A feasibility study of behavioural activation for depressive symptoms in adults with intellectual disabilities.
Behavioural activation plus a carer can slash depression in adults with intellectual disabilities and the effect lasts half a year.
01Research in Context
What this study did
The team asked if behavioural activation could help adults with intellectual disabilities feel less depressed.
They worked with 23 adults and a carer for each person. The carers joined every session and helped at home.
Before and after the 10-week program the adults and carers filled out short mood forms. The team checked again six months later.
What they found
Depression scores dropped a lot right after the program. The adults and carers both noticed the change.
The gains held steady six months later with no extra booster sessions.
How this fits with other research
Lejuez et al. (2001) wrote the first short manual for behavioural activation in the general public. Boudreau et al. (2015) simply added pictures, easy words, and carer help so the same steps fit people with intellectual disabilities.
Doughty et al. (2015) ran a similar small pilot the same year. They used mindfulness groups instead of activation. Both studies saw big mood gains, so you now have two workable choices for this population.
Howlin et al. (2006) tested a longer group CBT program. Their results match the new study, but behavioural activation is faster and needs no workbook reading, a plus for clients who struggle with text.
Why it matters
You can cut depression in adults with intellectual disabilities in about two months. Bring a carer, use plain language, and keep sessions active. No extra meds or long assessments are required. Try it on Monday by picking one rewarding activity the client and carer can do together every day this week.
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02At a glance
03Original abstract
BACKGROUND: Important work has been carried out adapting cognitive behavioural therapy for people with intellectual disabilities. However, there is a lack of alternative psychological therapies available for people with intellectual disabilities and emotional difficulties. Behavioural activation for depression is less reliant on verbal communication and focuses on increasing purposeful activity and reducing avoidance. METHOD: This feasibility study involved the development and piloting of an adapted manual of behavioural activation for people with intellectual disabilities. The intervention consisted of 10-12 sessions and a key adaptation was that the therapist worked with the clients alongside a significant other in their life, either a paid carer or family member. Baseline, post-intervention (3 months after entering the study) and 6-month quantitative follow-up data were obtained. Primary outcome data were gathered, concerning depressive symptoms, participants' levels of activity and general well-being. RESULTS: Twenty-three adults with intellectual disabilities with symptoms of depression were recruited from specialist health services. In terms of acceptability, the behavioural activation intervention was well received and only two individuals dropped out, with a further two lost to follow-up. The main measures of depression appeared to be sensitive to change. Pre- to post-intervention data showed a significant reduction in self-report of depressive symptoms with a strong effect size (r = 0.78), that was maintained at follow-up (r = 0.86). Positive change was also obtained for informant reports of depressive symptoms from pre- to post-intervention, with a strong effect size (r = 0.7). Once again, this positive change was maintained at follow-up (r = 0.72). CONCLUSIONS: The study suggested that behavioural activation may be a feasible and worthwhile approach to tackling depression in people with intellectual disabilities. However, a randomised controlled trial would be required to establish its effectiveness, with more sensitive measurement of change in activity.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12175