Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial

Jahoda, Andrew; Hastings, Richard P.; Hatton, Chris; Cooper, Sally‐Ann; Dagnan, Dave; Zhang, Ruiqi; McConnachie, Alex; McMeekin, Nicola; Appleton, Kim; Jones, Rob; Scott, Katie; Fulton, Lauren; Knight, Rosie; Knowles, Dawn; Williams, Chris; Briggs, Andrew; Macmahon, Kenneth; Lynn, Helen; Smith, Ian; Thomas, GN; Melville, Craig

doi:10.1016/s2215-0366(17)30426-1

Cited by 62 publications

(90 citation statements)

References 31 publications

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“…The materials were not developed with people with associated intellectual disability in mind as this was not part of the commissioning brief and recent research has reported successful adaptation of BA for adults with intellectual disability. 71…”

Section: Chapter 5 Discussionmentioning

confidence: 99%

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Guided self-help for depression in autistic adults: the ADEPT feasibility RCT

Russell

Gaunt

Cooper

et al. 2019

Health Technol Assess

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Background Co-occurring depression frequently occurs in autism. Evidence-based psychological interventions have been successfully adapted to treat co-occurring anxiety, but there is little evidence about the usefulness of adapted cognitive–behavioural therapy for depression. To the authors’ knowledge, to date there have been no randomised trials investigating the usefulness of low-intensity cognitive–behavioural therapy for depression in autism. Objectives The objectives of the study were to (1) develop a low-intensity psychological intervention for depression adapted for autism, (2) assess the feasibility and patient and therapist acceptability of the intervention, (3) estimate the rates of recruitment and retention for a full-scale randomised controlled trial and (4) identify an appropriate measure of depression to be used in a full-scale randomised controlled trial. Design The study comprised a randomised controlled trial (n = 70) with a nested qualitative evaluation (n = 21). Seventy eligible and consenting participants were randomly allocated to guided self-help or to treatment as usual. Setting Adult autism services in two NHS regions. Participants Adults with a diagnosis of autism spectrum disorder with depression, that is, a Patient Health Questionnaire-9 items score of ≥ 10. People who had attended more than six sessions of cognitive–behavioural therapy in the previous 6 months were excluded. Interventions The low-intensity intervention (guided self-help) comprised materials for nine individual sessions, based on behavioural activation adapted for autism, facilitated by therapist guides (coaches) who were graduate-level psychologists who attended training and regular supervision. Treatment as usual was standard NHS care for depression. Main outcome measures Outcomes were measured 10, 16 and 24 weeks post randomisation using self-report and interview measures of depression, anxiety, obsessive–compulsive symptoms, social function and quality of life, and a health-care and service use questionnaire. As this was a feasibility study also designed to identify the most appropriate measure of depression, it was not possible to specify the primary outcome measure or outcome point a priori. Results The aims of the study were met in full. The guided self-help intervention was feasible and well received by participants and coaches. The majority of allocated participants attended the intervention in full. The most practical outcome point was determined to be 16 weeks. There were differential rates of attrition across the treatment groups: 86% of the guided self-help group remained in the study at 24 weeks, compared with 54% of treatment as usual group. The qualitative study suggested that guided self-help had enhanced credibility with participants at the point of randomisation. Inter-rater reliability of the interview measure of depression was less than adequate, limiting the conclusions that can be drawn from the prespecified sensitivity to change analyses. Conclusions The intervention was feasible and well received. Although this feasibility study was not a fully powered trial, it provided some evidence that the guided self-help intervention was effective in reducing depressive symptoms. A full-scale clinical effectiveness and cost-effectiveness trial of the intervention is warranted. Future work Improvements to the intervention materials as a result of qualitative interviews. Stakeholder consultation to consider future trial design, consider strategies to improve retention in a treatment as usual arm and select a self-report measure of depression to serve as the primary outcome measure. Trial registration Current Controlled Trials ISRCTN54650760. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 68. See the NIHR Journals Library website for further project information. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.

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Section: Chapter 5 Discussionmentioning

confidence: 99%

“…Transcripts and field notes were imported into NVivo version 10 software (QSR International, Warrington, UK) for analysis. 71…”

Section: Interview Conductmentioning

confidence: 99%

Guided self-help for depression in autistic adults: the ADEPT feasibility RCT

Russell

Gaunt

Cooper

et al. 2019

Health Technol Assess

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“…In the current paper, the present authors explore the experiences of adults with intellectual disabilities randomized to one of two psychological interventions for depression; Behavioural Activation or Guided Self‐Help, using a psycho‐educational approach. This was a component of a RCT whose primary objective was to compare the clinical and cost‐effectiveness of Behavioural Activation versus Guided Self‐Help for the treatment of depressive symptoms in adults with intellectual disabilities (Jahoda, Hastings, et al, ). Both interventions were adapted to be suitable for adults with mild and moderate intellectual disabilities.…”

Section: Introductionmentioning

confidence: 99%

“Getting into it”: People with intellectual disabilities’ experiences and views of Behavioural Activation and Guided Self‐Help for depression

Knight

Jahoda

Scott

et al. 2019

Research Intellect Disabil

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Background No studies have explored the acceptability of Behavioural Activation and Guided Self‐Help interventions for depression with people who have intellectual disabilities. Method Twenty‐five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self‐Help intervention. A framework analysis was used to analyse interviews covering participants’ expectations and views of therapy. Results Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time‐limited nature of the interventions and a wish for longer‐term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. Conclusions The participants reported having positive engagement with the therapies but expressed a wish for longer‐term supportive relationships.

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“…In this issue of the Lancet Psychiatry, Jahoda et al 1 present the findings of a rigorous UK based multicentre randomised controlled trial of behavioural activation (BA; Beat it) vs active control (Step up) for people with mild to moderate intellectual disabilities and depression.…”

Section: Angela Hassiotis Rory Sheehan Marc Serfatymentioning

confidence: 99%