Victoria Ann Mason

A Randomized Controlled Trial of Cognitive Behavioural Therapy as an Adjunct to Pharmacotherapy in Primary Care Based Patients with Treatment Resistant Depression: A Pilot Study

No randomised controlled trials (RCTs) have been conducted of cognitive behavioural therapy (CBT) for depressed patients who have not responded to antidepressants, yet CBT is often reserved for this group. We conducted a pilot study for a pragmatic RCT of the clinical effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with treatment resistant depression (TRD). Patients on antidepressants for at least 6 weeks were mailed a study invitation by their GP. Those who consented to contact were mailed a questionnaire. TRD was defined as compliance with medication (self-report) and Beck Depression Inventory (BDI) ≥ 15. Those who met ICD-10 depression criteria were eligible for randomisation and followed after 4 months. Of 440 patients mailed, 65% responded and 72% consented to contact. 94% completed the questionnaire and 82 patients (42%) had TRD. Thirty were subsequently identified as ineligible and 10 did not participate further. Twenty-six of the remaining 42 patients met ICD-10 depression criteria and 25 agreed to being randomised. 23 patients completed the 4-month follow-up questionnaire. Recruitment into a RCT to examine the effectiveness of CBT as an adjunct to pharmacotherapy in primary care based patients with TRD appears feasible and should now be conducted.

The blurred edges of intellectual disability

The label of ‘intellectual disability’ can be a very blurred concept, because for those on the borders their label often arises from the interaction of the individual with their environment, from their socio-economic status, and from the social role which they choose to undertake. This paper explores the contested notion of intellectual disability in the context of people who have been in trouble with the law in England, and contrasts their situation with that of people who have been protected by best interests decisions under the Mental Capacity Act (England and Wales). People who are on the ‘borderline’ of having an intellectual disability, like any citizens, have a range of intersecting identities. Drawing on the notions of ‘interactional’ disability theory, we reflect on the shifting, relative nature of intellectual disability, and the need for the law to focus on support needs, rather than on impairment.

Commentary: enabling good emotional support for and with people with learning disabilities

Purpose Picking up from Cotter et al.’s article on the transferential process, the purpose of this paper is to set out some arguments about the ways of meeting the emotional needs of people with learning disabilities. Design/methodology/approach The commentary draws on two studies: one is about understanding and changing disabling practices, and the other is about bereavement support for people with learning disabilities. Both use qualitative approaches, and in both studies, people with learning disabilities are active agents or co-researchers, who have assisted in shaping the ideas and values of the research. Findings Professional practices, including those within the therapeutic context, can act as institutional barriers which create people with learning disabilities as passive or incompetent. However, this paper sets out some preliminary findings showing that not only can people with learning disabilities support each other, but also that face-to-face support workers can support people with learning disabilities to understand and cope with their emotions. Practical implications Frontline support workers should be seen as professionals, with their own range of resources to provide good emotional support. Further, people with learning disabilities can come together in groups to develop peer support about difficult and sensitive topics. Originality/value Talking about therapies for people with learning disabilities has long been overlooked. As their value is now recognised, it is important that the views and wishes of people with learning disabilities themselves are heard, so that they can contribute to the processes which support them.