The use of cognitive behaviour therapy to treat depression in people with learning disabilities: a systematic review

2015 ◽  
Vol 20 (2) ◽  
pp. 54-64 ◽  
Author(s):  
Caroline Jennings ◽  
Olivia Hewitt

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.

Author(s):  
Stuart Pack ◽  
Emma Condren

AbstractLow self-esteem is widely acknowledged to be associated with the phenomenology of a number of mental health diagnoses, including those which are treated under the umbrella of Improving Access to Psychological Therapies (IAPT) services. To evaluate the effectiveness of group Cognitive Behaviour Therapy (CBT) based on the work of Fennell in treating low self-esteem 50 participants attended a 10-week group programme. Pre- and post-group measures of depression, anxiety and self-esteem were compared using Mann–Whitney U tests. The results indicated that there was a statistically significant and clinically meaningful change across all pre- and post-group measures. Mean post-group measures indicated levels of depression and anxiety which were below caseness and a healthy level of self-esteem. Results indicated that gains were well maintained at 3-month follow-up. The results from this study highlight the effectiveness of group CBT for low self-esteem and thus contribute to the limited evidence base in this area. Results are discussed with consideration of the existing evidence base, implications for clinical practice, and future research.


2015 ◽  
Vol 20 (2) ◽  
pp. 65-68
Author(s):  
Peter E. Langdon

Purpose – The purpose of this paper is to provide a commentary on “The use of cognitive-behaviour therapy to treat depression in people with learning disabilities: a systematic review”. Design/methodology/approach – Drawing on the literature, as well as both clinical and research experience, some reasons are outlined for the lack of attention given to psychological therapies to treat depression amongst people with intellectual disabilities (IDs). Findings – More research is needed, but existing evidence is promising regarding the effectiveness of adapted cognitive-behaviour therapy for depression amongst people with IDs. Originality/value – The commentary draws attention to the scope for developing a range of effective cognitive, behavioural and cognitive-behavioural treatments.


2018 ◽  
Vol 12 (2) ◽  
pp. 67-76 ◽  
Author(s):  
Lauren Evans ◽  
Kate Allez

Purpose Low self-esteem is common in people with learning disabilities. There is limited research examining the effectiveness of cognitive behavioural therapy (CBT) focused on low self-esteem within this client group. The purpose of this paper is to add to the limited evidence by describing the use of CBT focused on low self-esteem for a person with a learning disability in the context of emotion regulation difficulties. Design/methodology/approach An individual case study design was used, with repeated quantitative measures to monitor progress during weekly individual psychology sessions. Findings There was a reduction in the client’s feelings of anger and an increase in their self-esteem. Research limitations/implications Further studies and follow-up would determine longevity of benefits. The inclusion of distress tolerance techniques may have impacted on the findings and limits the conclusions that can be drawn about the impact of CBT focused on low self-esteem. Originality/value This case study could make a small contribution to the evidence base for the effectiveness of CBT-based treatments for low self-esteem in people with learning disabilities, which is an under-researched area.


2021 ◽  
pp. 095269512110277
Author(s):  
David J. Harper ◽  
Sebastian Townsend

Although histories of cognitive behaviour therapy have begun to appear, their use with people with psychosis diagnoses has received relatively little attention. In this article, we elucidate the conditions of possibility for the emergence of cognitive behaviour therapy for psychosis (CBTp) in England between 1982 and 2002. We present an analysis of policy documents, research publications and books, participant observation, and interviews with a group of leading researchers and senior policy actors. Informed by Derksen and Beaulieu’s articulation of social technologies, we show how CBTp was developed and stabilised through the work of a variety of overlapping informal, academic, clinical, professional, and policy networks. The profession of clinical psychology played a key role in this development, successfully challenging the traditional ‘division of labour’ where psychologists focused on ‘neurosis’ and left ‘psychosis’ to psychiatry. Following Abbott's systems approach to professions, we identify a number of historical factors that created a jurisdictional vulnerability for psychiatry while strengthening the jurisdictional legitimacy of clinical psychology in providing psychological therapies to service users with psychosis diagnoses. The National Institute for Health and Clinical Excellence played a significant role in adjudicating jurisdictional legitimacy, and its 2002 schizophrenia guidelines, recommending the use of psychological therapies, marked a radical departure from the psychiatric consensus. Our analysis may be of wider interest in its focus on social technologies in a context of jurisdictional contestation. We discuss the implications of our study for the field of mental health and for the relationship between clinical psychology and psychiatry.


2019 ◽  
Vol 14 (1) ◽  
pp. 14-24
Author(s):  
Ashley Chapman ◽  
Karen Dodd ◽  
Laurence Rogers

Purpose The purpose of this paper is to evaluate staff knowledge of Mental Capacity Act (MCA) capacity assessments within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust. The limited research available suggests staff knowledge tends to be poor, particularly concerning who is the decision maker. Design/methodology/approach A 12-item multiple choice questionnaire, which reflects the five core principles of MCA (2005), was developed. Questionnaires were completed by 262 health and social staff members who support people with LD. Findings Results show high variability of MCA capacity assessment knowledge within the LD division. However, qualified staff and those from health services scored significantly higher across all categories on the questionnaire compared to non-qualified and social care staff, respectively. On average, all staff scored poorly when asked to identify “who is the decision maker?” in a case scenario question. Research limitations/implications The main limitation is that we did not collect data on how many previous capacity assessments and discussions each person had been involved with. The findings clearly suggest current methods of training lack efficacy in helping staff apply MCA knowledge to their clinical work. Originality/value Compared to past literature, this study utilised a novel and more comprehensive questionnaire. This focused on case scenario questions to assess staff situational judgement. In addition, the findings add to a sparse evidence base that provides a foundation for future research.


2013 ◽  
Vol 19 (4) ◽  
pp. 270 ◽  
Author(s):  
Karen Scott ◽  
Lisa Beatty

Despite the evidence base for Internet-delivered self-help programmes, their application to cancer carers has not been reported. This feasibility study evaluated a 6-week internet cognitive behaviour therapy (CBT) programme for early stage cancer carers. The study participants comprised 13 carers who were recruited over a 17-month period. Measures included distress, quality of life and programme engagement. Changes over time were measured using effect sizes (Cohen’s d), whereas acceptibility was assessed using qualitative feedback. Low enrolment and high attrition rates resulted in a failure to demonstrate feasibility. Large improvements in negative affect (d = 0.88) and emotional functioning (d = 0.62) were found. For treatment completers, the intervention holds promise in reducing distress. However, in light of the serious challenges with recruitment and retention, further research is needed to resolve participation barriers.


1999 ◽  
Vol 29 (1) ◽  
pp. 19-25 ◽  
Author(s):  
K. EVANS ◽  
P. TYRER ◽  
J. CATALAN ◽  
U. SCHMIDT ◽  
K. DAVIDSON ◽  
...  

Background. The treatment of deliberate self-harm (parasuicide) remains limited in efficacy. Despite a range of psychosocial, educational and pharmacological interventions only one approach, dialectical behaviour therapy, a form of cognitive-behaviour therapy (CBT), has been shown to reduce repeat episodes, but this is lengthy and intensive and difficult to extrapolate to busy clinical practice. We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy (six self-help booklets) alone to six sessions of cognitive therapy linked to the booklets, which contained elements of dialectical behaviour therapy.Methods. Thirty-four patients, aged between 16 and 50, seen after an episode of deliberate self-harm, with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months, were randomly assigned to treatment with manual-assisted cognitive-behaviour therapy (MACT N=18) or treatment as usual (TAU N=16). Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months. The number and rate of all parasuicide attempts, time to next episode and costs of care were also determined.Results. Thirty-two patients (18 MACT; 14 TAU) were seen at follow-up and 10 patients in each group (56% MACT and 71% TAU) had a suicidal act during the 6 months. The rate of suicidal acts per month was lower with MACT (median 0·17/month MACT; 0·37/month TAU; P=0·11) and self-rated depressive symptoms also improved (P=0·03). The treatment involved a mean of 2·7 sessions and the observed average cost of care was 46% less with MACT (P=0·22).Conclusions. Although limited by the small sample, the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice.


1987 ◽  
Vol 21 (1) ◽  
pp. 5-15 ◽  
Author(s):  
Rosalyn A. Griffiths ◽  
Stephen W. Touyz ◽  
Philip B. Mitchell ◽  
Wendy Bacon

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.


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