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research and evidence: mental health
can adapted psychological therapies help with

depression and improve quality of life?

People with learning disabilities may experience depression for longer than other people.
Chris Hatton worked on a study led by andrew Jahoda to examine the effects of adapted
versions of psychological therapies and whether they should be offered

Background
People with learning disabilities are at key messages
least as likely as other people to
experience depression; their depression is ● Adults with learning disabilities who are depressed can be helped by adapted
more likely to be enduring, possibly versions of psychological therapies that are routinely offered to everyone else.
because it is more likely to go ● Psychological therapies can reduce anxiety and help improve the quality of life of
unrecognised. adults with learning disabilities who are depressed. These therapies are not
The National Institute for Health and expensive and can be delivered to a high standard by community learning disability
Care Excellence has issued guidelines on nurses and a wide range of other professionals, with some training and supervision.
how to help people with learning ● Adapted psychological therapies should be made routinely available to people
disabilities and mental health problems with learning disabilities and mental health problems.
(NICE, 2016).
Therapies or psychological
interventions, such as cognitive behaviour Methods One hundred and sixty-one adults barriers getting in the way. Guided
therapy, behavioural activation and with learning disabilities from Scotland, self-help involved eight sessions with a
guided self-help, are all recommended for North Wales and North West England who trained therapist working through four
helping people with depression in these had been diagnosed by the project team booklets focusing on major issues in
guidelines. However, NICE found that as depressed took part in the project. depression, such sleep and problem
there was little evidence about whether Everyone gave their consent to take part, solving. Therapists were mainly
adapted versions of these therapies were and had a supporter who knew them well community learning disability nurses.
useful for people with learning disabilities with them in the therapy sessions. Information was collected from
who are depressed. All participants received help; it was participants at three points: before the
This research project used a gold randomly decided who would receive therapy started; four months afterwards
standard method – the randomised behavioural activation and who would get (when the therapy would have finished);
controlled trial (RCT) – to compare guided self-help. behavioural activation and another eight months after that (12
behavioural activation and guided involved 12 sessions with a trained months from the start). Everyone was
self-help in people with learning therapist to help the person take part in asked about their depression and other
disabilities who are depressed. more activities and work through any aspects of their life, including what health
and social care services they were using.

Comparison of behavioural activation with guided self-help for Findings
treatment of depression in adults with intellectual disabilities: a behavioural activation and guided
self-help resulted in people both becoming
randomised controlled trial substantially less depressed by the end of
aims To compare two ways of helping people with learning disabilities who are their therapy sessions, and staying less
depressed – are they helpful in reducing people’s depression and improving depressed eight months after the end of
people’s lives more generally, and how much do they cost? the therapy. This was the same for anxiety,
Methods A group of 161 adults with learning disabilities and a diagnosis of which was reduced and stayed lower.
depression were randomly assigned to receive behavioural activation or guided Quality of life improved over the course
self-help. Therapists were mainly community learning disability nurses. People of both therapies; this was sustained eight
were asked about their depression and other aspects of their lives before the months after the end of therapy.
therapy started, four months after the start (when the therapy had finished) and There were no important differences
one year from the start. between behavioural activation and guided
results and conclusion Both methods improved quality of life and reduced self-help – both had a positive effect.
depression, and continued to do so a year after the project started. The therapies Carers also reported their confidence in
are not expensive and can be done well by community learning disability nurses. helping people with emotional difficulties
had improved by the end of the therapy
read the report Jahoda et al (2017) Comparison of behavioural activation with sessions; this had not changed eight
guided self-help for treatment of depression in adults with intellectual disabilities: months afterwards.
a randomised controlled trial. The Lancet Psychiatry; 4(12): 909–919. https:// behavioural activation, because it lasted
www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30426-1/ longer, was more expensive (average £1,789
per person) than guided self-help (average

20 Vol 31 No 4 | Summer 2018 community Living www.cl-initiatives.co.uk