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Jahoda A, Dagnan D, Hastings R, Gillooly A, Miller J, Baines S, Hatton C. Adapting psychological interventions for people with severe and profound intellectual disabilities: A behavioural activation exemplar. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13199. [PMID: 38361369 DOI: 10.1111/jar.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/06/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with severe to profound intellectual disabilities experience similar or higher levels of depression than those with more mild intellectual disabilities. Yet, there is an absence of evidence about how to adapt existing psychological therapies for this population. METHOD A behavioural activation intervention (BeatIt) for people with mild to moderate intellectual disabilities was adapted for people with severe to profound intellectual disabilities and depression. Key considerations include: (i) beginning with a more in-depth assessment process; (ii) including the person in session activities and developing a relationship with them; (iii) formulation and the use of film to document the link between activity and mood; and (iv) addressing barriers to change at an individual and inter-personal level and considering how the carer could support the person's engagement in activity. RESULTS Successfully adapting BeatIt represents a first step towards gathering evidence about the effectiveness of behavioural activation for people with severe to profound intellectual disabilities.
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Affiliation(s)
- Andrew Jahoda
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dave Dagnan
- Community Learning Disability Services, Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, Workington, UK
| | - Richard Hastings
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
| | - Amanda Gillooly
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenny Miller
- Promoting A More Inclusive Society (PAMIS), Dundee, UK
| | - Susie Baines
- Division of Health Research, University of Lancaster, Lancaster, UK
| | - Chris Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
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Melville CA, Hatton C, Beer E, Hastings RP, Cooper SA, McMeekin N, Dagnan D, Appleton K, Scott K, Fulton L, Jones RSP, McConnachie A, Zhang R, Knight R, Knowles D, Williams C, Briggs A, Jahoda A. Predictors and moderators of the response of adults with intellectual disabilities and depression to behavioural activation and guided self-help therapies. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:986-1002. [PMID: 37344986 DOI: 10.1111/jir.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND No 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. METHODS This 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. RESULTS Higher 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. CONCLUSIONS Our 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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Affiliation(s)
- C A Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Hatton
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - E Beer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - S-A Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D Dagnan
- Clinical Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and University of Cumbria, Newcastle upon Tyne Tyne, UK
| | - K Appleton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Scott
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Fulton
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R S P Jones
- School of Psychology, Bangor University, Bangor, UK
| | - A McConnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R Zhang
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - R Knight
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - D Knowles
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - C Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A Briggs
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Jahoda
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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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. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
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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