STAFF RESPONSES TO CHALLENGING BEHAVIOUR: AN EVALUATION OF BEHAVIOUR ANALYTIC CONCEPTS AND INTERVENTION STRATEGIES

This research project is divided into two studies. Study 1 considers the proposition that where the challenging behaviours of learning disabled people are sensitive to social reinforcement, the responses of unit staff may be counter-habilitative. This was investigated using a questionnaire-based self-report study involving 43 unit staff. The questionnaires covered staff emotional reactions to, attributions for and responses to challenging behaviours. In addition key aspects of the staff sub-culture were considered. Results confirmed the possible counter-habilitative nature of staff responses. These responses appeared to be influenced by both contingency effects related to high levels of stress and counter -habilitative beliefs within staff sub-cultures. Study 2 had two aims. First, to gather qualitative data with regard to both contingency and sub-culture effects. Secondly, to evaluate a training package designed to ameliorate counter-habilitative influences upon staff responses. The qualitative data gathered was strongly suggestive of an interaction between contingency and culture effects, reinforced by aspects of the wider service culture. Key issues appeared to be high levels of stress related to challenging behaviours, highly counter-habilitative beliefs in which staff feel that they have to 'deal with anything' and a perceived lack of support from the wider service itself For example, only a minority of staff had access to a consistent debriefing procedure. The training package proved to be largely ineffective in changing key counter-habilitative beliefs and responses. It is argued that future intervention strategies and research may need to consider wider service issues if habilitative changes are to be acheived. The implications of these findings for clinical psychologists working with learning disability services are also discussed.Exeter Community Health Services Trus

Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial

BackgroundAbout 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive–behavioural therapy (CBT).AimsTo test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression.MethodForty-two consecutively recruited participants meeting criteria for medication-refractory residual depression were randomly allocated to TAU v. TAU plus up to 12 sessions of individual rumination-focused CBT. The trial has been registered (ISRCTN22782150).ResultsAdding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination.ConclusionsThis is the first randomised controlled trial providing evidence of benefits of rumination-focused CBT in persistent depression. Although suggesting the internal validity of rumination-focused CBT for residual depression, the trial lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-focused CBT v. non-specific therapy effects.</jats:sec

Rumination-focused cognitive behaviour therapy for residual depression: a case series.

addresses: Mood Disorders Centre, School of Psychology, University of Exeter, Exeter EX4 4QG, UK.types: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov'tCopyright © 2007 Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Experimental Social Psychology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published Behaviour Research and Therapy, 2007, Vol. 45, Issue 9, pp. 2144 – 2154 DOI: http://dx.doi.org/10.1016/j.brat.2006.09.018The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression