The experiences of therapists providing psychological treatment for adults with depression and intellectual disabilities as part of a randomised controlled trial

Smith, Ian; Huws, Jaci C.; Appleton, Kim; Cooper, Sally‐Ann; Dagnan, Dave; Hastings, Richard P.; Hatton, Chris; Jones, Robert S. P.; Melville, Craig; Scott, Katie; Williams, Chris; Jahoda, Andrew

doi:10.1111/jar.12886

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…Practical resources provided during the training, such as examples of ACT-consistent feedback, practise in drafting written feedback using the case examples, and continued opportunities for practice and supervision, also increased confidence and facilitated greater acceptability among the therapists. These findings support the wider findings, which suggested that getting more experience in delivering the intervention over time was key to developing mastery of the therapeutic approaches and increased confidence (Smith et al, 2021). It has been previously reported that those trial therapists who felt satisfied with training and supervision received were more likely to participate in the delivery of a similar type of intervention in the future (Rodda et al, 2019).…”

Section: Discussionsupporting

confidence: 85%

Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

Contreras¹,

Hout

Farquhar³

et al. 2021

tCBT

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This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial. Key learning aims (1) To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS). (2) To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS. (3) To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.

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Section: Discussionsupporting

confidence: 85%

Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

Contreras¹,

Hout

Farquhar³

et al. 2021

tCBT

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“…Interestingly, the BeatIt and StepUp therapists in the study felt that developing a strong grasp of the interventions gave them the confidence and know how to adapt their approach to meet the particular needs of the individuals they worked with (Smith et al . 2021).…”

Section: Discussionmentioning

confidence: 99%

“…We encourage therapists to use their experience and creativity to personalise the treatment of depression, in the context of a clear therapeutic approach. Interestingly, the BeatIt and StepUp therapists in the study felt that developing a strong grasp of the interventions gave them the confidence and know how to adapt their approach to meet the particular needs of the individuals they worked with (Smith et al 2021).…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Predictors and moderators of the response of adults with intellectual disabilities and depression to behavioural activation and guided self‐help therapies

Melville

Hatton

Beer

et al. 2023

J intellect Disabil Res

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BackgroundNo previous studies have reported predictors and moderators of outcome of psychological therapies for depression experienced by adults with intellectual disabilities (IDs). We investigated baseline variables as outcome predictors and moderators based on a randomised controlled trial where behavioural activation was compared with guided self‐help.MethodsThis study was an exploratory secondary data analysis of data collected during a randomised clinical trial. Participants (n = 161) were randomised to behavioural activation or guided self‐help and followed up for 12 months. Pre‐treatment variables were included if they have previously been shown to be associated with an increased risk of having depression in adults with IDs or have been reported as a potential predictor or moderator of outcome of treatment for depression with psychological therapies. The primary outcome measure, the Glasgow Depression Scale for Adults with Learning Disabilities (GDS‐LD), was used as the dependant variable in mixed effects regression analyses testing for predictors and moderators of outcome, with baseline GDS‐LD, treatment group, study centre and antidepressant use as fixed effects, and therapist as a random effect.ResultsHigher baseline anxiety (mean difference in outcome associated with a 1 point increase in anxiety 0.164, 95% confidence interval [CI] 0.031, 0.297; P = 0.016), lower performance intelligence quotient (IQ) (mean difference in outcome associated with a 1 point increase in IQ 0.145, 95% CI 0.009, 0.280; P = 0.037) and hearing impairment (mean difference 3.449, 95% CI 0.466, 6.432; P = 0.024) were predictors of poorer outcomes, whilst greater severity of depressive symptoms at baseline (mean difference in outcome associated with 1 point increase in depression −0.160, 95% CI −0.806, −0.414; P < 0.001), higher expectation of change (mean difference in outcome associated with a 1 point increase in expectation of change −1.013, 95% CI −1.711, −0.314; p 0.005) and greater percentage of therapy sessions attended (mean difference in outcome with 1 point increase in percentage of sessions attended −0.058, 95% CI −0.099, −0.016; P = 0.007) were predictors of more positive outcomes for treatment after adjusting for randomised group allocation. The final model included severity of depressive and anxiety symptoms, lower WASI performance IQ subscale, hearing impairment, higher expectation of change and percentage of therapy sessions attended and explained 35.3% of the variance in the total GDS‐LD score at 12 months (R2 = 0.353, F4, 128 = 17.24, P < 0.001). There is no evidence that baseline variables had a moderating effect on outcome for treatment with behavioural activation or guided self‐help.ConclusionsOur results suggest that baseline variables may be useful predictors of outcomes of psychological therapies for adults with IDs. Further research is required to examine the value of these potential predictors. However, our findings suggest that therapists consider how baseline variables may enable them to tailor their therapeutic approach when using psychological therapies to treat depression experienced by adults with IDs.

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“…People with mild IDs receive support and treatment from various types of services, such as ID services, community social care, mainstream mental health services, non-acute and acute psychiatric services and emergency departments (Standen et al 2016;Whittle et al 2018). Forming a valuable and meaningful relationship with a professional contributes greatly to both the quality of life and support for people with mild IDs and therapeutic outcomes (Embregts 2020;Evans & Randle-Phillips 2020;Smith et al 2020). In general client populations, this sense of alignment between healthcare professionals and clients is commonly referred to as the working alliance.…”

mentioning

confidence: 99%

“…Forming a valuable and meaningful relationship with a professional contributes greatly to both the quality of life and support for people with mild IDs and therapeutic outcomes (Embregts 2020 ; Evans & Randle‐Phillips 2020 ; Smith et al . 2020 ). In general client populations, this sense of alignment between healthcare professionals and clients is commonly referred to as the working alliance.…”

mentioning

confidence: 99%

Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability

Oudshoorn

Frielink

Riper

et al. 2022

J intellect Disabil Res

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Background The establishment of a valuable and meaningful working alliance between people with mild intellectual disabilities (IDs) and healthcare professionals is critically important for improving both the quality of life and impact of therapy for people with mild IDs. Measuring the working alliance as a treatment or support component is therefore of utmost relevance. In light of the increased use of eHealth tools, it is also essential to measure the alliance using these tools, which is referred to as technical alliance. There was a lack of validation of these two measurements for healthcare professionals working with people with mild IDs, which this study sought to address. Method Both the validated Working Alliance Inventory -Short Form -MID (WAI-SF-MID) and Technical Alliance Inventory -Short Form -MID (TAI-SF-MID) for general patient populations were adapted for healthcare professionals working with people with mild IDs. A two-step approach was conducted to systematically adapt both measurements with an expert group of healthcare professionals. Confirmatory factor analysis was conducted to test a three-factor structure for both the WAI-SF-MID (N = 199) and the TAI-SF-MID (N = 139), and internal consistency was determined for both scales. Results An acceptable-to-good model fit was found for both the WAI-SF-MID and the TAI-SF-MID; confirmatory factor analysis confirmed a three-factor model for both measurements. Cronbach's alpha and McDonald's omega were excellent for both total scales (≥0.90) and acceptable to good for sub-scales of both versions. Conclusion Both the WAI-SF-MID and the TAI-SF-MID are promising measurements for determining healthcare professionals' perspective on the (digital) working alliance with people with mild IDs.

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The experiences of therapists providing psychological treatment for adults with depression and intellectual disabilities as part of a randomised controlled trial

Cited by 4 publications

References 20 publications

Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

Predictors and moderators of the response of adults with intellectual disabilities and depression to behavioural activation and guided self‐help therapies

Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability

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