed covering the same five themes: performance/effort, skill/ability, popularity, future goals, and autonomy. The same two sets of scenarios were presented in the same order to each participant. However, there were two versions of the task. In version A, the researcher narrated the first five stories with a criticism ending and the second five stories with a praise ending. In version B, the first five stories had a praise ending and the second five stories a criticism ending. Alternate versions of the task were delivered to successive participants. An equal number of participants from each group received each version. Following the presentation of each scenario, participants were asked a series of questions to establish their emotions, beliefs, and thoughts in response to criticism and praise. The response format was a combination of forced-choice responses and open-ended questions, and all questions were asked in a tentative style, to ensure that the participants’ responses were not guided in any direction. Prompts were used only when necessary to ensure that the key information was obtained. Example of a scenario and response format: You are at home and (someone relevant to participant’s circumstances) is making dinner. She/he asks for your help. When the dinner is ready, your (insert person) says ’I couldn’t have done it without you. You were a lot of help.’’’ (Praise scenario, performance/ effort theme) a. b. c.
Emotional response was ascertained by asking an open-ended question,‘‘How does that make you feel?’’ Belief was ascertained by referring specifically to the criticism/praise given in the scenario. For example: ‘‘Are you a help to other people?’’ Thoughts were ascertained by asking an open-ended question that linked the emotional response to the scenario. For example: ‘‘Person X says you were a lot of help and you are feeling happy? What are you thinking?’’. If participants failed to respond to the open-ended question, a forced-choice question was
L. Esdale, A. Jahoda, and C. Pert
EAAIDD DOI: 10.1352/1944-7558-120.3.258
asked. For example: ‘‘Would you be thinking; (i) They are right, I was a lot of help. or (ii) they are wrong, I was not a lot of help’’. 4. Wechsler Abbreviated Scale of Intelligence (WASI; Psychological Corporation, 1999): The two subset form of the WASI was delivered to provide an estimate of the participants’ general intellectual ability. Psychometric properties include a high level of internal reliability (0.96–0.98), adequate test-retest reliability (0.88–0.92) and good concurrent validity (0.87).
Procedure All meetings took place in a private room at the participant’s college. Consent forms and information sheets were adapted to be accessible for people with intellectual disabilities. The researcher ordinarily met once with the participants, but for some participants it was necessary to meet on two occasions. The administration time was approximately 60 min. At the beginning of each meeting, time was spent establishing rapport with the participants to help them feel at ease. It was made explicit to participants that there were no right or wrong answers to the PACT questions. The WASI was completed at the end of each meeting because it does have right and wrong answers and therefore is contrary to the spirit of the main research task, where the aim was to obtain insight into the participants’ own views.
Results Descriptive Participant Data Table 1 shows the descriptive data for both groups. Mean scores for deprivation were 5.80 (SDSD 5 1.15, range 4–7) for the group with intellectual disabilities and 4.95 (SD 5 1.63, range 2–7) for those without disabilities. This difference was not statistically significant; t(38) 5 21.9, p 5 0.07. The living situation of the groups did not differ, x2(3) 5 2.9, p 5 0.40. However, the employment data did show significant group differences, x2(2) 5 6.23, p 5 0.04, with more people in the non-ID group in paid work than in the ID group. The groups did not differ in terms of reported symptoms of depression; Both groups had a mean score of 8.5 for the GDS-LD and similar standard deviations (ID group 5 5.98, non-ID group 5 6.18). As expected, the non-ID group had significantly higher WASI-IQ scores; t(38) 5 213.12, p , 0.001. 261
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
EAAIDD DOI: 10.1352/1944-7558-120.3.258
Table 1 Descriptive Data Measure GDS-LD WASI Gender Age Deprivation score Living situation
Employment
Mean (SD) Range Mean (SD) Range Male Female Mean (SD) Range Mean (SD) Range Lives alone With family Partner/ flatmate Supported accom Paid Voluntary None
ID group
Non-ID group
8.5 (5.98) 1–23 62.5 (5.88) 55–74 12 8 28.2 (12.06) 18–54 5.80 (1.15) 4–7 2 16 1 1 2 4 14
8.5 (6.18) 0–25 101 (12.35) 86–133 9 11 26.75 (13.18) 18–63 4.95 (1.63) 2–7 2 14 4 0 9 3 8
p value 1.00 , 0.001* 0.34
0.52 0.07
0.40
0.04*
Note. ID 5 intellectual disability; GDS-LD 5 Glasgow Depression Scale for People With a Learning Disability; WASI 5 Wechsler Abbreviated Scale of Intelligence. *p , .05.
PACT—Data Coding and Analysis Answers to the PACT questions were recorded on a response sheet during the interview. Responses were subsequently content analysed, and grouped into categories that characterized the different responses to each of the open-ended questions. A second independent rater was asked to group the participants’ responses into the categories developed for each question. The interrater agreement obtained was (a) emotions (criticism) Kappa 5 0.97, (b) emotions (praise) Kappa 5 0.92, (c) thoughts (criticism) Kappa 5 0.91, and (d) thoughts (praise) Kappa 5 0.90. Table 2 shows how the data to the open-ended questions were categorized and examples of these responses. The data obtained from the PACT was categorical, therefore, chi-square analysis was undertaken to investigate group differences. Where the conditions for chi-square tests were not met, the Fisher’s exact test was used. All analyses were two tailed.
Belief, Emotions, and Thoughts in Response to Criticism Table 3 shows the data for the emotional responses, belief in criticism, and thoughts in response to criticism expressed by both groups. 262
Belief in criticism. Analysis of the total belief scores showed a significant difference in belief in criticism between the two groups, x2(1) 5 3.87, p 5 0.049, with more people in the intellectual disability group stating that they believed the criticism they received. When the individual themes of criticism were tested, a significant difference was found in the popularity theme, x2(1) 5 13.33, p 5 , 0.001, with more people in the intellectual disability group believing the criticism. The other themes showed no significant differences; performance, x2(1) 5 1.91, p 5 0.168, skill, x2(1) 5 1.37, p 5 0.243, future plans, x2(1) 5 2.24, p 5 0.135, and autonomy, x2(1) 5 0.40, p 5 0.527. Emotional response to criticism. The data for emotion in response to criticism was coded into two categories; internal negative (sad, depressed, down) and external (angry, annoyed, rejecting). Comments categorized as ‘internal negative’ focused the blame for the criticism internally, whereas those categorized as external tended to focus the blame externally often on the protagonist. Table 2 gives definitions and examples of responses in these categories. The total scores showed a significant group difference in the emotional response to criticism, Coping With Criticism and Praise
L. Esdale, A. Jahoda, and C. Pert
Derogation
Thoughts
Examples
Negative emotion directed Sad, depressed, upset, internally to oneself. gutted. Emotion directed externally, Annoyed, angry, not often to another person. bothered. ‘‘I don’t fit it with the Thoughts that are team. I’m not important. characterised by negative What’s the use in being thoughts or uncertainty here’’ (ID group, future about the self and/or one’s plans category). abilities, skills etc.
Definition
Resiliemce
Unable to benefit Rejecting
Thoughts
Accepting
Positive
Emotions
Praise Categorisation
‘‘Was he even reading the Positive or supportive right paper? When a task beliefs about oneself, comes, I always put in the abilities, skills etc. The effort’’ (non-ID group, criticism seems to lack performance category). impact as it is recognised as unwarranted or being able to minimise it. ‘‘At least he’s told me and Constructive Perceiving criticism I’ve got a chance to as constructive improve it. I don’t and an opportunity suppose you’re always to improve one’s skills, going to get it right the abilities etc. first time anyway’’ (ID group, performance). ‘‘They’re being nasty. They Blaming the Negative views of other the other person or don’t like me and I’ve the other person’s done nothing to them’’ intentions. (ID group, popularity category).
Internal negative External
Emotions
Criticism Categorisation
Table 2 Categorisation of Open-Ended Questions From the PACT Examples
Happy, excited, good, confident. Negative emotion or Worried, anxious, dismissive. not bothered. ‘‘Are you sure about Negative views about that? We might the self. Feeling fall out and put a the praise is undeserved damper on it’’ (ID or unimportant. May group, popularity). also question the intention of the person giving the praise. ‘‘He can depend on Thoughts characteristics me. Good knowing by positive beliefs about someone can trust oneselves, abilities, etc. me’’ (ID group, Also, using praise in an performance positive manner bolster category). ones confidence or sense of self.
Positive emotion.
Definition
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
EAAIDD DOI: 10.1352/1944-7558-120.3.258
263
EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
x2(1) 5 22.33, p 5 0.001, with people in the ID group more frequently reporting an internal negative emotion in response to criticism. Examination of the different critical themes showed that those with intellectual disabilities reported more negative internal emotions than the non–ID group regarding performance, x2(1) 5 3.75, p 5 0.053, popularity, x2(1) 5 5.58, p 5 0.02 and autonomy, x2(1) 5 8.64, p 5 0.003. No significant group differences were found in the themes of skill, x2(1) 5 3.08, p 5 0.08 or future plans, x2(1) 5 3.31, p 5 0.069, although trends in the same direction were evident. Thoughts in response to criticism. The majority of participants in both groups managed to identify thoughts in response to criticism (ID group 5 89%, non-ID group 5 99%). Using a content analysis, the participants’ responses were coded into four categories: (a) self-derogation, (b) resilience, (c) constructive, and (d) blaming the other. Unfortunately, this meant that it was not possible to analyse the open-ended responses alongside the responses that the participants were asked make in the forced choice option. The open-ended responses are shown in Table 2. In terms of self-supporting statements, both the resilient and constructive responses contained a positive message about self. Derogatory statements about self were clearly negative, but whether or not the blaming responses were selfsupporting remained unclear. Table 3 shows the frequency of thoughts reported in each group. In terms of the study hypotheses, the participants’ ability to generate self-supporting thoughts in the face of criticism
was of interest. At a descriptive level the pattern of responses produced by both groups was very similar and when the two categories of responses with a clearly self supporting element were combined (resilient and constructive), a very similar number of self-supporting statements were produced by both groups. The ID group and the non-disabled group produced 49 and 52 selfsupporting statements, respectively.
Belief, Emotions, and Thoughts in Response to Praise Table 4 shows the findings for belief, emotional response, and thoughts in response to praise. Belief in praise. A significant group difference in the total scores was found, x2(1) 5 3.81, p 5 0.051; people with intellectual disabilities reported believing the praise they received more often than people without intellectual disabilities. The individual themes of praise showed a significant group difference in the autonomy theme (p 5 0.002). However, no significant group differences were found in the performance (p 5 1.00), skill (p 5 0.677), popularity (p 5 0.311), or future plans (p 5 0.677) themes. Emotional response to praise. Participants’ emotional response to praise was coded into two categories: (a) positive emotion and (b) ‘‘unable to benefit.’’ Table 2 gives a definition and examples of response in these categories. The total scores showed a significant group difference in the emotional response to praise, x2(1) 5 11.23, p 5 , 0.001, however, this difference was in the opposite direction than
Table 3 Responses When Faced With Criticism Variable Belief
Emotional response
Thoughts
Categorisation
ID group N 5 20
Non-ID group N 5 20
No Yes Missing Internal negative External Other/no response Derogation Resilient Constructive Blaming the other Other/no response
60 39 1 72 27 1 22 35 14 17 12
73 26 1 39 60 1 25 47 5 17 5
p value 0.049*
, 0.001*
Note. ID 5 intellectual disability.
264
Coping With Criticism and Praise
EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
Table 4 Responses to Praise Variable Belief
Emotional response
Thoughts
Categorisation
ID group
Non-ID group
No Yes Missing Positive Unable to benefit Unable to code Rejecting Accepting Other/no response
8 92 0 96 4 0 14 84 2
17 82 1 80 19 1 37 62 1
predicted. It was predicted that people with intellectual disabilities would be less likely to benefit from praise. However, it was the nondisabled participants who had a greater tendency to report being negative about praise. A significant group difference (p 5 0.003) was found for the theme of autonomy. There were no significant differences between the groups on the performance (p 5 0.487), skill (p 5 0.605), popularity (p 5 0.605), or future plans (p 5 1.00) themes. Thoughts in response to praise. People with intellectual disabilities appeared to have more difficulty identifying their thoughts in response to praise when asked an open-ended question (ID group 5 79%, Non-ID group 5 97%). Thoughts were coded into two categories: (a) rejecting and (b) accepting. Those who could not identify thoughts in response to the open-ended questions were able to answer a forced choice question. These responses were coded into the same framework. Table 2 gives a definition and example of thoughts in each category. Table 4 shows the frequency of thoughts in response to praise for each group. An overall group difference was found, x2(1) 5 13.68, p 5 ,0.001 showing that participants without intellectual disability reported rejecting thoughts in response to praise more frequently than participants with intellectual disability. When the PACT themes were examined separately, no significant group differences were found in the performance, F(1) 5 0.66, skill, x2(1) 5 2.85, p 5 0.091, future plans, x2(1) 5 0.44, p 5 0.507, or the popularity, F(1) 5 0.342, themes. A significant group difference was found in the autonomy theme, x2(1) 5 14.15, p 5 , 0.001. L. Esdale, A. Jahoda, and C. Pert
p value 0.051*
0.001*
, 0.001*
Discussion The study findings suggest that the participants with intellectual disability were more likely to believe criticism than the non-ID participants and more likely to report being affected by it. However, contrary to predictions, those with ID were also more likely to believe praise. Examining participants’ responses to specific scenarios may help to explain these group differences. It is perhaps unsurprising that criticism relating to popularity is particularly affecting for people with ID who commonly experience social exclusion. Their feelings of depression and sadness in relation to the critical scenes suggest a more general emotional sensitivity to being put down by others. In relation to praise, the only scenario where a significant group difference was found concerned autonomy. One explanation might be that praise about autonomy might be particularly salient for those with people with ID, who are likely to remain dependent on others for a degree of daily support, whereas, the non-ID participants might have failed to find anything praiseworthy about exercising a typical degree of autonomy. Nevertheless, it remains the case that the participants with ID expressed greater belief in praise across the different scenarios. Another potential explanation might be that the participants with ID were less skilled at managing praise than their peers without ID. Accepting praise is a subtle social skill, as a degree of modesty is required to avoid appearing boastful to others. Therefore, it may be that the greater willingness of the participants with ID to report that they would believe the praise 265
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
they were given was an indication of their more limited social skills. These exploratory findings need to be interpreted with considerable caution. If the research findings accurately identify an increased sensitivity to both criticism and praise, then this may suggest that the self-perceptions of people with intellectual disabilities are more dynamic and susceptible to both positive and negative social influence. In other words, people with ID may be more prone to internalizing others’ views of them. This explanation fits with symbolic interactionist theory (Mead, 1934), which proposes that one of the many ways people gain an objective sense of themselves is through observing the reactions of others. Symbolic interactionist theory has been used to help explain how stigma and other social factors might contribute to the development of psychological difficulties in people with ID (Emerson & Jahoda, 2012; Jahoda, Dagnan, Jarvie, & Kerr, 2006;). However, there may also be positive implications for clinical interventions with people experiencing mental health problems, because praise could play an important role in promoting well-being. Willner (2006) has already suggested that caregivers can have an important role in promoting engagement in Cognitive Behavioral Therapy (CBT) with people who have intellectual disability. Thus, significant others could have a more direct role in promoting change. Behavioral experiments that involve gathering the views of others could also prove to be effective therapeutic techniques. For example, if someone is reluctant to engage in particular tasks because of past experience of failure, then asking the person to try achievable tasks and seek feedback from others might be helpful in shifting the person’s self-perceptions. Whelton and Greenberg (2005) suggest that internalizing praise may provide a buffer to stress. The current study also indicates that it may be possible to use praise to bolster the self-perceptions of people with ID. Therefore, these results may also provide support for the use of therapeutic interventions with this group and the benefit that people themselves place on the therapeutic relationship (Pert et al., 2012). However, Gilbert (2010) also makes clear that the ability to internalize warmth and kindness in the therapeutic relationship relies on it being delivered in a genuine way by someone who is considered competent, who knows the person well. Therefore, the praise may not be accepted or believed 266
EAAIDD DOI: 10.1352/1944-7558-120.3.258
if it is not thought to be relevant or felt to lack sincerity. In Gilbert’s (2010), work on self-compassion he drew on symbolic interactionism in the development of compassionate focused therapy (CFT). He referred to the work of Cooley (1922), who highlighted the social and interpersonal basis of the development of self-concept and identity. In CFT, others are regarded as crucial in engendering feelings of safety and security; a basis for developing emotional regulation and self-compassion. CFT places emphasis on acceptance of the positive and negative aspects of oneself. Being aware and accepting of our positive characteristics and qualities may allow us to develop a kindness and caring stance to oneself. Having a balanced view of ourselves in which we accept our faults and limitations while recognizing our strengths may provide a way of coping, particularly during times when we are not prospering or succeeding. There are several methodological issues that require consideration when interpreting the findings. The PACT is a novel tool; and although it draws on effective approaches used previously, this study was essentially exploratory in nature. The open-ended questions may have allowed participants to provide more authentic and valid responses than a forced-choice option. However, the open-ended responses presented challenges in terms of the data coding and analysis. It was important for the resulting categories to be meaningful, yet there also had to be enough data in each category to allow for formal statistical analysis to be undertaken. This meant that more subtle differences in the participants’ responses may have been overlooked. For example, some thoughts in response to criticism were accepting of the criticism, whereas others seemed to use the criticism in a motivational way. Future studies would benefit from devising prompts to follow up the open-ended questions and should try to develop a more subtle approach to investigating self-supporting statements. A larger sample size would also provide more robust findings and help to avoid confounding factors due to a biased sample. Past research suggests that people with ID have more experience of criticism and interpersonal conflict (Bramston et al., 1999; Hartley & McLean, 2005). However, vignettes, such as those used in this study, do not necessarily capture typical or salient experiences for participants. Coping With Criticism and Praise
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
Qualitative or ethnographic methods might offer alternative approaches to investigate this topic, allowing a more detailed examination of how criticism and praise are perceived by people with ID in real-life settings. In conclusion, this study offers an initial exploration of the cognitive and emotional responses of people with and without ID to praise and criticism. Examining responses to both praise and criticism might help to shed light on key psychological factors that contribute to resilience, as well as vulnerability to emotional difficulties.
References Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. Bramston, P., Fogerty, G. J., & Cummins, R. A. (1999). The nature of stressors reported by people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 12, 1–10. http://dx.doi.org/10.1111/j.1468-3148. 1999.tb00046.x Carstairs,V., & Morris, R. (1991). Deprivation and health in Scotland. Aberdeen, Scotland: Aberdeen University Press. Cooley, C. H. (1922). Human nature and the social order. New York, NY: Scribner’s. Cuthill, F., Espie, C. A., & Cooper, S-A. (2003). Development and psychometric properties of the Glasgow Depression Scale for People With Learning Disability: Individual (GASLD) and carer supplement (GDS-CS) versions. British Journal of Psychiatry, 182, 347– 353. http://dx.doi.org/10.1192/bjp.182.4.347 Dagnan, D., & Waring, M. (2004). Linking stigma to psychological distress: testing a social cognitive model of the experience of people with intellectual disabilities. Clinical Psychology & Psychotherapy, 11, 247–54. http://dx.doi. org/10.1002/cpp.413 Emerson, E. (2010). Self-reported exposure to disablism is associated with poorer self reported health and well-being among adults with intellectual disabilities in England: a cross sectional survey. Public Health, 124, 682– 689. http://dx.doi.org/10.1016/j.puhe.2010. 08.020 Emerson, E., & Jahoda, A., (2012). Social and psychological factors as determinants of emotional and behavioural difficulties. In J. L. Taylor, W. R. Lindsay, C. Hatton, & R. L. Esdale, A. Jahoda, and C. Pert
EAAIDD DOI: 10.1352/1944-7558-120.3.258
P. Hastings. (Eds.). Cognitive behaviour therapy for people with intellectual and developmental disabilities. Chichester, UK: Wiley/Blackwell. http://dx.doi.org/10.1002/9781118329252.ch2 Gilbert, P. (2005). Compassion: Conceptualisations, research and use in psychotherapy. London, England: Routledge. Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15, 199–208. http://dx.doi.org/10.1192/ apt.bp.107.005264 Gilbert, P. (2010). Compassion focused therapy. Distinctive features. London, England: Routledge. Gilbert, P., Durrant, K., & McEwan, K. (2006). Investigating relationships between perfectionism, forms and functions of self-criticism, and sensitivity to put-down. Personality and Individual Differences, 41, 1299–1308. http:// dx.doi.org/10.1016/j.paid.2006.05.004 Gilbert, P., & Miles J. N. V. (2000). Sensitivity to put-down: Its relationship to perceptions of shame, social anxiety, depression, anger and self-other blame. Personality and Individual Differences, 29, 757–774. http://dx.doi.org/10. 1016/S0191-8869(99)00230-5 Hartley, S. L., & MacLean, W. E. (2005). Perceptions of stress and coping strategies among adults with mild mental retardation: Insight into psychological adjustment. American Journal on Mental Retardation, 110, 285–290. Jahoda, A., Dagnan, D., Jarvie, P., & Kerr, W. (2006). Depression, social context and cognitive behavioural therapy for people who have intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 19(1), 81–89. http://dx.doi.org/ 10.1111/j.1468-3148.2005.00286.x Jahoda, A., Dagnan, D., Kroese, B. S., Pert, C., & Trower, P. (2009). Cognitive behavioural therapy: From face to face interaction to a broader contextual understanding of change. Journal of Intellectual Disability Research, 53, 759–771. http://dx.doi.org/10.1111/j.13652788.2009.01189.x Jahoda, A., & Markova, I. (2004). Coping with social stigma: people with intellectual disabilities moving from institutions and the family home. Journal of Intellectual Disability Research, 48(part 8), 719–729. http://dx.doi.org/10. 1111/j.1365-2788.2003.00561.x MacMahon, P., & Jahoda, A. (2008). Social comparison and self-esteem in depressed and non-depressed people with mild and moder267
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
ate intellectual disability. America Journal on Mental Retardation, 113, 307–318. Mead, G. H. (1934). Mind, self and society. Chicago, IL: University of Chicago Press. Neff, K. D. (2009). The role of self-compassion in development: A healthier way to relate to oneself. Human Development, 52, 211–214. http://dx.doi.org/10.1159/000215071 Nihira, K., Leland, H., & Lambert, N. (1993). Adaptive Behavior Scale- Residential and Community (2nd ed.). Austin, TX: The American Association on Mental Retardation. Pert, C., & Jahoda, A. (2008). Social goals and conflict strategies of individuals with mild to moderate intellectual disabilities who present problems of aggression. Journal of Intellectual Disability Research, 52, 5, 393–403. http://dx. doi.org/10.1111/j.1365-2788.2007.01039.x Pert, C., Jahoda, A., Stenfert Kroese, B., Trower, P., Dagnan, D., & Selkirk, M. (2012). Cognitive behavioural therapy from the perspective of clients with mild intellectual disabilities: A qualitative investigation of process issues. Journal of Intellectual Disability Research, 57, 359–369. http://dx.doi.org/10. 1111/j.1365-2788.2012.01546.x Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence (WASI) San Antonio, TX: Harcourt Assessment Inc. Szivos-Bach, S. E. (1993). Social comparison, stigma and mainstreaming: The self-esteem of young people with mild mental handicap. Mental Handicap Research, 6, 217–236. http://dx.doi. org/10.1111/j.1468-3148.1993.tb00054.x Whelton, W. J., & Greenberg, L. S. (2005). Emotion in self-criticism. Personality and
268
EAAIDD DOI: 10.1352/1944-7558-120.3.258
Individual Differences, 38, 1583–1595. http:// dx.doi.org/10.1016/j.paid.2004.09.024 Whitehouse, R. M., Tudway, J. A., Look, R., & Kroese, B. S. (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. http://dx.doi.org/10. 1111/j.1468-3148.2005.00281.x Willner, P. (2006). Readiness for cognitive therapy in people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 19, 5–16. http://dx.doi.org/10.1111/j.1468-3148. 2005.00280.x
Submitted 1/15/2014, accepted 5/13/2014. Authors: Lynn Esdale and Andrew Jahoda, Institute of Health and Wellbeing, University of Glasgow, Scotland, United Kingdom; and Carol Pert, National Health Service Greater Glasgow and Clyde, Scotland, United Kingdom. Address correspondence concerning this article to Andrew Jahoda, Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, Trust Headquarters. 1st Floor, 1055 Great Western Road, Glasgow, G12 0XH United Kingdom (e-mail: [email protected]).
Coping With Criticism and Praise
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
Coping With Criticism and Praise Lynn Esdale, Andrew Jahoda, and Carol Pert
Abstract Through experiencing stigma and discrimination, people with intellectual disability may become more sensitive to criticism from others and be less likely to believe praise. This study compared how people with and without intellectual disability viewed praise and criticism, using a vignette task developed for the study. Participants were asked to imagine someone saying something praiseworthy or critical and were then asked about their emotions, beliefs, and thoughts. People with intellectual disability were more likely to believe and be distressed by criticism. Contrary to predictions, this group were also more likely to believe praise and experience positive affect. The results suggest that the selfperceptions of people with intellectual disabilities is more dynamic and reliant on the views of others. Key Words: intellectual disability; social cognition; compassion; criticism; praise; self-perceptions
In the general adult population, self-critical beliefs have been associated with a vulnerability to depression and other mental health difficulties. One construct thought to help explain how people cope with self-criticism, deal with negative life events and promote resilience, is self-compassion (Gilbert, 2005). Both self-criticism and selfcompassion can be viewed as internal ways of relating to oneself, which may be indicative of the beliefs we hold about ourselves. Self-criticism is a harsh, self-blaming style of thinking about oneself, and is thought to develop from experiences of being treated negatively by others. Interpersonal experiences, and our experience of relationships, are considered important in terms of how we think about ourselves. Hence, a self-blaming style of thinking might be linked to sensitivity to social put- down, that is, being sensitive to criticism from others. Moreover, it has been suggested that those who are more sensitive to criticism from others are more likely to internalise the criticism (Gilbert, Durrant, & McEwan, 2006). Gilbert et al. (2006) propose that being sensitive to criticism originates from negative social experiences, such as being bullied or subordinated. Once established, self-critical 258
beliefs can become self-maintaining; with a tendency not only to put oneself down but to believe others’ criticisms. Self-compassion is an ability to be kind to oneself. The literature on self-compassion suggests that adopting a kind, nonjudgmental approach to oneself at times of suffering can be an important coping strategy that can reduce distress (Gilbert, 2005). It may also help to promote positive mental well-being. Neff (2009) suggests that accepting both the positive and negative aspects of one’s self can help develop a balanced view of one’s emotional experience. Therefore, being selfcompassionate does not involve denying or rejecting one’s negative characteristics, but means accepting them as aspects of oneself, no matter how they compare with those of other people. The constructs of self-criticism and selfcompassion seem relevant to the emotional wellbeing of people with intellectual disability (ID), because this group is often subject to negative interpersonal experiences, such as bullying and discrimination (Emerson, 2010). Negative interpersonal experiences have been found to be more prevalent and cause greater stress than other negative events for people with intellectual Coping With Criticism and Praise
EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
disabilities (Bramston, Fogerty & Cummins, 1999; Hartley & McLean, 2005). Therefore, it may be that people with intellectual disabilities are sensitised to and, consequently, vulnerable to the effects of negative interpersonal experiences. In a study with adults with intellectual disabilities, Dagnan and Waring (2004) found that discriminatory views can be internalized and that being treated negatively was associated with viewing oneself as inferior to others (negative social comparison). In a study of young people with intellectual disabilities, Schivos-Bach (1993) found that those with the greatest awareness of stigma had the lowest self-esteem and felt the most different from others and their siblings. However, other research has failed to find such direct effects and has pointed to the ability of people with intellectual disabilities to reject a stigmatised identity (Jahoda & Markova, 2004). People with intellectual disability may also be vulnerable to emotional distress if they cannot benefit from positive and supportive interpersonal experiences. Supportive comments or praise may be discrepant with the self-views of people with intellectual disability, and therefore may not be accepted or given significance. MacMahon and Jahoda (2008) found that people with an intellectual disability who were depressed may recognize their strengths, but fail to attach significance to these strengths. It is possible that a vulnerability to low mood may be created through a lack of recognition of one’s positive characteristics. People with intellectual disability may internalize and believe criticism from others if it matches with their own self-view. However, it is unclear whether praise and positive interpersonal experiences are rejected if they are discrepant with negative self-views. Cognitive behavior therapy (CBT) has been developed and adapted for a range of mental health difficulties for people with intellectual disabilities, including depression and anxiety (Whitehouse, Tudway, Look, & Kroese, 2006). CBT aims to challenge negative and distorted views of reality that trigger and maintain distress and is proving to be a useful psychological intervention for people with intellectual disabilities (Jahoda, Dagnan, Kroese, Pert, & Trower, 2009). However, this approach may be less effective when used to tackle real life difficulties which these individuals face, including discriminatory treatment (Jahoda et al, 2009). Compassion focused therapy (CFT) takes a different stance and teaches the skills of self-compassion L. Esdale, A. Jahoda, and C. Pert
as a way of coping with distress and self-criticism (Gilbert, 2009). This approach aims to help people find a way of coping with negative feelings without denying their experiences. This involves encouraging people to recognize their strengths and positive characteristics and may be a valuable tool in promoting resilience. Self-criticism and self-compassion have been identified and studied in clinical and student populations in the general adult population. As a first step towards understanding these processes in people with intellectual disabilities, this study set out to investigate the reactions of a group of participants with intellectual disabilities and a group of participants without intellectual disabilities to criticism and praise. Due to their cognitive impairments and experience of social stigma (Jahoda & Markova, 2004), people with intellectual disabilities may be likely to have more experience of criticism than their non-disabled peers. Therefore, compared to their non disabled peers, it was anticipated that they would be more likely to believe criticism and feel upset. In contrast, it was expected that those with intellectual disabilities would be less likely to believe praise and feel positive. This study also aimed to explore the ability of people with and without intellectual disabilities to generate self-supportive responses when faced with criticism.
Materials and Methods Participants Twenty-five adults with intellectual disability (with mild to moderate levels of impairment) and 21 adults without intellectual disability over 18 years of age were recruited to the study from further education colleges. Participants who were included in the study all met the following criteria: (a) were aged 18–65 years of age, (b) had the ability to provide informed consent, and (c) had sufficient receptive and expressive verbal ability to describe everyday events. Participants were excluded from taking part in the study if they (a) had a severe visual or hearing impairment that would make it difficult to engage with the study materials and (b) had a diagnosis of autistic spectrum disorder because the social deficits associated with this diagnosis would be likely to make the research tasks challenging. Participants from both groups were recruited from Further Education colleges in the West of Scotland, providing courses for people with 259
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
intellectual disabilities. Senior staff from interested college departments identified classes of students who had sufficient receptive and expressive language to describe everyday events. To assist with this, the following items from the Adaptive Behavior Scale (ABS-RC:2) (Nihira, Leland, & Lambert, 1993) were used: (a) talks to others about sports, family, group activities, (b) sometimes uses complex sentences containing ‘‘because’’ or ‘‘but,’’ and (c) answers simple questions such as ‘‘What is your name?’’ or ‘‘What are you doing?‘‘ The researcher then presented information regarding the study to these classes for 5–10 min and provided written information. Six participants were excluded from the sample of recruited participants. Of these, four participants recruited to the intellectual disability group were excluded because their Wechsler Abbreviated Scale of Intelligence (WASI-IQ) scores fell within the low average or average range of cognitive functioning; therefore, it was unclear whether they had an intellectual disability. Another participant was excluded because he struggled to engage with the study materials, which appeared to result from a lack of understanding. One participant in the control group was excluded because his WASI-IQ score was within the borderline range of cognitive functioning. Therefore, the final sample consisted of 20 participants with intellectual disability (12 men, eight women, mean age 28.2 years, SD 5 12.06, range 18–54 years) and 20 participants without intellectual disability (nine men, 11women, mean age 26.8 years, SD 5 13.18, range 18–63 years).
Measures The following measures were delivered to each participant in the order presented here: 1. Demographic information: Information was gained from each participant on their age, gender, living situation, employment, and postcode. Deprivation was determined by their post code, using an index neighbourhood deprivation as a measure of socioeconomic status (Carstairs & Morris, 1991). The Carstairs Index is composed of four indicators judged to represent material disadvantage in the population and is collated from Census data. The four indicators are social class (as defined by the Census), lack of car ownership, overcrowding, and male unemployment. Deprivation categories (DepCats) range from 1 (affluent) to 7 (severe deprivation). 2. Glasgow Depression Scale for People With a Learning Disability (GDS-LD; Cuthill, Espie, & Cooper, 2003): The GDS-LD is a 20-item questionnaire used to measure depression in people with intellectual disability. This was used to ensure that there were no significant differences in
260
EAAIDD DOI: 10.1352/1944-7558-120.3.258
low mood between the two study groups, which could potentially be a confounding factor in terms of response to criticism and praise. The GDS-LD shows a strong correlation (r 5 0.88) with the Beck Depression Inventory II (BDI- II; Beck, Steer, & Brown, 1996) and good testretest reliability (r 5 0.97). There is also excellent criterion validity. The GDS-LD scores of a nonlearning disability depressed group were highly correlated with their scores on the BDI-II (r 5 0.94, p , 0.001). 3. Praise and Criticism Task (PACT): This task was devised for the purposes of this study. An existing body of work has used hypothetical vignettes to investigate the socialcognitive responses of people with intellectual disability to threat in interpersonal situations (Pert & Jahoda, 2008). This method was successful in engaging people with intellectual disability, and in eliciting their responses to social threat. Therefore, a similar method was considered appropriate in this study to ascertain responses to criticism and praise.
In the PACT, participants were presented with a self-referent scenario in which they were asked to imagine encountering a person who praises or criticizes them. Each hypothetical scenario was illustrated using three photographs and was presented in a story board format. The photographs depicted the unfolding sequence of events in each scenario, and the researcher read the narratives to the participants as the photographs were presented. Development and pilot. The PACT required careful development and piloting to ensure that the content of the scenarios had resonance in the lives of people both with and without intellectual disabilities. The Sensitivity to Social Putdown Scale (SPD; Gilbert & Miles, 2000) was used to help identify the social criticism scenarios to be included in the PACT. The SPD scale is an assessment tool developed for a general adult population, which measures responses to common social criticisms. Storyboards were produced for the 12 written scenarios and the scenes were illustrated using photographs taken by the researcher. Participants were presented with a selfreferent scenario in which they were asked to imagine encountering a person who says something positive (praise) or negative (criticism) about them. Each hypothetical scenario was illustrated using three photographs and the narratives were read to the participants by the researcher. The photographs show the scene from the perspective of the protagonist, thereby preventing any confusion caused by the participant being asked to identify with a picture of someone else. These 12 scenarios were then piloted with three individuals (two with intellectual disability and one without) before the main study commenced. The Coping With Criticism and Praise
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
pilot established the following: (a) which of the scenarios were salient to both groups and (b) the benefits of using opened-ended exploratory questions to assess emotions and thoughts. . Two scenarios were excluded because they lacked relevance to both groups. This resulted in 10 scenarios being deemed suitable for use in the research study, each ending with interactions involving criticism or praise. Final version of the PACT. Two sets of scenarios were developed covering the same five themes: performance/effort, skill/ability, popularity, future goals, and autonomy. The same two sets of scenarios were presented in the same order to each participant. However, there were two versions of the task. In version A, the researcher narrated the first five stories with a criticism ending and the second five stories with a praise ending. In version B, the first five stories had a praise ending and the second five stories a criticism ending. Alternate versions of the task were delivered to successive participants. An equal number of participants from each group received each version. Following the presentation of each scenario, participants were asked a series of questions to establish their emotions, beliefs, and thoughts in response to criticism and praise. The response format was a combination of forced-choice responses and open-ended questions, and all questions were asked in a tentative style, to ensure that the participants’ responses were not guided in any direction. Prompts were used only when necessary to ensure that the key information was obtained. Example of a scenario and response format: You are at home and (someone relevant to participant’s circumstances) is making dinner. She/he asks for your help. When the dinner is ready, your (insert person) says ’I couldn’t have done it without you. You were a lot of help.’’’ (Praise scenario, performance/ effort theme) a. b. c.
Emotional response was ascertained by asking an open-ended question,‘‘How does that make you feel?’’ Belief was ascertained by referring specifically to the criticism/praise given in the scenario. For example: ‘‘Are you a help to other people?’’ Thoughts were ascertained by asking an open-ended question that linked the emotional response to the scenario. For example: ‘‘Person X says you were a lot of help and you are feeling happy? What are you thinking?’’. If participants failed to respond to the open-ended question, a forced-choice question was
L. Esdale, A. Jahoda, and C. Pert
EAAIDD DOI: 10.1352/1944-7558-120.3.258
asked. For example: ‘‘Would you be thinking; (i) They are right, I was a lot of help. or (ii) they are wrong, I was not a lot of help’’. 4. Wechsler Abbreviated Scale of Intelligence (WASI; Psychological Corporation, 1999): The two subset form of the WASI was delivered to provide an estimate of the participants’ general intellectual ability. Psychometric properties include a high level of internal reliability (0.96–0.98), adequate test-retest reliability (0.88–0.92) and good concurrent validity (0.87).
Procedure All meetings took place in a private room at the participant’s college. Consent forms and information sheets were adapted to be accessible for people with intellectual disabilities. The researcher ordinarily met once with the participants, but for some participants it was necessary to meet on two occasions. The administration time was approximately 60 min. At the beginning of each meeting, time was spent establishing rapport with the participants to help them feel at ease. It was made explicit to participants that there were no right or wrong answers to the PACT questions. The WASI was completed at the end of each meeting because it does have right and wrong answers and therefore is contrary to the spirit of the main research task, where the aim was to obtain insight into the participants’ own views.
Results Descriptive Participant Data Table 1 shows the descriptive data for both groups. Mean scores for deprivation were 5.80 (SDSD 5 1.15, range 4–7) for the group with intellectual disabilities and 4.95 (SD 5 1.63, range 2–7) for those without disabilities. This difference was not statistically significant; t(38) 5 21.9, p 5 0.07. The living situation of the groups did not differ, x2(3) 5 2.9, p 5 0.40. However, the employment data did show significant group differences, x2(2) 5 6.23, p 5 0.04, with more people in the non-ID group in paid work than in the ID group. The groups did not differ in terms of reported symptoms of depression; Both groups had a mean score of 8.5 for the GDS-LD and similar standard deviations (ID group 5 5.98, non-ID group 5 6.18). As expected, the non-ID group had significantly higher WASI-IQ scores; t(38) 5 213.12, p , 0.001. 261
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
EAAIDD DOI: 10.1352/1944-7558-120.3.258
Table 1 Descriptive Data Measure GDS-LD WASI Gender Age Deprivation score Living situation
Employment
Mean (SD) Range Mean (SD) Range Male Female Mean (SD) Range Mean (SD) Range Lives alone With family Partner/ flatmate Supported accom Paid Voluntary None
ID group
Non-ID group
8.5 (5.98) 1–23 62.5 (5.88) 55–74 12 8 28.2 (12.06) 18–54 5.80 (1.15) 4–7 2 16 1 1 2 4 14
8.5 (6.18) 0–25 101 (12.35) 86–133 9 11 26.75 (13.18) 18–63 4.95 (1.63) 2–7 2 14 4 0 9 3 8
p value 1.00 , 0.001* 0.34
0.52 0.07
0.40
0.04*
Note. ID 5 intellectual disability; GDS-LD 5 Glasgow Depression Scale for People With a Learning Disability; WASI 5 Wechsler Abbreviated Scale of Intelligence. *p , .05.
PACT—Data Coding and Analysis Answers to the PACT questions were recorded on a response sheet during the interview. Responses were subsequently content analysed, and grouped into categories that characterized the different responses to each of the open-ended questions. A second independent rater was asked to group the participants’ responses into the categories developed for each question. The interrater agreement obtained was (a) emotions (criticism) Kappa 5 0.97, (b) emotions (praise) Kappa 5 0.92, (c) thoughts (criticism) Kappa 5 0.91, and (d) thoughts (praise) Kappa 5 0.90. Table 2 shows how the data to the open-ended questions were categorized and examples of these responses. The data obtained from the PACT was categorical, therefore, chi-square analysis was undertaken to investigate group differences. Where the conditions for chi-square tests were not met, the Fisher’s exact test was used. All analyses were two tailed.
Belief, Emotions, and Thoughts in Response to Criticism Table 3 shows the data for the emotional responses, belief in criticism, and thoughts in response to criticism expressed by both groups. 262
Belief in criticism. Analysis of the total belief scores showed a significant difference in belief in criticism between the two groups, x2(1) 5 3.87, p 5 0.049, with more people in the intellectual disability group stating that they believed the criticism they received. When the individual themes of criticism were tested, a significant difference was found in the popularity theme, x2(1) 5 13.33, p 5 , 0.001, with more people in the intellectual disability group believing the criticism. The other themes showed no significant differences; performance, x2(1) 5 1.91, p 5 0.168, skill, x2(1) 5 1.37, p 5 0.243, future plans, x2(1) 5 2.24, p 5 0.135, and autonomy, x2(1) 5 0.40, p 5 0.527. Emotional response to criticism. The data for emotion in response to criticism was coded into two categories; internal negative (sad, depressed, down) and external (angry, annoyed, rejecting). Comments categorized as ‘internal negative’ focused the blame for the criticism internally, whereas those categorized as external tended to focus the blame externally often on the protagonist. Table 2 gives definitions and examples of responses in these categories. The total scores showed a significant group difference in the emotional response to criticism, Coping With Criticism and Praise
L. Esdale, A. Jahoda, and C. Pert
Derogation
Thoughts
Examples
Negative emotion directed Sad, depressed, upset, internally to oneself. gutted. Emotion directed externally, Annoyed, angry, not often to another person. bothered. ‘‘I don’t fit it with the Thoughts that are team. I’m not important. characterised by negative What’s the use in being thoughts or uncertainty here’’ (ID group, future about the self and/or one’s plans category). abilities, skills etc.
Definition
Resiliemce
Unable to benefit Rejecting
Thoughts
Accepting
Positive
Emotions
Praise Categorisation
‘‘Was he even reading the Positive or supportive right paper? When a task beliefs about oneself, comes, I always put in the abilities, skills etc. The effort’’ (non-ID group, criticism seems to lack performance category). impact as it is recognised as unwarranted or being able to minimise it. ‘‘At least he’s told me and Constructive Perceiving criticism I’ve got a chance to as constructive improve it. I don’t and an opportunity suppose you’re always to improve one’s skills, going to get it right the abilities etc. first time anyway’’ (ID group, performance). ‘‘They’re being nasty. They Blaming the Negative views of other the other person or don’t like me and I’ve the other person’s done nothing to them’’ intentions. (ID group, popularity category).
Internal negative External
Emotions
Criticism Categorisation
Table 2 Categorisation of Open-Ended Questions From the PACT Examples
Happy, excited, good, confident. Negative emotion or Worried, anxious, dismissive. not bothered. ‘‘Are you sure about Negative views about that? We might the self. Feeling fall out and put a the praise is undeserved damper on it’’ (ID or unimportant. May group, popularity). also question the intention of the person giving the praise. ‘‘He can depend on Thoughts characteristics me. Good knowing by positive beliefs about someone can trust oneselves, abilities, etc. me’’ (ID group, Also, using praise in an performance positive manner bolster category). ones confidence or sense of self.
Positive emotion.
Definition
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
EAAIDD DOI: 10.1352/1944-7558-120.3.258
263
EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
x2(1) 5 22.33, p 5 0.001, with people in the ID group more frequently reporting an internal negative emotion in response to criticism. Examination of the different critical themes showed that those with intellectual disabilities reported more negative internal emotions than the non–ID group regarding performance, x2(1) 5 3.75, p 5 0.053, popularity, x2(1) 5 5.58, p 5 0.02 and autonomy, x2(1) 5 8.64, p 5 0.003. No significant group differences were found in the themes of skill, x2(1) 5 3.08, p 5 0.08 or future plans, x2(1) 5 3.31, p 5 0.069, although trends in the same direction were evident. Thoughts in response to criticism. The majority of participants in both groups managed to identify thoughts in response to criticism (ID group 5 89%, non-ID group 5 99%). Using a content analysis, the participants’ responses were coded into four categories: (a) self-derogation, (b) resilience, (c) constructive, and (d) blaming the other. Unfortunately, this meant that it was not possible to analyse the open-ended responses alongside the responses that the participants were asked make in the forced choice option. The open-ended responses are shown in Table 2. In terms of self-supporting statements, both the resilient and constructive responses contained a positive message about self. Derogatory statements about self were clearly negative, but whether or not the blaming responses were selfsupporting remained unclear. Table 3 shows the frequency of thoughts reported in each group. In terms of the study hypotheses, the participants’ ability to generate self-supporting thoughts in the face of criticism
was of interest. At a descriptive level the pattern of responses produced by both groups was very similar and when the two categories of responses with a clearly self supporting element were combined (resilient and constructive), a very similar number of self-supporting statements were produced by both groups. The ID group and the non-disabled group produced 49 and 52 selfsupporting statements, respectively.
Belief, Emotions, and Thoughts in Response to Praise Table 4 shows the findings for belief, emotional response, and thoughts in response to praise. Belief in praise. A significant group difference in the total scores was found, x2(1) 5 3.81, p 5 0.051; people with intellectual disabilities reported believing the praise they received more often than people without intellectual disabilities. The individual themes of praise showed a significant group difference in the autonomy theme (p 5 0.002). However, no significant group differences were found in the performance (p 5 1.00), skill (p 5 0.677), popularity (p 5 0.311), or future plans (p 5 0.677) themes. Emotional response to praise. Participants’ emotional response to praise was coded into two categories: (a) positive emotion and (b) ‘‘unable to benefit.’’ Table 2 gives a definition and examples of response in these categories. The total scores showed a significant group difference in the emotional response to praise, x2(1) 5 11.23, p 5 , 0.001, however, this difference was in the opposite direction than
Table 3 Responses When Faced With Criticism Variable Belief
Emotional response
Thoughts
Categorisation
ID group N 5 20
Non-ID group N 5 20
No Yes Missing Internal negative External Other/no response Derogation Resilient Constructive Blaming the other Other/no response
60 39 1 72 27 1 22 35 14 17 12
73 26 1 39 60 1 25 47 5 17 5
p value 0.049*
, 0.001*
Note. ID 5 intellectual disability.
264
Coping With Criticism and Praise
EAAIDD DOI: 10.1352/1944-7558-120.3.258
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
Table 4 Responses to Praise Variable Belief
Emotional response
Thoughts
Categorisation
ID group
Non-ID group
No Yes Missing Positive Unable to benefit Unable to code Rejecting Accepting Other/no response
8 92 0 96 4 0 14 84 2
17 82 1 80 19 1 37 62 1
predicted. It was predicted that people with intellectual disabilities would be less likely to benefit from praise. However, it was the nondisabled participants who had a greater tendency to report being negative about praise. A significant group difference (p 5 0.003) was found for the theme of autonomy. There were no significant differences between the groups on the performance (p 5 0.487), skill (p 5 0.605), popularity (p 5 0.605), or future plans (p 5 1.00) themes. Thoughts in response to praise. People with intellectual disabilities appeared to have more difficulty identifying their thoughts in response to praise when asked an open-ended question (ID group 5 79%, Non-ID group 5 97%). Thoughts were coded into two categories: (a) rejecting and (b) accepting. Those who could not identify thoughts in response to the open-ended questions were able to answer a forced choice question. These responses were coded into the same framework. Table 2 gives a definition and example of thoughts in each category. Table 4 shows the frequency of thoughts in response to praise for each group. An overall group difference was found, x2(1) 5 13.68, p 5 ,0.001 showing that participants without intellectual disability reported rejecting thoughts in response to praise more frequently than participants with intellectual disability. When the PACT themes were examined separately, no significant group differences were found in the performance, F(1) 5 0.66, skill, x2(1) 5 2.85, p 5 0.091, future plans, x2(1) 5 0.44, p 5 0.507, or the popularity, F(1) 5 0.342, themes. A significant group difference was found in the autonomy theme, x2(1) 5 14.15, p 5 , 0.001. L. Esdale, A. Jahoda, and C. Pert
p value 0.051*
0.001*
, 0.001*
Discussion The study findings suggest that the participants with intellectual disability were more likely to believe criticism than the non-ID participants and more likely to report being affected by it. However, contrary to predictions, those with ID were also more likely to believe praise. Examining participants’ responses to specific scenarios may help to explain these group differences. It is perhaps unsurprising that criticism relating to popularity is particularly affecting for people with ID who commonly experience social exclusion. Their feelings of depression and sadness in relation to the critical scenes suggest a more general emotional sensitivity to being put down by others. In relation to praise, the only scenario where a significant group difference was found concerned autonomy. One explanation might be that praise about autonomy might be particularly salient for those with people with ID, who are likely to remain dependent on others for a degree of daily support, whereas, the non-ID participants might have failed to find anything praiseworthy about exercising a typical degree of autonomy. Nevertheless, it remains the case that the participants with ID expressed greater belief in praise across the different scenarios. Another potential explanation might be that the participants with ID were less skilled at managing praise than their peers without ID. Accepting praise is a subtle social skill, as a degree of modesty is required to avoid appearing boastful to others. Therefore, it may be that the greater willingness of the participants with ID to report that they would believe the praise 265
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
they were given was an indication of their more limited social skills. These exploratory findings need to be interpreted with considerable caution. If the research findings accurately identify an increased sensitivity to both criticism and praise, then this may suggest that the self-perceptions of people with intellectual disabilities are more dynamic and susceptible to both positive and negative social influence. In other words, people with ID may be more prone to internalizing others’ views of them. This explanation fits with symbolic interactionist theory (Mead, 1934), which proposes that one of the many ways people gain an objective sense of themselves is through observing the reactions of others. Symbolic interactionist theory has been used to help explain how stigma and other social factors might contribute to the development of psychological difficulties in people with ID (Emerson & Jahoda, 2012; Jahoda, Dagnan, Jarvie, & Kerr, 2006;). However, there may also be positive implications for clinical interventions with people experiencing mental health problems, because praise could play an important role in promoting well-being. Willner (2006) has already suggested that caregivers can have an important role in promoting engagement in Cognitive Behavioral Therapy (CBT) with people who have intellectual disability. Thus, significant others could have a more direct role in promoting change. Behavioral experiments that involve gathering the views of others could also prove to be effective therapeutic techniques. For example, if someone is reluctant to engage in particular tasks because of past experience of failure, then asking the person to try achievable tasks and seek feedback from others might be helpful in shifting the person’s self-perceptions. Whelton and Greenberg (2005) suggest that internalizing praise may provide a buffer to stress. The current study also indicates that it may be possible to use praise to bolster the self-perceptions of people with ID. Therefore, these results may also provide support for the use of therapeutic interventions with this group and the benefit that people themselves place on the therapeutic relationship (Pert et al., 2012). However, Gilbert (2010) also makes clear that the ability to internalize warmth and kindness in the therapeutic relationship relies on it being delivered in a genuine way by someone who is considered competent, who knows the person well. Therefore, the praise may not be accepted or believed 266
EAAIDD DOI: 10.1352/1944-7558-120.3.258
if it is not thought to be relevant or felt to lack sincerity. In Gilbert’s (2010), work on self-compassion he drew on symbolic interactionism in the development of compassionate focused therapy (CFT). He referred to the work of Cooley (1922), who highlighted the social and interpersonal basis of the development of self-concept and identity. In CFT, others are regarded as crucial in engendering feelings of safety and security; a basis for developing emotional regulation and self-compassion. CFT places emphasis on acceptance of the positive and negative aspects of oneself. Being aware and accepting of our positive characteristics and qualities may allow us to develop a kindness and caring stance to oneself. Having a balanced view of ourselves in which we accept our faults and limitations while recognizing our strengths may provide a way of coping, particularly during times when we are not prospering or succeeding. There are several methodological issues that require consideration when interpreting the findings. The PACT is a novel tool; and although it draws on effective approaches used previously, this study was essentially exploratory in nature. The open-ended questions may have allowed participants to provide more authentic and valid responses than a forced-choice option. However, the open-ended responses presented challenges in terms of the data coding and analysis. It was important for the resulting categories to be meaningful, yet there also had to be enough data in each category to allow for formal statistical analysis to be undertaken. This meant that more subtle differences in the participants’ responses may have been overlooked. For example, some thoughts in response to criticism were accepting of the criticism, whereas others seemed to use the criticism in a motivational way. Future studies would benefit from devising prompts to follow up the open-ended questions and should try to develop a more subtle approach to investigating self-supporting statements. A larger sample size would also provide more robust findings and help to avoid confounding factors due to a biased sample. Past research suggests that people with ID have more experience of criticism and interpersonal conflict (Bramston et al., 1999; Hartley & McLean, 2005). However, vignettes, such as those used in this study, do not necessarily capture typical or salient experiences for participants. Coping With Criticism and Praise
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
Qualitative or ethnographic methods might offer alternative approaches to investigate this topic, allowing a more detailed examination of how criticism and praise are perceived by people with ID in real-life settings. In conclusion, this study offers an initial exploration of the cognitive and emotional responses of people with and without ID to praise and criticism. Examining responses to both praise and criticism might help to shed light on key psychological factors that contribute to resilience, as well as vulnerability to emotional difficulties.
References Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. Bramston, P., Fogerty, G. J., & Cummins, R. A. (1999). The nature of stressors reported by people with an intellectual disability. Journal of Applied Research in Intellectual Disabilities, 12, 1–10. http://dx.doi.org/10.1111/j.1468-3148. 1999.tb00046.x Carstairs,V., & Morris, R. (1991). Deprivation and health in Scotland. Aberdeen, Scotland: Aberdeen University Press. Cooley, C. H. (1922). Human nature and the social order. New York, NY: Scribner’s. Cuthill, F., Espie, C. A., & Cooper, S-A. (2003). Development and psychometric properties of the Glasgow Depression Scale for People With Learning Disability: Individual (GASLD) and carer supplement (GDS-CS) versions. British Journal of Psychiatry, 182, 347– 353. http://dx.doi.org/10.1192/bjp.182.4.347 Dagnan, D., & Waring, M. (2004). Linking stigma to psychological distress: testing a social cognitive model of the experience of people with intellectual disabilities. Clinical Psychology & Psychotherapy, 11, 247–54. http://dx.doi. org/10.1002/cpp.413 Emerson, E. (2010). Self-reported exposure to disablism is associated with poorer self reported health and well-being among adults with intellectual disabilities in England: a cross sectional survey. Public Health, 124, 682– 689. http://dx.doi.org/10.1016/j.puhe.2010. 08.020 Emerson, E., & Jahoda, A., (2012). Social and psychological factors as determinants of emotional and behavioural difficulties. In J. L. Taylor, W. R. Lindsay, C. Hatton, & R. L. Esdale, A. Jahoda, and C. Pert
EAAIDD DOI: 10.1352/1944-7558-120.3.258
P. Hastings. (Eds.). Cognitive behaviour therapy for people with intellectual and developmental disabilities. Chichester, UK: Wiley/Blackwell. http://dx.doi.org/10.1002/9781118329252.ch2 Gilbert, P. (2005). Compassion: Conceptualisations, research and use in psychotherapy. London, England: Routledge. Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15, 199–208. http://dx.doi.org/10.1192/ apt.bp.107.005264 Gilbert, P. (2010). Compassion focused therapy. Distinctive features. London, England: Routledge. Gilbert, P., Durrant, K., & McEwan, K. (2006). Investigating relationships between perfectionism, forms and functions of self-criticism, and sensitivity to put-down. Personality and Individual Differences, 41, 1299–1308. http:// dx.doi.org/10.1016/j.paid.2006.05.004 Gilbert, P., & Miles J. N. V. (2000). Sensitivity to put-down: Its relationship to perceptions of shame, social anxiety, depression, anger and self-other blame. Personality and Individual Differences, 29, 757–774. http://dx.doi.org/10. 1016/S0191-8869(99)00230-5 Hartley, S. L., & MacLean, W. E. (2005). Perceptions of stress and coping strategies among adults with mild mental retardation: Insight into psychological adjustment. American Journal on Mental Retardation, 110, 285–290. Jahoda, A., Dagnan, D., Jarvie, P., & Kerr, W. (2006). Depression, social context and cognitive behavioural therapy for people who have intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 19(1), 81–89. http://dx.doi.org/ 10.1111/j.1468-3148.2005.00286.x Jahoda, A., Dagnan, D., Kroese, B. S., Pert, C., & Trower, P. (2009). Cognitive behavioural therapy: From face to face interaction to a broader contextual understanding of change. Journal of Intellectual Disability Research, 53, 759–771. http://dx.doi.org/10.1111/j.13652788.2009.01189.x Jahoda, A., & Markova, I. (2004). Coping with social stigma: people with intellectual disabilities moving from institutions and the family home. Journal of Intellectual Disability Research, 48(part 8), 719–729. http://dx.doi.org/10. 1111/j.1365-2788.2003.00561.x MacMahon, P., & Jahoda, A. (2008). Social comparison and self-esteem in depressed and non-depressed people with mild and moder267
AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015, Vol. 120, No. 3, 258–268
ate intellectual disability. America Journal on Mental Retardation, 113, 307–318. Mead, G. H. (1934). Mind, self and society. Chicago, IL: University of Chicago Press. Neff, K. D. (2009). The role of self-compassion in development: A healthier way to relate to oneself. Human Development, 52, 211–214. http://dx.doi.org/10.1159/000215071 Nihira, K., Leland, H., & Lambert, N. (1993). Adaptive Behavior Scale- Residential and Community (2nd ed.). Austin, TX: The American Association on Mental Retardation. Pert, C., & Jahoda, A. (2008). Social goals and conflict strategies of individuals with mild to moderate intellectual disabilities who present problems of aggression. Journal of Intellectual Disability Research, 52, 5, 393–403. http://dx. doi.org/10.1111/j.1365-2788.2007.01039.x Pert, C., Jahoda, A., Stenfert Kroese, B., Trower, P., Dagnan, D., & Selkirk, M. (2012). Cognitive behavioural therapy from the perspective of clients with mild intellectual disabilities: A qualitative investigation of process issues. Journal of Intellectual Disability Research, 57, 359–369. http://dx.doi.org/10. 1111/j.1365-2788.2012.01546.x Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence (WASI) San Antonio, TX: Harcourt Assessment Inc. Szivos-Bach, S. E. (1993). Social comparison, stigma and mainstreaming: The self-esteem of young people with mild mental handicap. Mental Handicap Research, 6, 217–236. http://dx.doi. org/10.1111/j.1468-3148.1993.tb00054.x Whelton, W. J., & Greenberg, L. S. (2005). Emotion in self-criticism. Personality and
268
EAAIDD DOI: 10.1352/1944-7558-120.3.258
Individual Differences, 38, 1583–1595. http:// dx.doi.org/10.1016/j.paid.2004.09.024 Whitehouse, R. M., Tudway, J. A., Look, R., & Kroese, B. S. (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. http://dx.doi.org/10. 1111/j.1468-3148.2005.00281.x Willner, P. (2006). Readiness for cognitive therapy in people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 19, 5–16. http://dx.doi.org/10.1111/j.1468-3148. 2005.00280.x
Submitted 1/15/2014, accepted 5/13/2014. Authors: Lynn Esdale and Andrew Jahoda, Institute of Health and Wellbeing, University of Glasgow, Scotland, United Kingdom; and Carol Pert, National Health Service Greater Glasgow and Clyde, Scotland, United Kingdom. Address correspondence concerning this article to Andrew Jahoda, Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Administration Building, Trust Headquarters. 1st Floor, 1055 Great Western Road, Glasgow, G12 0XH United Kingdom (e-mail: [email protected]).
Coping With Criticism and Praise
