Manualised Individual Cognitive Behavioural Therapy for mood disorders in people with mild to moderate intellectual disability: A feasibility randomised controlled trial

UCL Mental Health Sciences Unit, 1st Floor, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK. Electronic address: .
Journal of Affective Disorders (Impact Factor: 3.38). 07/2013; 151(1). DOI: 10.1016/j.jad.2013.05.076
Source: PubMed


Evaluation of complex interventions, including standardisation of the intervention, types of outcomes selected and measures of change, is a fairly novel concept in the field of intellectual disabilities. Our aim was to explore these issues in a feasibility study of Manualised Individual Cognitive Behaviour Treatment (M-iCBT) compared to the treatment as usual alone (TAU).
Service users with mild to moderate intellectual disability experiencing a mood disorder or symptoms of depression and/or anxiety (mini PAS-ADD total score >10 or 7 respectively) were randomly assigned to either.
In total, 32 participants were randomly assigned to 16 sessions of M-iCBT (n=16) in addition to TAU or TAU alone (n=16). We explored recruitment and accrual rates, willingness to participate, acceptability of the intervention and suitability of assessment tools. Mean change (95% CI) in the Beck Depression Inventory-Youth (BDI-Y) score from baseline to the 16 week endpoint (primary variable) was 0.10 (95% CI: -8.56, 8.76) and in the Beck Anxiety Inventory-Youth (BAI-Y) 2.42 (95% CI: -5.27, 10.12) in favour of TAU. However, there was a clear trend in favour of CBT in depressed participants with or without anxiety.
The intervention targeted both depression and anxiety following a transdiagnostic model. This may have impacted the anticipated size of change in the primary outcome. The precise impact of cognitive limitations on ability to use therapy effectively is not fully understood.
This study demonstrates that it is feasible to carry out a pragmatic randomised controlled trial of M-iCBT for people with mild to moderate intellectual disability. However, uncertainties about its clinical and cost effectiveness can only be fully answered by further examination of its superiority against other treatments.

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    • "Further research is needed to explore this. Hassiotis et al. (2013) demonstrated that it is possible to conduct a clinical trial with individuals with a learning disability and the results initially suggest that CBT for depression may be beneficial for these individuals. This is a positive step in moving towards building an evidence base for psychological treatments for people with a learning disability and depression. "
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    ABSTRACT: Purpose: Cognitive behaviour therapy (CBT) is currently one of the recommended treatments for depression for the general population and guidance recommends that people with a learning disability should have access to the same treatments as people without a learning disability. The purpose of this paper is to identify, outline and evaluate current research on the effectiveness of CBT for depression for people with a learning disability. The clinical, service and research implications are considered. Design/methodology/approach: A systematic search was conducted and five relevant articles were identified for critical review. Findings: There is a limited but promising evidence base for the use of CBT for depression with people with learning disabilities. Research limitations/implications: The current review identified a number of methodological issues and future research should attempt to overcome these (e.g. small sample sizes and lack of controls). In particular, research should focus on determining the relative contribution of cognitive and behavioural techniques in producing a change in depressive symptoms. Practical implications: Services (including those provided as part of Improving Access to Psychological Therapies) should be offering CBT-based interventions for people with learning disabilities who are experiencing depression. Originality/value: This paper provides a comprehensive and up to date review of the current literature regarding the use of CBT for depression for people with a learning disability. This will be of value to clinicians working with people with a learning disability as well as those commissioning services.
    Tizard Learning Disability Review 04/2015; 20(2):54-64. DOI:10.1108/TLDR-05-2014-0013
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    ABSTRACT: The aim of this study was to evaluate the efficacy of psychological therapies for people with intellectual disabilities (IDs) through a systematic review and meta-analysis of the current literature. A comprehensive literature search identified 143 intervention studies. Twenty-two trials were eligible for review, and 14 of these were subsequently included in the meta-analysis. Many studies did not include adequate information about their participants, especially the nature of their IDs; information about masked assessment, and therapy fidelity was also lacking. The meta-analysis yielded an overall moderate between-group effect size, g=.682, while group-based interventions had a moderate but smaller treatment effect than individual-based interventions. Cognitive-behaviour therapy (CBT) was efficacious for both anger and depression, while interventions aimed at improving interpersonal functioning were not effectual. When CBT was excluded, there was insufficient evidence regarding the efficacy of other psychological therapies, or psychological therapies intended to treat mental health problems in children and young people with IDs. Adults with IDs and concurrent mental health problems appear to benefit from psychological therapies. However, clinical trials need to make use of improved reporting standards and larger samples.
    Research in developmental disabilities 09/2013; 34(11):4085-4102. DOI:10.1016/j.ridd.2013.08.030 · 4.41 Impact Factor
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    ABSTRACT: Background Several studies have found a heightened prevalence of mental health disorders in people with intellectual disabilities (ID). There have been a number of successful case series and two promising controlled treatment trials of cognitive behaviour therapy (CBT) for emotional disorders (excluding anger) for people with ID. Several authors have promoted the development of trans-diagnostic approaches to cognitive treatment. The present study extends this work with the development and evaluation of a trans-diagnostic treatment manual for CBT in people with ID.MethodA controlled treatment trial was conducted with 12 participants in treatment and waiting list control data. Each treatment participant was matched to a control on age, IQ, presenting problem, and Brief Symptom Inventory (BSI) global severity index (GSI) score. The treatment group was also evaluated on the Glasgow anxiety and depression scales and was followed up for 3 to 6 months after treatment.ResultsThere were no significant differences between groups at baseline. Following treatment, the CBT group was significantly improved when compared with the control group on the GSI scale of the BSI. The ancovas for all other measures were not significant but there were significant improvements for the treatment group on all scaled except BSI depression from pre to post-CBT. Gains were maintained to follow up, and changes were associated with large effect sizes.Conclusions It was possible to treat a range of symptoms and psychiatric diagnoses with a general trans-diagnostic CBT manual. The effects of therapy were promising, suggesting that the participants could respond to treatment in a meaningful and helpful manner and supporting the case for further evaluation of the trans-diagnostic approach in ID.
    Journal of Intellectual Disability Research 08/2014; 59(4). DOI:10.1111/jir.12145 · 2.41 Impact Factor
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