Potential for children with intellectual disability to engage in cognitive behaviour therapy: the parent perspective.

BACKGROUND: This study aimed to obtain the opinions of parents and carers of children with intellectual disability (ID) as to whether cognitive behaviour therapy (CBT) could be useful for their children. METHODS: A mixed qualitative and quantitative method was employed. Twenty-one carers of children aged 10 to 17 having borderline to moderate intellectual functioning responded to an online questionnaire. Participants were provided with information about CBT and asked to respond to open-ended questions. Quantitative data pertained to questions about their child's ability to identify and describe thoughts, feelings and behaviours. Thematic analysis of responses was conducted using an inductive method of identifying themes from the qualitative data collected. RESULTS: Five themes emerged from the qualitative analysis: Emotional Attunement (i.e. parent's understanding and recognition of their child's emotions), Role of the Therapist (i.e. ways therapists could facilitate the intervention), Role of the Parent (i.e. ways parents could engage in the therapy process), Anticipated Obstacles (i.e. what may get in the way of the therapy) and Suggested Adaptations for Therapy (i.e. how CBT can be adapted to suit the needs of children with ID). Seventy-six per cent agreed that their child would be able to engage in CBT with assistance. CONCLUSIONS: The majority of parents believed that CBT is an intervention that children with ID could engage in, provided the therapy is adapted, and the therapist accommodates their needs.

A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people.

BACKGROUND: Four constructs are encompassed by the term "falls-related psychological concerns" (FrPC); "fear of falling" (FOF), "falls-related self-efficacy" (FSe), "balance confidence" (BC) and "outcome expectancy" (OE). FrPC are associated with negative consequences including physical, psychological, and social. Identifying factors associated with FrPC could inform interventions to reduce these concerns. METHODS: Sixty-two empirical papers relating to psychological factors associated with FrPC in community-dwelling older people (CDOP) were reviewed. Four levels of evidence were used when evaluating the literature: good, moderate, tentative, and none. RESULTS: Evidence that anxiety predicted FOF, BC, and OE was tentative. Moderate evidence was found for anxiety predicting FSe. Good evidence was found for depression predicting FSe. Moderate evidence was found for depression predicting both FOF and BC. No evidence was found for depression predicting OE. Tentative evidence was found for FSe predicting depression. Good and moderate evidence was found for quality of life (QoL) being predicted by FOF and BC respectively. Tentative evidence was found for FSe predicting QoL. Moderate evidence was found for QoL predicting both FSe and BC. No evidence was found for QoL predicting FOF. Good and moderate evidence was found for activity avoidance/restriction (AA/AR) being predicted by FOF and FSe respectively. Tentative evidence was found for BC and OE predicting AA/AR, as well as for AA/AR predicting FOF. Moderate evidence for activity level (AL) predicting FOF was identified, however the evidence of this predicting FSe and BC was tentative. Evidence for FOF, FSe, and BC predicting AL was tentative as was evidence to suggest FOF predicted coping. CONCLUSIONS: Mixed evidence has been found for the association of psychological factors in association with FrPCs. Future research should employ theoretically grounded concepts, use multivariate analysis and longitudinal designs.

Systematic review of leisure therapy and its effectiveness in managing functional outcomes in stroke rehabilitation.

BACKGROUND: Evidence suggests that the incorporation of leisure activities in adult stroke rehabilitation can contribute to improved physical, cognitive, and psychological outcomes. However, differences in study design and treatment delivery may affect these findings. Furthermore, the magnitude of therapeutic change associated with leisure therapy is unclear, with few quantitative reviews available. OBJECTIVE: To synthesize and evaluate the empirical evidence examining leisure therapy in stroke rehabilitation. METHODS: Eight independent studies (N = 615 participants) were identified from a comprehensive database search. Study quality was evaluated using the Oxford Levels of Evidence. Pre- and posttreatment data for participants who received leisure therapy, in comparison with peers who received standard care or no treatment, were evaluated by calculating Cohen's d effect sizes and 95% confidence intervals. RESULTS: No studies met the criteria for the highest level of methodological rigor, although all used randomization procedures. Leisure therapy contributed to significant short-term improvements in psychological outcomes, namely quality of life and mood (d range, 2.10 to 0.54), in addition to leisure-specific outcomes, including increased participation in and satisfaction with leisure activities (d range, 0.81 to 1.23). Longer term effects of treatment could not be determined, with one study providing data and reporting nonsignificant effects (d range, -0.07 to 0.17). CONCLUSIONS: There is some evidence that leisure therapy offers an opportunity to enhance short-term treatment gains in community-based stroke rehabilitation. Further controlled research is needed to establish its longer term effects and assist the development of evidence-based guidelines for this treatment.

Corrigendum to "A Longitudinal Examination of the Hopelessness Theory of Depression in People Who Have Multiple Sclerosis".

[This corrects the article DOI: 10.1155/2015/190405.].

A Longitudinal Examination of the Hopelessness Theory of Depression in People Who Have Multiple Sclerosis.

PURPOSE: Hopelessness theory predicts that negative attributional style will interact with negative life events over time to predict depression. The intention of this study was to test this in a population who are at greater risk of negative life events, people with Multiple Sclerosis (MS). METHOD: Data, including measures of attributional style, negative life events, and depressive symptoms, were collected via postal survey in 3 phases, each one a year apart. RESULTS: Responses were received from over 380 participants at each study phase. Negative attributional style was consistently able to predict future depressive symptoms at low to moderate levels of association; however, this ability was not sustained when depressive symptoms at Phase 1 were controlled for. No substantial evidence to support the hypothesised interaction of negative attributional style and negative life events was found. CONCLUSIONS: Findings were not supportive of the causal interaction proposed by the hopelessness theory of depression. Further work considering other time frames, using methods to prime attributional style before assessment and specifically assessing the hopelessness subtype of depression, may prove to be more fruitful. Intervention directly to address attributional style should also be considered.

Psychological management of post-stroke depression.

PURPOSE: To evaluate existing research literature on psychological interventions to manage post-stroke depression (PSD). METHOD: First, the particular nature of post-stroke depression (PSD) was established. Then, relevant published material was identified through computerized literature searches (to May 1999) and via the first author's clinical experience in the area. This material was critically reviewed against recommended standards for the empirical validation of treatment effectiveness. RESULTS: Methodological limitations in existing research prevent a conclusion as any one psychological intervention has empirical support for its effectiveness. However, cognitive behaviour therapy in particular was identified as worthy of further investigation. CONCLUSIONS: It is recommended that future research investigates treatments for PSD appropriate for those with cognitive impairment and communication difficulties, younger versus older stroke victims and those in institutional settings. Studies should also consider the necessity of specialist assessment strategies and allow for possible subtypes of PSD for which psychological treatments might be differentially effective.

Breaking bad news in stroke rehabilitation: a consultation with a community stroke team.

PURPOSE: Within stroke care clinicians are frequently required to break bad news to patients, however, formal training and guidance remains limited. This article provides a case example of a multidisciplinary stroke rehabilitation team consultation, and aims to contribute towards an evidence base and a model of training for breaking bad news (BBN) in stroke care. METHOD: The stroke rehabilitation team requested clinical psychology consultation to help with difficulties they were experiencing in BBN to patients. The consultation comprised an assessment of the request, development of a proposal, delivery of a workshop on BBN and an evaluation of consultation impact. A collaborative consultation model underpinned the work, which aimed to empower and facilitate the team to generate solutions by drawing upon their existing expertise. RESULTS: The consultation was found to meet the team's expectations and needs. Consultees reported increased confidence to communicate difficult messages to patients and rated the consultation highly. A follow-up review indicated the consultation had led to changes in practice. CONCLUSIONS: Communication skills are central to BBN effectively. Clinicians may be supported to recognize their existing skill set and increase confidence in their ability to break bad news through a process of collaborative team consultation.

A preliminary investigation of the reliability and validity of the Brief Assessment Schedule Depression Cards and the Beck Depression Inventory-Fast Screen to screen for depression in older stroke survivors.

OBJECTIVE: To conduct an initial assessment of the reliability and validity of the Brief Assessment Schedule Depression Cards (BASDEC) and the Beck Depression Inventory-Fast Screen (BDI-FS) to screen for depression in older stroke survivors. METHODS: Participants from four inpatient rehabilitation units completed the BASDEC and the BDI-FS together with the Hospital Anxiety and Depression Scale (HADS) for comparison. The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID) was then completed with all participants to ascertain a criterion depression diagnosis. The BASDEC and BDI-FS were subsequently completed for a second time. RESULTS: Forty-nine stroke survivors (M=78.80, SD=6.79 years) were included. The BASDEC and BDI-FS demonstrated acceptable internal consistency and test-retest reliability. The BASDEC (cut-off >or=7) resulted in a sensitivity of 1.0 and specificity of 0.95 for detecting major depression whereas the BDI-FS (cut-off >or=4) had a sensitivity of 0.71 and specificity of 0.74. When participants with minor depression were included in analyses, sensitivity lowered to 0.69 (specificity=0.97) for the BASDEC and 0.62 (specificity=0.78) for the BDI-FS. CONCLUSIONS: The BASDEC and BDI-FS were found to have acceptable reliability. The BASDEC demonstrated some advantage in criterion validity over the BDI-FS at the examined cut-offs.

Treatment of depression in people who have multiple sclerosis.

Depression is common among people with multiple sclerosis (MS). Research suggests that treatments for depression are effective in this population, though few patients appear to access these treatments. Our objectives were to consider whether persons with MS and significant depressive symptoms, prompted to seek treatment by letter, did so, what professionals they consulted, and the benefits of any treatment obtained. A total of 495 individuals with MS (401 female; 94 male), aged 22-65 years (mean: 45.8 years), were surveyed in three phases at yearly intervals. Significant depressive symptoms were found over the three phases (50-60.2%). Despite a high prevalence of depressive symptoms, few participants sought treatment, even though prompted to do so. Where treatment was sought, general practitioners remained the principal group consulted. Contrary to previous reports of the efficacy of treatment in clinical trials, no strong support for this was found. Future research needs to consider why the majority of people with MS do not seek treatment for depression, and why interventions, which are not clinical trials, seem to lack effectiveness.

Symptoms of depression in older adults with multiple sclerosis (MS): comparison with a matched sample of younger adults.

The study considered for the first time depression in older adults with multiple sclerosis (MS). Depression symptom scores of 27 persons aged over 65 years who were part of a large study of persons with MS (n = 529), were compared with those of a matched sample of younger adults from the same study. The association between cognitive (attitudinal) variables known to explain significant variance in depressive symptoms in younger adults with MS was then considered in the older adult sample. Consistent with findings from studies with general community samples, older adults with MS reported significantly fewer depressive symptoms than younger adults with MS. The relationship between cognitive variables and depressive symptoms found previously in younger adults was also evident for the older adults. Multiple sclerosis related helplessness was found to be significantly higher in older as opposed to younger adults with MS, the opposite of what was predicted given the differences between the groups in depression scores. Differences in the cognitive variables do not appear to explain the differences between older and younger adults with MS in terms of depressive symptoms. This finding offers support for the view that a decrease in emotional responsiveness may explain differences in depressive symptoms between younger and older adults with MS, rather than this being the result of differences in emotional control exerted via cognitive means.