Individual Psychological Interventions Research Articles

Substance Use Within Trials of Psychological Interventions for Psychosis: Sample Inclusion, Secondary Measures, and Intervention Effectiveness.

Current clinical guidelines recommend that patients with co-occurring psychosis and alcohol or substance use disorders (A/SUD) receive evidenced-based treatment for both disorders, including psychological intervention for psychosis. However, the efficacy of such treatments for individuals with co-occurring psychosis and A/SUD is unclear. Randomized controlled trials (RCTs) of psychological interventions for psychosis were systematically reviewed, to investigate how alcohol and substance use has been accounted for across sample inclusion and secondary measures. Findings from trials including individuals with co-occurring alcohol or substance use issues were then narratively summarized using the Synthesis Without Meta-Analysis guidelines, to indicate the overall efficacy of psychological interventions for psychosis, for this comorbid population. Across the 131 trials identified, 60.3% of trials excluded individuals with alcohol or substance use issues. Additionally, only 6.1% measured alcohol or substance use at baseline, while only 2.3% measured alcohol or substance use as a secondary outcome. Across trials explicitly including individuals with alcohol or substance use issues, insufficient evidence was available to conclude the efficacy of any individual psychological intervention. However, preliminary findings suggest that psychoeducation (PE) and metacognitive therapy (MCT) may be proposed for further investigation. Overall, co-occurring alcohol and substance use issues have been largely neglected across the recent RCTs of psychological interventions for psychosis; highlighting the challenges of making treatment decisions for these individuals using the current evidence base.

Parental Involvement in Adolescent Psychological Interventions:A Meta-analysis.

Psychological interventions for adolescents have shown mixed efficacy, and including parents in interventions may be an important avenue to improve treatment outcomes. Evidence from meta-analyses examining the role of parents in interventions for youth is inconsistent and has typically combined findings for both children and adolescents together. No prior meta-analysis has examined the specific role of parents in adolescent interventions as compared with interventions focused solely on adolescents across several disorders. To address this gap, systematic literature reviews were conducted utilizing a combination of searches among keywords including (parent* OR family) AND (intervention OR therap* OR treatment OR prevent*) AND (adolescen*). Inclusion criteria were (1) a randomized controlled trial of an individual psychological intervention compared to the same intervention with a parental component, and (2) adolescents must have at least current symptoms or risk to be included. Literature searches identified 20 trials (N = 1251). Summary statistics suggested that interventions involving parents in treatment have a significantly greater impact on adolescent psychopathology when compared to interventions that targeted adolescents alone (g = -0.18, p < .01, 95% CI [-0.30, -0.07]). Examination with symptom type (internalizing or externalizing) as a moderator found that the significant difference remained for externalizing (g = -0.20, p = .01, 95% CI [-0.35, -0.05]) but not internalizing psychopathology (p = .11). Findings provide evidence of the importance of including parents in adolescent therapy, particularly for externalizing problems.

Examining Youth Flexible ACT Model Implementation in the Netherlands

Model adherence is a key indicator of mental health care quality. This study investigates the degree of model adherence, as well as content and staging of care, among the first Youth Flexible Assertive Community Treatment (ACT) teams in the Netherlands. Model fidelity was assessed in sixteen teams with the Youth Flexile ACT model fidelity scale (2014 version). Mental health workers completed a ‘content of care questionnaire’ to map the interventions applied in the teams. Model fidelity scores revealed that twelve teams adhered to the Youth Flexible ACT standard with ‘optimal implementation’ (≥ 4.1 on a 5 point scale) and four teams with ‘adequate implementation’. Most disciplines were well integrated within the teams; however, several items regarding the involvement of specific disciplines and the availability of treatment interventions (peer support worker, employment and education specialist and programs, family interventions, integrated dual disorder treatment) scored below the optimum. Frequency of contact during ACT and the use of Routine Outcome Monitoring instruments scored below the optimum as well. The ‘content of care’ data showed that most clients received an individual psychological intervention, and nearly half of the client sample received scaled-up / intensified ACT care. The findings indicate a predominantly successful translation of care from the theoretical Flexible ACT framework into practice, covering both ACT and non-ACT functions. Further room for improvement lies in the incorporation of specialized disciplines in the personal and social recovery domains, including the peer support worker and employment and education specialist, as well as in specific protocolled interventions.

Precision Mental Health and Data-Informed Decision Support in Psychological Therapy: An Example

AbstractOutcome measurement including data-informed decision support for therapists in psychological therapy has developed impressively over the past two decades. New technological developments such as computerized data assessment, and feedback tools have facilitated advanced implementation in several seetings. Recent developments try to improve the clinical decision-making process by connecting clinical practice better with empirical data. For example, psychometric data can be used by clinicians to personalize the selection of therapeutic programs, strategies or modules and to monitor a patient’s response to therapy in real time. Furthermore, clinical support tools can be used to improve the treatment for patients at risk for a negative outcome. Therefore, measurement-based care can be seen as an important and integral part of clinical competence, practice, and training. This is comparable to many other areas in the healthcare system, where continuous monitoring of health indicators is common in day-to-day clinical practice (e.g., fever, blood pressure). In this paper, we present the basic concepts of a data-informed decision support system for tailoring individual psychological interventions to specific patient needs, and discuss the implications for implementing this form of precision mental health in clinical practice.

Analysis of the influence of individual psychological intervention on antiviral therapy for AIDS patients.

Analysis of the influence of individual psychological intervention on antiviral therapy for AIDS patients.

Moderators and mediators of effects of interventions to reduce stress in hospital employees: A systematic review.

This systematic review examines moderators and mediators tested in evaluations of stress management interventions for hospital employees to determine their significance for intervention outcomes. To be included, studies had to comprise a moderator or mediator analysis and a quantitative assessment of stress or mental well-being, and to be published in English or German language. Five databases (APA PsycInfo, APA PsycArticles, Embase, Medline, and Web of Science) were searched. Moderators and mediators were categorised thematically and examined using effect direction plots. Study quality was assessed using RoB 2 and ROBINS-I. In fifteen included studies, 22 moderators and ten mediators were identified. Moderators and mediators were categorised into individual psychological factors (14), socio-economic status (6), work situation (5), intervention (3), and duration of employment (3). Two moderators (perceived stressfulness of residency, job control) had a positive, two a negative impact (spirituality, socially desirable responding). One moderator (years of professional experience) had a positive and negative impact. Three moderators measured on categorical scales (gender, profession, and shiftwork) also had effects, favouring women, physicians and night-shift employees. Five mediators (adherence to intervention, mindfulness, non-reactivity to inner experience, total observing, and self-compassion) had a positive impact, while three (isolation, over-identification, psychological inflexibility) had a negative impact. In conclusion, effects of interventions were predominantly driven by individual psychological factors, while the role of other variables seems to be limited. Interventions focussing on primary or tertiary prevention were rare. Also processes through which organisational-level interventions can be most effective have been hardly investigated. Larger and methodologically robust studies are needed to better understand causal pathways and optimise matching of interventions to target groups.

Understanding female survivors of interpersonal trauma and their experience of the ‘Survive &amp; Thrive’ course

The majority of publications have concentrated on individual psychological interventions with a limited focus on manualized group-based approaches for those presenting with mental health difficulties following a history of trauma. Survive &amp; Thrive (S&amp;T) is a psychoeducational course designed for survivors of interpersonal trauma which utilizes cognitive behavioural skills training while delivering psychoeducation on how a history of victimization can impact on the survivors’ life. This qualitative study was designed to gain an insight into female survivors of interpersonal trauma experience of S&amp;T and the associated group dynamics component to evaluate this psychological intervention. The participants described their experience of S&amp;T as a journey towards recovery. The study highlights the benefits of group-based interventions in regard to learning experience within a social context whilst also identifying areas for further development based on the participants’ feedback.

Health Psychology Services for People in Disadvantaged Regions of Hungary: Experiences from the Primary Health Care Development Model Program.

The importance of community health psychology in providing complex bio-psycho-social care is well documented. We present a mixed-method outcome-monitoring study of health psychology services in the public-health-focused Primary Health Care Development Model Program (2012-2017) in four disadvantaged micro-regions in northeast Hungary. Study 1 assessed the availability of the services using a sample of 17,003 respondents. Study 2 applied a follow-up design to measure the mental health outcomes of the health psychology services on a sample of 132 clients. In Study 3, we conducted focus-group interviews to assess clients' lived experiences. More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in less depression and (marginally) higher well-being. Thematic analysis of the focus-group interviews indicated that participants deemed topics such as psychoeducation, greater acceptance of psychological support, and heightened awareness of individual and community support important. The results of the monitoring study demonstrate the important role health psychology services can play in primary healthcare in disadvantaged regions in Hungary. Community health psychology can improve well-being, reduce inequality, raise the population's health awareness, and address unmet social needs in disadvantaged regions.

A pilot randomised controlled trial to assess the feasibility and acceptability of recovery-focused therapy for older adults with bipolar disorder.

Despite increasing evidence for the effectiveness of individual psychological interventions for bipolar disorder, research on older adults is lacking. We report the first randomised controlled trial of psychological therapy designed specifically for older adults with bipolar disorder. To evaluate the feasibility and acceptability of recovery-focused therapy, designed in collaboration with older people living with bipolar disorder. A parallel, two-armed, randomised controlled trial comparing treatment as usual with up to 14 sessions of recovery-focused therapy plus treatment as usual, for older adults with bipolar disorder. Thirty-nine participants (67% female, mean age 67 years) were recruited over a 17-month period. Feasibility and acceptability of recruitment, retention (>80% observer-rated outcomes at both 24 and 48 weeks) and intervention processes were demonstrated. The majority of participants started therapy when offered, adhered to the intervention (68% attended all sessions and 89% attended six or more sessions) and reported positive benefits. Clinical assessment measures provide evidence of a signal for effectiveness on a range of outcomes including mood symptoms, time to relapse and functioning. No trial-related serious adverse events were identified. Recovery-focused therapy is feasible, acceptable and has the potential to improve a range of outcomes for people living with bipolar disorder in later life. A large-scale trial is warranted to provide a reliable estimate of its clinical and cost-effectiveness.

QOL-19. Post-Intensive-Care Syndrome – pediatric (PICS-p) among patients with brain tumors – therapeutic strategies and preventive recommendations

Abstract BACKGROUND: Patients with brain tumors needed in intensive care unit (ICU) stay due to tumors symptoms or neurosurgery, experience a complex of physical, psychological, and cognitive symptoms. This constellation of signs and symptoms has been named Post-Intensive-Care Syndrome – pediatric (PICS-p). An interesting problem emerging from this research and requires a deeper exploration are the differences between PICS-p symptoms and primary tumors effects or side effects of treatment e.g. irradiation. METHOD: Psychological repeated testing and long-term observation was performed in 350 childhood brain tumor survivors (various types and localizations of tumor) to determine PICS-p symptoms. Age at psychological diagnosis ranged from 6 to 20 years. Full psychological outcome included assessment of psychophysical, cognitive and affective problems. The patients were examined using battery of neuropsychological methods and psychological interview. Analysis of medical history was also performed. The next level of the study was distinguished between PICS-p symptoms and the effects of tumor localization and oncology treatment, including radiotherapy. RESULTS: In our sample patients presents low scores in the all PICS-p domains: physical, cognitive and mental. Low level of motor skills, impairing daily living activities are characteristic. In this group lower IQ scores, poorer visual motor integration, learning disabilities, memory and language problems persisted. Typical problems in mental area are depressive symptoms, anxiety with intrusive memories, emotional and behavioural disruptions, socialization problems with significantly low level of social contacts. CONCLUSIONS: The results of this study suggest that PICS-p well describes and explains the psychosocial problems of these patients. It allows prepare an individual psychological interventions and rehabilitative program for particular patient as well as therapeutic strategies for whole group of patients. Draft recommendations for diagnosis of PICS-p specific for patients with brain tumors, risk factors and preventive procedures will be presented and discussed.

QOL-20. Post-Intensive-Care Syndrome – pediatric (PICS-p) among patients with brain tumors – therapeutic strategies and preventive recommendations

Abstract BACKGROUND: Patients with brain tumors needed in intensive care unit (ICU) stay due to tumors symptoms or neurosurgery, experience a complex of physical, psychological, and cognitive symptoms. This constellation of signs and symptoms has been named Post-Intensive-Care Syndrome – pediatric (PICS-p). An interesting problem emerging from this research and requires a deeper exploration are the differences between PICS-p symptoms and primary tumors effects or side effects of treatment e.g. irradiation. METHOD: Psychological repeated testing and long-term observation was performed in 350 childhood brain tumor survivors (various types and localizations of tumor) to determine PICS-p symptoms. Age at psychological diagnosis ranged from 6 to 20 years. Full psychological outcome included assessment of psychophysical, cognitive and affective problems. The patients were examined using battery of neuropsychological methods and psychological interview. Analysis of medical history was also performed. The next level of the study was distinguished between PICS-p symptoms and the effects of tumor localization and oncology treatment, including radiotherapy. RESULTS: In our sample patients presents low scores in the all PICS-p domains: physical, cognitive and mental. Low level of motor skills, impairing daily living activities are characteristic. In this group lower IQ scores, poorer visual motor integration, learning disabilities, memory and language problems persisted. Typical problems in mental area are depressive symptoms, anxiety with intrusive memories, emotional and behavioural disruptions, socialization problems with significantly low level of social contacts. CONCLUSIONS: The results of this study suggest that PICS-p well describes and explains the psychosocial problems of these patients. It allows prepare an individual psychological interventions and rehabilitative program for particular patient as well as therapeutic strategies for whole group of patients. Draft recommendations for diagnosis of PICS-p specific for patients with brain tumors, risk factors and preventive procedures will be presented and discussed.

The impacts of a psychological skills course on quality of life outcomes in adults accessing a primary care NHS mental health service: A service evaluation

A service evaluation investigating the efficacy of a new primary care treatment pathway, which incorporates a psychoeducational skills course prior to individual psychological intervention. Findings reflect increased quality of life scores following both the course and the full treatment pathway.

How Sexual and Gender-Based Violence Affects the Settlement Experiences Among Yazidi Refugee Women in Canada

Gender and sexual violence is historically used as a weapon of war. Yazidi women resettled in Canada directly from northern Iraq after the 2014 Daesh-led attacks in the Sinjar region. This direct resettlement experience makes the Yazidi refugees a very distinct group from a resettlement perspective. The severe human rights violations and sexual and gender-based violence they have experienced has affected both their physical and mental health. However, research on pre-arrival trauma and its impact on resettlement has been limited to individual post-arrival psychological interventions without considering how pre-arrival trauma experiences may affect their overall settlement experience. Our paper focuses on the settlement challenges and needs of 21 Yazidi women resettled in the four Canadian cities with the largest Yazidi communities. Because the resettlement of the Yazidi often happened within weeks after their release from captivity, the structural deficiencies within the Canadian settlement network revealed challenges for resettlement organizations in terms of how they assist those with acute trauma. We argue that although the Canadian resettlement program is generous in many ways, it falls short of adequately addressing trauma at the acute stage, especially sexual and gender-based violence as experienced by the Yazidi women and children. Our analysis reveals that single-female-headed families, particularly those with young children, have a difficult time navigating the resettlement system in Canada. We have identified the resettlement experiences of Yazidi women and recommend resettlement to happen in three stages, to account for the acute level of trauma this particular group faces. The first stage lasts between six weeks and three months as many women require more dedicated support from settlement providers for housing, language, and health. The second stage is a period of adjustment which occurs within the next eighteen months, depending on the available support these refugee women have to navigate the different settlement services. The third stage begins sometime after the second year when many women can start navigating the social support, education and health systems independently. Thinking of how SGBV may influence the resettlement process in these three stages is a good way for us to consider the additional assistance that may be needed and how they may better access resettlement services.

Study Protocol for the Evaluation of Individual Psychological Interventions for Family Caregivers of Advanced Cancer Patients.

Background: Both anxiety and depression in family caregivers (FCs) of advanced cancer patients are common, and they have a negative influence on both the FCs and the patients. Some studies suggested that a variety of interventions could alleviate the psychological symptoms of FCs. However, there is no consensus on much more effective methods for intervention, and relatively high-quality research is blank in psychological problems of these population in China. The validity of mindfulness-based stress reduction (MBSR) and psychological consultation guided by the needs assessment tool (NST) in the psychological status of caregivers will be compared in this study to select a more suitable intervention for the FCs of advanced cancer patients in China.Methods and Analysis: A randomized N-of-1 trial would be conducted at the Cancer Hospital, Chinese Academy of Medical Sciences. Fifty eligible FCs of advanced cancer patients will be recruited, and all will receive three cycles of psychological intervention treatment, with each cycle including both of MBSR and psychological consultation guided by the NST. MBSR and psychological consultation guided by the NST will be compared with each other in each cycle, and the intervention sequence will be based on the random number table generated after the informed consent has been completed. Each treatment period is 2 weeks, and the interval between different treatment cycles or treatment periods is 1 week. The self-reported scales are measured at the beginning and end of each treatment period, including the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), Distress Thermometer (DT), Zarit Burden Interview (ZBI), Chinese version of the Medical Outcomes Study 12-item Short Form (C-SF-12), and Family Carer Satisfaction with Palliative Care scale (FAMCARE-2).Dissemination: The protocol of the study was approved by the Institutional Review Board of the Ethical Committee of the Cancer Hospital, Chinese Academic of Medical Science. The results will be published in a peer-reviewed medical journal. The study is registered at Chinese Clinical Trials Registry with the trial registration number chiCTR2000033707. This study employs an innovative methodological approach on the effectiveness of MBSR and psychological consultation guided by the NST for psychological status of FCs of advanced cancer patients. The findings of the study will be helpful to provide high-quality evidence-based medical data for psychological intervention of FCs of advanced cancer patients, and guide clinicians on best quality treatment recommendations.

The Efficacy of Individual Psychological Interventions With Non-Clinical Older Adults

Abstract. A number of reviews and meta-analyses have consistently documented the positive effect of individual psychological intervention with clinical older adults suffering from late-life depression, anxiety disorders, or other mental illnesses. However, many older adults without clinical disorders might seek and benefit from individual psychological interventions too. Given the aging populations across the globe, knowing the potential efficacy of individual psychological interventions with non-clinical older adults therefore is important. However, the research on this topic has not been reviewed systematically. This was the primary aim of the present review. Secondarily, we wanted to find out how many of these studies were conducted in a European context. A systematic literature search identified nine eligible studies yielding an aggregated sample size of 983. Two of these were European. Eight of the nine studies (including one European) reported significant positive effects of individual psychological interventions, that is, increases in psychological well-being and decreases in depression symptoms and distress. Effect sizes were extracted or calculated when possible to estimate the magnitude of the intervention effects. These effect sizes varied across studies and ranged from trivial in size to large and even very large, the median being a medium effect size. The results from the present review suggest that non-clinical older adults benefit from individual psychological interventions. However, the limited number of studies available for review precludes conclusions regarding the comparative efficacy of different types of psychological interventions in this population. Directions for future research are discussed.

Psychological interventions for sexual fantasies and implications for sexual violence: A systematic review

Sexual fantasies are a common aspect of human experience and a prominent consideration in the conceptualisation and treatment of harmful sexual behaviour. Yet, little is known about the evidence that supports the use of psychological interventions for sexual fantasies or how such interventions may modify the multifaceted nature of sexual fantasies. The purpose of this systematic review was to examine the existing literature regarding psychological interventions for sexual fantasies in adult forensic and non-forensic populations to provide a synthesis and evaluation of relevant research. A comprehensive search of six electronic databases was undertaken to identify literature regarding psychological interventions for sexual fantasies. Reference lists of articles were also hand searched and contact was made with authors in the field to identify additional works. A total of ten studies were included in the review. From the ten studies, psychological interventions encompassed group-based therapy (e.g., CBT, psychodynamic), concurrent techniques (e.g., covert sensitisation, orgasmic reconditioning, aversive therapy), and individual techniques (e.g., imagery-competitive tasks, in vivo aversive behaviour therapy). The data synthesis indicated a range of differences between studies, warranting caution in interpreting intervention effectiveness and consideration of multiple confounding factors (e.g., population, sample size, methodology, measurement). The evidence tentatively supports the use of group-based therapy in forensic populations as a result of greater research in this area. There are individual psychological interventions that may be beneficial for sexual fantasies in the context of harmful sexual behaviour but more research is required to support their efficacy.

The effects of psychological interventions on sexual function of women: A systematic review and meta-analysis

Background &amp; Aim: Despite expand using psychological interventions, there is no obvious evidence about the effects of them on sexual function. The study aimed to determine the effect of psychological interventions based on different approaches to the sexual function of women.&#x0D; Methods &amp; Materials: Pubmed, ISI, SCOPUS, EMBASE, Cochrane reviews, Science direct, SID, and Magiran were searched up to May 2019. Eligible studies were randomized controlled trials in which the effect of psychological interventions on the sexual function of women was assessed using the Female Sexual Function Index without any limitations based on age, ethnicity, language, and nationality. Two of the authors screened the titles/abstracts and obtained all full text of the candidate studies, independently. The quality of studies was assessed using the Cochrane checklist risk of bias. Meta-analysis performed via standardized mean differences with a randomeffects model using Review Manager Software (RevMan) version 5.3.&#x0D; Results: Twenty-one studies with 1460 participants were included. The most effective psychological intervention was individual and group type (SMD=3.82; 95% CI, 2.56, 5.08; P&lt;0.001) with cognitive approach (SMD=2.50; 95% CI, 1.06, 3.95; P&lt;0.001), especially in women with no specific condition (SMD=2.17; 95% CI, 1.20-3.15; P&lt;0.001). The effect of psychological interventions on sexual function increased from 1.48 in one month to 2.30 and 3.78 in two and three months after the intervention; however, it decreased to 1.43 in six months or more follows ups (all Ps&lt;0.001). There was a significant change in all FSFI domains (all Ps&lt;0.01).&#x0D; Conclusion: Based on the results, individual and group psychological interventions using the cognitive approach and multidimensional therapies with long term follow-ups are suggested for the treatment of sexual dysfunction.

The efficacy of Motivational Intervention and Cognitive-Behavioral Therapy for Pathological Gambling.

The aim of the current study is to determine the effectiveness of an individual psychological intervention based on the motivational interview and cognitive-behavioral therapy for the treatment of pathological gambling. A sample of 18 participants, diagnosed of pathological gambling and without any other associated comorbidity, were assessed, attended at the publicly-funded Gambling and Behavioral Addictions Unit (Consorci Sanitari de Terrassa). Median age was 46 years (SD = 12). All the patients achieved abstinence and completed follow-up. The Screen for Gambling Problems (NODS), Quality of Life Enjoyment and Satisfaction (Q-LES-Q), Impulsive Behavior Scale (UPPS-P), Sheehan Disability Inventory (SDI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were administered pre- and posttreatment. Results showed that patients significantly reduced the problems related to gambling behavior according to the NODS score (p &lt; .000). Regarding impulsive behavior (UPPS-P), we found significant differences in negative urgency (p &lt; .001), positive urgency (p &lt; .001), (lack of) premeditation (p &lt; .029) and (lack of) perseverance (p &lt; .048). Some relevant aspects of quality of life as assessed by the Q-LES-Q had improved. In conclusion, the study shows that psychological intervention based on the motivational interview and cognitive-behavioral therapy not only significantly reduces gambling-related behavior problems but also leads to improvements in impulsivity and quality of life.&nbsp.

Sociocultural Determinants of Infertility Stress in Patients Undergoing Fertility Treatments.

Introduction:Involuntary childlessness is a distressing condition that has considerable social implications in developing nations.Aim:The present study aims to investigate the less known sociocultural determinants of infertility stress in patients undergoing assisted conception and reproductive treatments.Methods:This cross-sectional research was conducted on 300 men and women with primary infertility. The profile of sociodemographic variables, clinical variables, and sociocultural variables was collected using a locally devised questionnaire. Infertility stress was assessed using the psychological evaluation test.Statistical Analysis:Research data were analyzed using SPSS 15. Chi-square test is used for univariate analysis. Multiple logistic regression with enter method is used to examine the association between infertility stress and sociocultural variables.Results:The findings suggest that in both men and women, low spousal support, financial constraints, and social coercion in early years of marriage predicts infertility distress. Peer-support neither predicts nor protects against distress.Discussion:Family acceptance and social security for infertility is low. Stigma, concealment, and discrimination among men are reported to be high. Distress is three times greater in women with overinvolved family members who had unrealistic expectations from treatments. Taking continuous cycles of fertility treatments seems unaffordable for most patients. Subfertile individuals were socially perceived to be deprived, blemished, incomplete, and sexually incompetent.Conclusion:Data from this investigation, provides a glimpse into sociocultural aspects of infertility. The findings may be useful for identifying targets for individual and family-focused psychological interventions for distress reduction in infertility.

Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial

SummaryBackgroundPsychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp).MethodsWe did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005.FindingsBetween Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI −2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change −4·2 GDS-LD points [95% CI −6·0 to −2·4], p<0·0001; StepUp, mean change −4·5 GDS-LD points [–6·2 to −2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants' total support costs. No treatment-related or trial-related adverse events were reported.InterpretationThis study is, to our knowledge, the first large randomised controlled trial assessing individual psychological interventions for people with intellectual disabilities and mental health problems. These findings show that there is no evidence that BeatIt is more effective than StepUp; both are active and potentially effective interventions.FundingNational Institute for Health Research.