Research and evidence

The guidance that NAC offers is on approaches that are backed by science to impact positively on emotional and mental wellbeing. Over the last 10 years or so there has been a growth in recognition and acceptance of body-based approaches to tend to our mental health needs. Many of these approaches do not require language and cognition and therefore people with severe and profound intellectual disabilities need not be excluded from their use. Neuroscience is increasingly showing how such body-based approaches, some of which are based on ancient wisdom and practices such as mindfulness and yoga, can play an important role in supporting mental health.

The bidirectional nature of the mind-body relationship has been well-established and an appreciation of the mind and body working together as a whole guides us to understanding that the body and the senses can be a route to mental wellbeing.

We have read some of this latest research, evidence and neuroscience on mental well-being and trauma and, along with professional and personal experience, this has informed the creation of NAC and the guidance that is offered. The research and science about how the mind and body work can be highly complex, but the strategies and practices that have been shown to be effective are often simple and can be integrated into daily life, as shown with the guidance provided by NAC. Research is showing that you don’t have to do hours of meditation or go on a retreat to see the benefits, and you don’t have to escape from the real world to put the ideas into practice

“According to research people with SLD/PMLD are more susceptible to emotional and mental health conditions than the rest of the population plus these conditions are hard to establish due to the seriousness of their cognitive and communication difficulties. Therefore, I am very glad to see the development of organisations such NAC which aim to increase awareness and promote better quality of life for these people. This is definitely an area which warrants more attention and research.” – Dr Lila Kossyvaki, University of Birmingham, Department of Disability Inclusion and Special Needs

NAC promotes experiences that the research shows can:

Be neurologically calming, regulating and grounding
Activate the ‘rest and digest’ parasympathetic nervous systems and deactivate the ‘fight or flight’ sympathetic nervous system
Improve breathing, heart rate variability and blood pressure
Increase feelings of safety and calmness
Reduce feelings of anxiety, fear, frustration and anger
Increase relaxation and release stress
Enable a positive psychological state of flow
Relieve physical and psychological tension
Support healing from trauma
Reduce distressed behaviour, which may be labelled as ‘challenging behaviour’
Develop a greater range of healthy ways to regulate emotions and physiology
Expand psychological and emotional resilience
Provide greater capacity to cope with the difficulties and challenges of everyday life
Deepen relationships and connections with other people and the environment
Reduce feelings of loneliness and isolation
Increase engagement and participation
Improve confidence and self-esteem
Build self-awareness and awareness of others
Develop and provide opportunities for self-expression
Increase capacity for learning, development and growth
Improve cognition and memory
Improve mood and reduce depression
Increase happiness, enjoyment and contentment

The research also tells us that what works for one person may not be the same as for another. It is therefore essential that the guidance is used with an open and inquiring mind and preparedness for carrying out detailed observation of how a person responds to each experience tried and what impact it has on them personally and at that particular time (record keeping). This blend of science and research and experiential discovery informing practice ensures that our approaches are most securely rooted with an evidence base.

The emotional and mental health needs of people with intellectual disabilities and Profound and Multiple Learning Disabilities

Adams, T.M. and Jahoda, A. (2018) Listening to Mothers: Experiences of mental health support and insights into adapting therapy for people with severe or profound intellectual disabilities. International Journal of Developmental Disabilities, 65(3).

Bourne, J., Harrison, T.L., Wigham, S., Morison, C.J. and Hackett, S. (2022) A Systematic Review of Community Psychosocial Group Interventions for Adults with Intellectual Disabilities and Mental Health Conditions. Journal of Applied Research in Intellectual Disabilities, 351), pp.3-23.

Burke, C.K. (2014) Feeling Down: Improving the mental health of people with learning disabilities. Foundation for People with Learning Disabilities. London.

Calveley, J. (2021) Understanding and Managing Trauma in People with Severe and Profound Learning Disabilities. Learning Disability Practice. doi: 10.7748/ldp.2021.e2165.

Colley, A., Tilbury, J. and Yates, S. (2021). Enhancing Wellbeing and Independence for Young People with Profound and Multiple Learning Difficulties: Lives Lived Well. London: Routledge

Department of Health (2001) Valuing People: A new strategy for the 21st century. HMRC: London.

Eaton, C., Tarver, J., Shirazi, A., Pearson, E., Walker, L., Bird, M., Oliver, C. and Waite, J. (2021) A systematic review of the behaviours associated with depression in people with severe–profound intellectual disability. Journal of Intellectual Disability Research, 65(3), 221-229.

Ferguson, A., Howley, M. and Rose, R. (2008) Responding to the Mental Health Needs of Young People with Profound and Multiple Learning Disabilities and Autistic Spectrum Disorders: Issues and challenges. Mental Health and Learning Disabilities Research and Practice, 5, 240-251.

O’Hara, J. (2020) Better Health and Care for All: Health and care services for people with learning disabilities. National Institute for Health Research. February 2020, NIHR Dissemination Centre, doi 10.3310/themedreview-04326.

PAMIS (2011) Responding to the Mental and Emotional Needs of People with Profound and Multiple Learning Disabilities. www.pamis.org.uk.

Sheehy, K. and Nind, M. (2005) Emotional Well-Being for All: Mental health and people with profound and multiple learning disabilities. British Journal of Learning Disabilities, 33, 34-38.

Sheerin, F., Fleming, S., Burke, E., Byrne, K., Cleary, M., Doyle, C. and Keenan, P. (2022) Exploring Mental Health Issues in People with an Intellectual Disability. Learning Disability Practice, 25(3).

Skelly, A. et al (2017) Incorporating Attachment Theory into Practice: Clinical practice guidelines for clinical psychologists working with people who have intellectual disabilities. The British Psychological Society: Leicester. www.bps.org.uk

The British Psychological Society, Division of Clinical Psychology, Faculty for People with Intellectual Disabilities (2020) Covid-19: Meeting the psychological needs of people with learning/intellectual disabilities, and their families and staff. https://www.bps.org.uk/

Body-based, interactional and sensory approaches to emotional and mental wellbeing

Stephen Porges, Professor of Psychiatry and Founding Director of the Traumatic Stress Research Consortium
Bibliography
Books
Articles

Bessel van der Kolk, Psychiatrist and Researcher
The Body Keeps The Score resources
Scientific publications

Daniel Siegel, Clinical Professor of Psychiatry and Director of the Mindsight Institute
Books and more

Peter Levine, Clinical Psychologist and Medical Biophysicist
National Institute for the Clinical Application of Behavioral Medicine (NICABM)

Jon Kabat-Zinn, Professor of Medicine and Founder of MBSR (Mindfulness-Based Stress Reduction)
Books
Scientific papers

Touch

Cascio, C.J., Moore, D. and McGlone, F. (2019) Social Touch and Human Development. Developmental Cognitive Neuroscience, 35, 5-11.

Denworth, L. (2015) The Social Power of Touch. Scientific American Mind, 26(4), 30–39.

Fairhurst, M.T., McGlone, F. and Croy, I. (2022). Affective Touch: a communication channel for social exchange. Current Opinion in Behavioral Sciences, 43, pp.54-61.

Field, T. (2019) Social Touch, CT Touch and Massage Therapy: A narrative review. Developmental Review, 51, 123-145.

Jakubiak, B.K. and Feeney, B.C. (2017) Affectionate Touch to Promote Relational, Psychological, and Physical Wellbeing in Adulthood: A theoretical model and review of the research. Personality and Social Psychology Review, 21(3), 228-252.

Jakubiak, B.K., Fuentes, J.D. and Feeney, B.C. (2022) Affectionate Touch Promotes Shared Positive Activities. Personality and Social Psychology Bulletin p.01461672221083764.

Schirmer, A., Croy, I. and Schweinberger, S.R. (2022) Social Touch: A tool rather than a signal. Current Opinion in Behavioral Sciences, 44, p.101100.

Movement

Capon, H., O’Shea, M. and McIver, S. (2019) Yoga and Mental Health: A synthesis of qualitative findings. Complementary Therapies in Clinical Practice, 37, 122-132.

Kizhakkeveettil, A., Whedon, J., Schmalzl, L. and Hurwitz, E.L. (2019) Yoga for Quality of Life in Individuals With Chronic Disease: A systematic review. Alternative Therapies, 25(1), 36-43.

Levine, B. and Land, H.M. (2016) A Meta-Synthesis of Qualitative Findings About Dance/Movement Therapy for Individuals with Trauma. Qualitative Health Research, 26(3), 330-344.

Lundqvist, L.-O., Matérne, M., Granberg, A., et al. (2020) Structured Water Dance

Intervention (SWAN) for Adults with Profound intellectual and Multiple Disabilities: Study

protocol. Heliyon, 6(7): e04242.

Mino-Roy, J. et al (2022) Effects of Music, Dance and Drama Therapies for People with an Intellectual Disability: A scoping review. British Journal of Learning Disabilities, 50, 385-410, doi: 10.1111/bld.12402.

Sullivan, M.B., Erb, M., Schmalzl, L., Moonaz, S., Noggle Taylor, J. and Porges, S.W. (2018) Yoga Therapy and Polyvagal Theory: The convergence of traditional wisdom and contemporary neuroscience for self-regulation and resilience. Hypothesis and Theory, 12(87). doi: 10.3389/fnhum.2018.00067.

Nature

Bates, V., Hickman, C., Manchester, H., Prior, J. and Singer, S. (2020) Beyond Landscape’s Visible Realm: Recorded sound, nature, and wellbeing. Health and Place, 61.

Bratman, G.N., Anderson, C.B., Berman, M.G., Cochran, B. Sjerp de Vries, Flanders , J. Folke, C., Frumkin, H., Gross, J.J., Hartig, T., Kahn Jr., P.H., Kuo, M., Lawler, J.J., Levin, P.S., Lindahl, T., Meyer-Lindenberg, A., Mitchell, R., Ouyang, Z., Roe, J., Scarlett, L., Smith, J.R., van den Bosch, M., Wheeler, B.W., White, M.P., Zheng and Daily, G.C.H. (2019) Nature and Mental Health: An ecosystem service perspective. Science Advances Review, 5.

Chavaly, D. and Naachimuthu, K.P. (2020) Human Nature Connection and Mental Health: What do we know so far? Indian Journal of Health and Well-Being, 11(1-3), 84-92.

Cox, D.T.C. and Gaston, K.J. (2016) Urban Bird Feeding: Connecting people with nature. PLoS One, Jul 1,11(7).

Curtin, S. (2009) Wildlife Tourism: The intangible, psychological benefits of human- wildlife encounters. Curr Issues Tour, 12(5–6), 451–74.

Curtin, S. and Kragh, G. (2014) Wildlife Tourism: Reconnecting people with nature. Hum Dimens Wildl, Nov 2:19(6), 545–54.

Soulsbury, C.D. and White, P.C.L. (2015) Human-Wildlife Interactions in Urban Areas: A review of conflicts, benefits and opportunities. Vol. 42, Wildlife Research. CSIRO, 541–53.

Senses

Kadohisa M. (2013) Effects of Odor on Emotion, with Implications. Frontiers in Systems Neuroscience, 10;7:66. doi: 10.3389/fnsys.2013.00066.

Also see publications listed under the categories of touch, nature, music, arts and creativity and mindfulness.

Music

Daykin, N., Mansfield, L., Meads, C., Julier, G., Tomlinson, A., Payne, A., Grigsby Duffy, L., Lane, J., D’Innocenzo, G., Burnett, A., Kay, T., Dolan, P., Testoni, S. and Victor, C. (2018) What Works for Wellbeing? A systematic review of wellbeing outcomes for music and singing in adults. Perspectives in Public Health, 138(1), 39-46.

MacDonald, R.A.R. (2013) Music, Health and Well-Being: A review. Int J Qualitative Stud Health Well-being, 8.

Rushton, R. and Kossyvaki, L. (2020) Using Musical Play with Children with Profound and

Multiple Learning Disabilities at School. British Journal of Special Education, 47(4),

489–509.

Rushton, R. and Kossyvaki, L. (2022) The Role of Music within the Home‐Lives of Young

People with Profound and Multiple Learning Disabilities: Parental perspectives. British

Journal of Learning Disabilities, 50(1), 29–40.

Rushton, R., Kossyvaki, L .and Terlektsi, E. (2022) Music-Based Interventions for People

with Profound and Multiple Learning Disabilities: A systematic review of the literature.

Journal of Intellectual Disabilities, doi.org/10.1177/17446295221087563

Welch, G.F., Ockelford, A. (2015) The Importance of Music in Supporting the Development of Children with Learning Disabilities. The International Journal of Birth and Parent Education, 2(3), 23-25.

Interactions and Relationships

Porges, S. (2003) Neuroception: A subconscious system for detecting threats and safety. Zero to Three, May 2004.

Porges, S. (2015). Making the World Safe for our Children: Down-regulating defence and up-regulating social engagement to ‘optimise’ the human experience. Children Australia, 40, 114-123.

Tough, H., Siegrist, J. and Fekete, C. (2017) Social Relationships, Mental Health and Wellbeing in Physical Disability: A systematic review. Biomed Central Public Health, 17(414).

Arts & Creativity

Boyce, M., Bungay, H., Munn-Giddings, C. and Wilson, C. (2017) The Impact of the Arts in Healthcare on Patients and Service Users: A critical review. Health and Social Care in the Community, 26, 458-473.

Davies, C., Knuiman, M. and Rosenberg, M. (2016) The Art of Being Mentally Healthy: A study to quantify the relationship between recreational arts engagement and mental well-being in the general population. Bio Med Central Public Health, 16(15), DOI 10.1186/s12889-015-2672-7.

Pankova, S.N. (2016) Possibilities of Creativity as Indicator of Self-Development and Subjective Well-Being. International Multidisciplinary Scientific Conference on Social Sciences and Arts SGEM, 751-758.

Poulos, R.G., Marwood, S., Harkin, D., Opher, S., Clift, S., Cole, A.M.D., Rhee, J., Beilharz, K. and Poulos, C.J. (2018) Arts on Prescription for Community‐Dwelling Older People with a Range of Health and Wellness Needs. Health and Social Care in the Community, 27:483-492.

Mindfulness

Blair, J. (2020) Using the Technique of Mindfulness in People with Learning Disabilities. Learning Disability Practice, 23(4), 27-32.

Dunning, D.L., Griffiths, K., Kuyken, W. Crane, C., Foulkes, L., Parker, J. and Dalgleish, T. (2019) Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents – a meta-analysis of randomized controlled trials. The Journal of Child Psychology and Psychiatry, 60(3), 244-258.

Jones, S.A. and Finch, M. (2020) A Group Intervention Incorporating Mindfulness-Informed Techniques and Relaxation Strategies for Individuals with Learning Disabilities. British Journal of Learning Disabilities, 48, 175-189. doi: 10.1111/bld.12337.

Lomas, T., Medina, J.C., Ivtzan, I., Rupprecht, S. and Eiroa-Orosa, F.J. (2018) A Systematic Review of the Impact of Mindfulness on the Well-Being of Healthcare Professionals. Journal of Clinical Psychology, 74, 319-355.

Other publications and reports

Doukas, T., Fergusson, A., Fullerton, M. and Grace, J. (2017) Supporting People with Profound and Multiple Learning Disabilities: Core and Essential Service Standards. Available here. Accessed on 5 July 2018.

Hewett, D. (2007) Do Touch: Physical contact and people who have severe, profound and multiple learning difficulties. Support for Learning, 22(3), 116-123.

Hewett, D. (2018) The Intensive Interaction Handbook. London: Sage.

Lacey, P. (2015) The Routledge Companion to Severe, Profound and Multiple Learning Difficulties. Oxon:Routledge.

Nind, M. (2012) Intensive Interaction, Emotional Development and Emotional Well-Being. In D. Hewett (Ed.) Intensive Interaction: Theoretical perspectives. London: Sage.

Nind, M. and Strnadova, I. (2020) Belonging for People with Profound Intellectual and Multiple Disabilities: Pushing the boundaries of inclusion. Oxon: Routledge.

Simmons, B. and Watson, D. (2014) The PMLD Ambiguity: Articulating the life-worlds of children with profound and multiple learning disabilities. Oxon: Routledge.

Ware, J. (1996) Creating Responsive Environments for People with Profound and Multiple Learning Disabilities. London: David Fulton.

If you are aware of other research, publications or reports that you think should be added to this page, please contact us and let us know.