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Depression: HELP
Articles by Chris Williams
Based on 21 articles published since 2010
(Why 21 articles?)
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Between 2010 and 2020, Chris Williams wrote the following 21 articles about Depression.
 
+ Citations + Abstracts
1 Editorial Psychological interventions for difficult-to-treat depression. 2012

Williams, Chris / Ridgway, Nicola. · ·Br J Psychiatry · Pubmed #23028083.

ABSTRACT: Mindfulness-based cognitive therapy (MBCT) may be helpful in preventing relapse in those with three or more depressive episodes. Recent research suggests it may also benefit those who have experienced fewer previous episodes of depression. If confirmed, this raises challenges of how MBCT is offered, accessed and supported.

2 Review Cognitive behavioural therapy self-help for depression: an overview. 2011

Ridgway, Nicola / Williams, Chris. ·Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK. ·J Ment Health · Pubmed #22126636.

ABSTRACT: BACKGROUND: The World Health Organisation suggests that 60-80% of those affected by depression can be effectively treated using medication or psychotherapy within primary care. However, less than 50% of those affected actually receive such treatments. In practice, it remains a challenge to provide access to psychotherapy due to limited numbers of therapists combined with a growing number of treatment guidelines recommending the delivery of evidence-based psychological therapies such as cognitive behavioural therapy (CBT). One way to overcome this problem is to offer therapy in different ways - with so-called low-intensity (LI) working. One example of LI working is CBT self-help (CBT-SH). AIMS: To provide an overview of the current literature surrounding the effectiveness of CBT-SH with a particular focus on depression and discuss the future directions for both research and policy implementation. CONCLUSIONS: It is clear that self-help has a place within a healthcare framework but more work is needed to clarify where and how it should be delivered. The paper concludes that there appears to be enough benefits and sufficient evidence to argue for the introduction of LI working as an appropriate first step for most people facing depression and anxiety.

3 Clinical Trial An off-line pilot evaluation of a web-based systemic cognitive-behavioral intervention for carers of people with anorexia nervosa. 2011

Grover, Miriam / Williams, Chris / Eisler, Ivan / Fairbairn, Pennie / McCloskey, Catherine / Smith, Grainne / Treasure, Janet / Schmidt, Ulrike. ·South London and Maudsley NHS Foundation Trust, Eating Disorders Unit, London, UK. ·Int J Eat Disord · Pubmed #22072408.

ABSTRACT: OBJECTIVE: To evaluate the feasibility and acceptability of a novel systemic cognitive behavior therapy-based intervention for carers of people with anorexia nervosa (AN). The intervention provides information and promotes skills development in managing the illness. Carers were also offered professional support. METHOD: Twenty-seven carers were recruited. Outcomes measuring carer distress, experience of care-giving, level of expressed emotion and problem solving were measured pre- and post-intervention and at follow-up. Carers also gave feedback. RESULTS: There was a significant reduction in carers' anxiety and depression, negative experiences of caregiving and expressed emotion and a significant increase in positive experiences in caregiving after the intervention. Most improvements were maintained at follow-up. The intervention was well received. DISCUSSION: The results of this pilot study indicate that the intervention is acceptable to carers and may have a positive impact on carers' mental health and experience of care-giving. Further investigation of the intervention is warranted.

4 Article An expert consensus on the most effective components of cognitive behavioural therapy for adults with depression: a modified Delphi study. 2019

Taylor, Abigail / Tallon, Deborah / Kessler, David / Peters, Tim J / Shafran, Roz / Williams, Chris / Wiles, Nicola. ·Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK. · Bristol Medical School, University of Bristol, Learning and Research, Southmead Hospital , Bristol , UK. · Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health , London , UK. · Institute of Health and Wellbeing, University of Glasgow, Administration Building, Gartnavel Royal Hospital , Glasgow , UK. · Five Areas Ltd , Clydebank , UK. ·Cogn Behav Ther · Pubmed #31429639.

ABSTRACT: Designing new approaches to delivering cognitive behavioural therapy (CBT) requires an understanding of the key components. This study aimed to establish an expert consensus on the effective components of CBT for depressed adults. An international panel of 120 CBT experts was invited to participate in a modified Delphi study. Thirty-two experts participated in round 1; 21 also provided data in round 2. In round 1, experts rated the effectiveness of 35 content and process components.

5 Article "Getting into it": People with intellectual disabilities' experiences and views of Behavioural Activation and Guided Self-Help for depression. 2019

Knight, Roseanna / Jahoda, Andrew / Scott, Katie / Sanger, Kevanne / Knowles, Dawn / Dagnan, Dave / Hastings, Richard P / Appleton, Kim / Cooper, Sally-Ann / Melville, Craig / Jones, Rob / Williams, Chris / Hatton, Chris. ·Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK. · Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. · Centre for Disability Research, Lancaster University, Lancaster, UK. · Cumbria Partnership NHS Foundation Trust, Barrow-in-Furness, UK. · Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. · Betsi Cadwaladr University Health Board, Bangor, UK. · School of Psychology, Bangor University, Bangor, UK. ·J Appl Res Intellect Disabil · Pubmed #30762261.

ABSTRACT: BACKGROUND: No studies have explored the acceptability of Behavioural Activation and Guided Self-Help interventions for depression with people who have intellectual disabilities. METHOD: Twenty-five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self-Help intervention. A framework analysis was used to analyse interviews covering participants' expectations and views of therapy. RESULTS: Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time-limited nature of the interventions and a wish for longer-term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. CONCLUSIONS: The participants reported having positive engagement with the therapies but expressed a wish for longer-term supportive relationships.

6 Article Materials used to support cognitive behavioural therapy for depression: a survey of therapists' clinical practice and views. 2019

Tallon, Debbie / McClay, Carrie-Anne / Kessler, David / Lewis, Glyn / Peters, Tim J / Shafran, Roz / Williams, Chris / Wiles, Nicola. ·Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol , Bristol , UK. · Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK. · Centre for Academic Primary Care, Bristol Medical School, University of Bristol , Bristol , UK. · Division of Psychiatry, University College London , London , UK. · Bristol Medical School, University of Bristol , Bristol , UK. · Great Ormond Street Institute of Child Health London, University College London , London , UK. · Five Areas Ltd , Clydebank , UK. ·Cogn Behav Ther · Pubmed #30507343.

ABSTRACT: Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used "frequently" or "very frequently" by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.

7 Article Supporting people with intellectual disabilities in psychological therapies for depression: A qualitative analysis of supporters' experiences. 2019

Scott, Katie / Hatton, Chris / Knight, Rosie / Singer, Kevanne / Knowles, Dawn / Dagnan, Dave / Hastings, Richard P / Appleton, Kim / Cooper, Sally-Ann / Melville, Craig / Jones, Rob / Williams, Chris / Jahoda, Andrew. ·Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. · Centre for Disability Research, Lancaster University, Lancaster, UK. · Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK. · Cumbria Partnership NHS Foundation Trust, Workington, UK. · Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. · Betsi Cadwaladr University Health Board, Porthmadog, UK. · School of Psychology, Bangor University, Bangor, UK. ·J Appl Res Intellect Disabil · Pubmed #30264419.

ABSTRACT: BACKGROUND: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. METHOD: Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. RESULTS: Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. CONCLUSIONS: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.

8 Article Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial. 2017

Jahoda, Andrew / Hastings, Richard / Hatton, Chris / Cooper, Sally-Ann / Dagnan, Dave / Zhang, Ruiqi / McConnachie, Alex / McMeekin, Nicola / Appleton, Kim / Jones, Rob / Scott, Katie / Fulton, Lauren / Knight, Rosie / Knowles, Dawn / Williams, Chris / Briggs, Andrew / MacMahon, Ken / Lynn, Helen / Smith, Ian / Thomas, Gail / Melville, Craig. ·Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. Electronic address: Andrew.Jahoda@glasgow.ac.uk. · Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia. · Faculty of Health and Medicine, University of Lancaster, Lancaster, UK. · Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. · Cumbria Partnership NHS Foundation Trust and University of Lancaster, Lancaster, UK. · School of Psychology, Bangor University, Bangor, UK. · Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK. · School of Health in Social Science, University of Edinburgh, Edinburgh, UK. · Learning Disability Services, NHS Ayrshire and Arran, Ayrshire, UK. · Specialist Learning Disability Psychological Services, South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, UK. ·Lancet Psychiatry · Pubmed #29153873.

ABSTRACT: BACKGROUND: Psychological 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). METHODS: We 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. FINDINGS: Between 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. INTERPRETATION: This 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. FUNDING: National Institute for Health Research.

9 Article Individuals' Long Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study. 2017

French, Lydia R M / Thomas, Laura / Campbell, John / Kuyken, Willem / Lewis, Glyn / Williams, Chris / Wiles, Nicola J / Turner, Katrina M. ·University of Bristol,UK. · University of Exeter Medical School,UK. · University of Oxford,UK. · University College London,UK. · University of Glasgow,UK. ·Behav Cogn Psychother · Pubmed #27629570.

ABSTRACT: BACKGROUND: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals' continued use of CBT skills once treatment has finished. AIMS: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. METHOD: Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. RESULTS: 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. CONCLUSIONS: Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment.

10 Article Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial. 2016

Wiles, Nicola J / Thomas, Laura / Turner, Nicholas / Garfield, Kirsty / Kounali, Daphne / Campbell, John / Kessler, David / Kuyken, Willem / Lewis, Glyn / Morrison, Jill / Williams, Chris / Peters, Tim J / Hollinghurst, Sandra. ·Centre for Academic Mental Health, University of Bristol, Bristol, UK. Electronic address: nicola.wiles@bristol.ac.uk. · Centre for Academic Mental Health, University of Bristol, Bristol, UK. · Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK. · Primary Care Research Group, University of Exeter Medical School, Exeter, UK. · Centre for Academic Primary Care, University of Bristol, Bristol, UK. · Department of Psychiatry, University of Oxford, Oxford, UK. · Division of Psychiatry, University College London, London, UK. · Institute of Health and Wellbeing, General Practice and Primary Care Group, University of Glasgow, Glasgow, Scotland, UK. · Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, Scotland, UK. · School of Social and Community Medicine and School of Clinical Sciences, University of Bristol, Bristol, UK. ·Lancet Psychiatry · Pubmed #26777773.

ABSTRACT: BACKGROUND: Cognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome is unknown. In a long-term follow-up of the CoBalT trial, we examined the clinical and cost-effectiveness of cognitive behavioural therapy as an adjunct to usual care that included medication over 3-5 years in primary care patients with treatment-resistant depression. METHODS: CoBalT was a randomised controlled trial done across 73 general practices in three UK centres. CoBalT recruited patients aged 18-75 years who had adhered to antidepressants for at least 6 weeks and had substantial depressive symptoms (Beck Depression Inventory [BDI-II] score ≥14 and met ICD-10 depression criteria). Participants were randomly assigned using a computer generated code, to receive either usual care or CBT in addition to usual care. Patients eligible for the long-term follow-up were those who had not withdrawn by the 12 month follow-up and had given their consent to being re-contacted. Those willing to participate were asked to return the postal questionnaire to the research team. One postal reminder was sent and non-responders were contacted by telephone to complete a brief questionnaire. Data were also collected from general practitioner notes. Follow-up took place at a variable interval after randomisation (3-5 years). The primary outcome was self-report of depressive symptoms assessed by BDI-II score (range 0-63), analysed by intention to treat. Cost-utility analysis compared health and social care costs with quality-adjusted life-years (QALYs). This study is registered with isrctn.com, number ISRCTN38231611. FINDINGS: Between Nov 4, 2008, and Sept 30, 2010, 469 eligible participants were randomised into the CoBalT study. Of these, 248 individuals completed a long-term follow-up questionnaire and provided data for the primary outcome (136 in the intervention group vs 112 in the usual care group). At follow-up (median 45·5 months [IQR 42·5-51·1]), the intervention group had a mean BDI-II score of 19·2 (SD 13·8) compared with a mean BDI-II score of 23·4 (SD 13·2) for the usual care group (repeated measures analysis over the 46 months: difference in means -4·7 [95% CI -6·4 to -3·0, p<0·001]). Follow-up was, on average, 40 months after therapy ended. The average annual cost of trial CBT per participant was £343 (SD 129). The incremental cost-effectiveness ratio was £5374 per QALY gain. This represented a 92% probability of being cost effective at the National Institute for Health and Care Excellence QALY threshold of £20 000. INTERPRETATION: CBT as an adjunct to usual care that includes antidepressants is clinically effective and cost effective over the long-term for individuals whose depression has not responded to pharmacotherapy. In view of this robust evidence of long-term effectiveness and the fact that the intervention represented good value-for-money, clinicians should discuss referral for CBT with all those for whom antidepressants are not effective. FUNDING: National Institute for Health Research Health Technology Assessment.

11 Article Conditional Beliefs of Primary-Care Patients with Treatment-Resistant Depression. 2016

Burrage, Alex / Green, Samantha / Turner, Katrina / Kuyken, Willem / Williams, Chris / Wiles, Nicola / Lewis, Glyn. ·University of Bristol,UK. · University of Oxford,UK. · University of Glasgow,UK. · University College London,UK. ·Behav Cogn Psychother · Pubmed #26530496.

ABSTRACT: BACKGROUND: Cognitive behaviour therapy (CBT) for patients with treatment-resistant depression (TRD) aims to reframe underlying conditional beliefs that are thought to maintain depression. AIM: To systematically explore conditional beliefs expressed by primary-care based patients with TRD, defined as non-response to at least 6 weeks of antidepressants. METHOD: Conditional beliefs (stated in an "If. . .then. . ." format) were extracted from a random sample of 50 sets of therapist notes from the CoBalT trial, a large randomized controlled trial of CBT for TRD in primary care. The beliefs were separated into their two constituent parts; the demands (Ifs) and consequences (thens). An approach based on framework analysis provided a systematic way of organizing the data, and identifying key themes. RESULTS: Four main themes emerged from the demand part of the conditional beliefs (Ifs): 1. High standards; 2. Putting others first/needing approval; 3. Coping; and 4. Hiding "true" self. Three main themes emerged from the consequence part of the conditional beliefs (thens): 1. Defectiveness; 2. Responses of others; 3. Control of emotions. CONCLUSIONS: Identifying common themes in the conditional beliefs of patients with TRD adds to our clinical understanding of this client group, providing useful information to facilitate the complex process of collaborative case conceptualization and working with conditional beliefs within CBT interventions.

12 Article BEAT-IT: Comparing a behavioural activation treatment for depression in adults with intellectual disabilities with an attention control: study protocol for a randomised controlled trial. 2015

Jahoda, Andrew / Melville, Craig / Cooper, Sally-Ann / Hastings, Richard / Briggs, Andrew / Dagnan, Dave / Hatton, Chris / McConnachie, Alex / Williams, Chris / Jones, Robert S P. ·Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12OXH, UK. andrew.jahoda@glasgow.ac.uk. · Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12OXH, UK. craig.melville@glasgow.ac.uk. · Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12OXH, UK. sally-ann.cooper@glasgow.ac.uk. · CEDAR, University of Warwick, Kirby Corner Road, Coventry, CV4 8UW, UK. r.hastings@warwick.ac.uk. · HETA, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK. andrew.briggs@glasgow.ac.uk. · Cumbria Partnership NHS Foundation Trust, Penrith CA11, Portland PI, UK. dave.dagnan@cumbria.nhs.uk. · CeDR, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, LA14YG, UK. chris.hatton@lancaster.ac.uk. · Robertson Centre, University of Glasgow, Boyd Orr Building, Glasgow, G12 ORR, UK. alex.mcconnachie@glasgow.ac.uk. · Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12OXH, UK. chris.williams@glasgow.ac.uk. · School of Psychology, Bangor University, Brigantia Building, Bangor, Gwynedd, North Wales, LL57 2DG, UK. r.s.jones@bangor.ac.uk. ·Trials · Pubmed #26714891.

ABSTRACT: BACKGROUND: Depression appears to be more enduring amongst people with intellectual disabilities, suggesting that it is a more chronic problem or more poorly managed in this population. This is not helped by a lack of evidence about the effectiveness of psychological therapies for people who have intellectual disabilities and depression. Behavioural activation, which aims to counteract depression by increasing individuals' level of meaningful activity and their exposure to positive reinforcers, has proven to be as effective as cognitive behavioural therapy in the general population. Given that this therapy makes fewer communicative demands and focuses on activity, it was thought that behavioural activation would be both accessible and apt for people with intellectual disabilities, who are often socially marginalised. METHODS/DESIGN: This study is a multi-centre single-blind randomised controlled trial of behavioural activation versus a self-help attention control intervention for depression in adults with mild/moderate intellectual disabilities. The study has an internal pilot in one centre, to establish that recruitment can be built up and sustained at the required level, before being rolled out across the other sites. One hundred sixty-six participants will be randomly assigned to the behavioural activation or self-help interventions, which will be delivered to individuals with mild to moderate intellectual disabilities, accompanied by someone who provides them with regular support. Both interventions are manualised and will be delivered over a period of approximately 4 months. The primary outcome measure will be the Glasgow Depression Scale, a self-report measure which is completed at baseline and 4 and 12 months post-randomisation. Secondary outcomes include measures of participants' activity levels, proxy reports of depressive symptoms, and cost-effectiveness. DISCUSSION: The study will provide evidence about the effectiveness of behavioural activation for depression, adapted for people who have mild/moderate intellectual disabilities, and will inform the delivery of psychological therapies to people with intellectual disabilities in practice. TRIAL REGISTRATION: Date trial registered: Nov. 13, 2012; trial registration number: ISRCTN 09753005.

13 Article Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial. 2014

Wiles, Nicola / Thomas, Laura / Abel, Anna / Barnes, Maria / Carroll, Fran / Ridgway, Nicola / Sherlock, Sofie / Turner, Nicholas / Button, Katherine / Odondi, Lang'o / Metcalfe, Chris / Owen-Smith, Amanda / Campbell, John / Garland, Anne / Hollinghurst, Sandra / Jerrom, Bill / Kessler, David / Kuyken, Willem / Morrison, Jill / Turner, Katrina / Williams, Chris / Peters, Tim / Lewis, Glyn. ·Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK. · Mood Disorders Centre, University of Exeter, Exeter, UK. · Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK. · Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. · ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, UK. · Primary Care Research Group, University of Exeter Medical School, Exeter, UK. · Nottingham Psychotherapy Unit, Nottinghamshire Healthcare NHS Trust, Nottingham, UK. · Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK. · Institute of Health and Wellbeing, General Practice and Primary Care Group, University of Glasgow, Glasgow, UK. · School of Clinical Sciences, University of Bristol, Bristol, UK. · Division of Psychiatry, University College London, London, UK. ·Health Technol Assess · Pubmed #24824481.

ABSTRACT: BACKGROUND: Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'. OBJECTIVE: The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone. DESIGN: Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD. SETTING: General practices in Bristol, Exeter and Glasgow, and surrounding areas. PARTICIPANTS: Patients aged 18-75 years who had TRD [on antidepressants for ≥ 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of ≥ 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years. INTERVENTIONS: Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care. MAIN OUTCOME MEASURES: The primary outcome was 'response', defined as ≥ 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of < 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years. RESULTS: A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p < 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p < 0.001) and for a secondary 'remission' outcome (BDI-II score of < 10) 2.74 (95% CI 1.82 to 4.13, p < 0.001). The mean cost of CBT per participant was £ 910, the incremental health and social care cost £ 850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £ 14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication. CONCLUSIONS: Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression. TRIAL REGISTRATION: Current Controlled Trials ISRCTN38231611.

14 Article Cost-effectiveness of cognitive-behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: economic evaluation of the CoBalT Trial. 2014

Hollinghurst, Sandra / Carroll, Fran E / Abel, Anna / Campbell, John / Garland, Anne / Jerrom, Bill / Kessler, David / Kuyken, Willem / Morrison, Jill / Ridgway, Nicola / Thomas, Laura / Turner, Katrina / Williams, Chris / Peters, Tim J / Lewis, Glyn / Wiles, Nicola. ·Sandra Hollinghurst, BA, MA, PhD, Fran E. Carroll, BSc, MSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Anna Abel, BSc, Mphil; John Campbell, MD, FRCGP, University of Exeter Medical School, Exeter; Anne Garland, MSc, Nottingham Psychotherapy Unit, Nottinghamshire Healthcare NHS Trust, Nottingham; Bill Jerrom, PhD, Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham; David Kessler, MD, School of Social and Community Medicine, University of Bristol, Bristol; Willem Kuyken, BSc, PhD, DclinPsy, School of Psychology, University of Exeter, Exeter; Jill Morrison, MBChB, MSc, PhD, Academic Unit of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Nicola Ridgway, MA, PgDip, PhD, Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow; Laura Thomas, BA, MPhil, Katrina Turner, BSc, MSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Chris Williams, MBChB, BSc, MmedSc, MD, Academic Unit of Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow; Tim J. Peters, BSc, MSc, PhD, School of Clinical Sciences, University of Bristol, Bristol; Glyn Lewis, PhD, FRCPsych, Nicola Wiles, BSc, PhD, School of Social and Community Medicine, University of Bristol, Bristol, UK. ·Br J Psychiatry · Pubmed #24262818.

ABSTRACT: BACKGROUND: Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication. AIMS: To assess the cost-effectiveness of cognitive-behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone. METHOD: Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs). RESULTS: The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups. CONCLUSIONS: The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.

15 Article Prevalence of treatment-resistant depression in primary care: cross-sectional data. 2013

Thomas, Laura / Kessler, David / Campbell, John / Morrison, Jill / Peters, Tim J / Williams, Chris / Lewis, Glyn / Wiles, Nicola. ·School of Social and Community Medicine, University of Bristol, Bristol, UK. · University of Exeter Medical School, Exeter, UK. · Institute of Health and Wellbeing, General Practice and Primary Care Group, University of Glasgow, Glasgow, UK. · School of Clinical Sciences, University of Bristol, Bristol, UK. · Mental Health Sciences Unit, University College London, London, UK. · Reader in epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK. ·Br J Gen Pract · Pubmed #24351501.

ABSTRACT: BACKGROUND: Antidepressants are often the first-line treatment for depression in primary care. However, not all patients respond to medication after an adequate dose and duration of treatment. Currently, there are no estimates of the prevalence of treatment-resistant depression (TRD) from UK primary care. AIM: To estimate the prevalence of TRD in UK primary care. Design and setting Data were collected as part of a multicentre randomised controlled trial, from 73 general practices in UK primary care. METHOD: Potential participants (aged 18-75 years who had received repeated prescriptions for antidepressants) were identified from general practice records. Those who agreed to be contacted were mailed a questionnaire that included questions on depressive symptoms (Beck Depression Inventory [BDI-II]), and adherence to antidepressants. Those who scored ≥14 on the BDI-II and had taken antidepressants for at least 6 weeks at an adequate dose were defined as treatment resistant. RESULTS: A total of 2439 patients completed the questionnaire (84% of those who agreed to be contacted), of whom 2129 had been prescribed an adequate dose of antidepressants for at least 6 weeks. Seventy-seven per cent (95% CI = 75% to 79%) had a BDI score of ≥14. Fifty-five per cent (95% CI = 53% to 58%) (n = 1177) met the study's definition of TRD, of whom 67% had taken their antidepressants for more than 12 months. CONCLUSION: The high prevalence of TRD is an important challenge facing clinicians in UK primary care. A more proactive approach to managing this patient population is required to improve outcome.

16 Article Evaluation of a web-based skills intervention for carers of people with anorexia nervosa: a randomized controlled trial. 2013

Hoyle, Danielle / Slater, Judith / Williams, Chris / Schmidt, Ulrike / Wade, Tracey D. ·School of Psychology, Flinders University, Australia. ·Int J Eat Disord · Pubmed #23712500.

ABSTRACT: OBJECTIVE: To investigate the feasibility and usefulness of an online information and skills development intervention for carers of individuals with anorexia nervosa (AN) and individuals with AN. METHOD: Thirty-seven carers and seventeen individuals with AN were recruited; carers completed the intervention Overcoming Anorexia Online (OAO), with random allocation to receiving additional clinician guidance (OAO-G) or no guidance (OAO-NoG). Level of expressed emotion, distress, depressive symptoms, experience of caregiving, and impact of eating disorder symptoms were assessed in carers and perceptions of changes in their carers' expressed emotion were assessed in individuals with AN. Participants completed questionnaires at pre-intervention, post-intervention and 3-month follow-up. RESULTS: Significant reductions were found for carer intrusiveness, negative experiences of caregiving, and the impact of starvation and guilt. Within group effect sizes suggested mixed findings with respect to whether greater benefits were conferred for carers receiving clinician guidance. Decreases in perceived intrusiveness of the carer by the individual with AN were associated with a large effect size. DISCUSSION: Results demonstrate the feasibility and usefulness of an online intervention for carers. Further examination of the efficacy of the intervention for both carers and individuals with AN is warranted.

17 Article A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK. 2013

Maxwell, Margaret / Harris, Fiona / Hibberd, Carina / Donaghy, Eddie / Pratt, Rebekah / Williams, Chris / Morrison, Jill / Gibb, Jennifer / Watson, Philip / Burton, Chris. ·Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK. margaret.maxwell@stir.ac.uk ·BMC Fam Pract · Pubmed #23557512.

ABSTRACT: BACKGROUND: Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. METHODS: Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. RESULTS: We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. CONCLUSION: The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

18 Article Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. 2013

Wiles, Nicola / Thomas, Laura / Abel, Anna / Ridgway, Nicola / Turner, Nicholas / Campbell, John / Garland, Anne / Hollinghurst, Sandra / Jerrom, Bill / Kessler, David / Kuyken, Willem / Morrison, Jill / Turner, Katrina / Williams, Chris / Peters, Tim / Lewis, Glyn. ·Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol, UK. nicola.wiles@bristol.ac.uk ·Lancet · Pubmed #23219570.

ABSTRACT: BACKGROUND: Only a third of patients with depression respond fully to antidepressant medication but little evidence exists regarding the best next-step treatment for those whose symptoms are treatment resistant. The CoBalT trial aimed to examine the effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment resistant depression compared with usual care alone. METHODS: This two parallel-group multicentre randomised controlled trial recruited 469 patients aged 18-75 years with treatment resistant depression (on antidepressants for ≥6 weeks, Beck depression inventory [BDI] score ≥14 and international classification of diseases [ICD]-10 criteria for depression) from 73 UK general practices. Participants were randomised, with a computer generated code (stratified by centre and minimised according to baseline BDI score, whether the general practice had a counsellor, previous treatment with antidepressants, and duration of present episode of depression) to one of two groups: usual care or CBT in addition to usual care, and were followed up for 12 months. Because of the nature of the intervention it was not possible to mask participants, general practitioners, CBT therapists, or researchers to the treatment allocation. Analyses were by intention to treat. The primary outcome was response, defined as at least 50% reduction in depressive symptoms (BDI score) at 6 months compared with baseline. This trial is registered, ISRCTN38231611. FINDINGS: Between Nov 4, 2008, and Sept 30, 2010, we assigned 235 patients to usual care, and 234 to CBT plus usual care. 422 participants (90%) were followed up at 6 months and 396 (84%) at 12 months, finishing on Oct 31, 2011. 95 participants (46%) in the intervention group met criteria for response at 6 months compared with 46 (22%) in the usual care group (odds ratio 3·26, 95% CI 2·10-5·06, p<0·001). INTERPRETATION: Before this study, no evidence from large-scale randomised controlled trials was available for the effectiveness of augmentation of antidepressant medication with CBT as a next-step for patients whose depression has not responded to pharmacotherapy. Our study has provided robust evidence that CBT as an adjunct to usual care that includes antidepressants is an effective treatment, reducing depressive symptoms in this population. FUNDING: National Institute for Health Research Health Technology Assessment.

19 Article Exploring patients' reasons for declining contact in a cognitive behavioural therapy randomised controlled trial in primary care. 2012

Barnes, Maria / Wiles, Nicola / Morrison, Jill / Kessler, David / Williams, Chris / Kuyken, Willem / Lewis, Glyn / Turner, Katrina. ·School of Social and Community Medicine, University of Bristol, UK. maria.barnes@bristol.ac.uk ·Br J Gen Pract · Pubmed #22546597.

ABSTRACT: BACKGROUND: The difficulties of recruiting individuals into mental health trials are well documented. Few studies have collected information from those declining to take part in research, in order to understand the reasons behind this decision. AIM: To explore patients' reasons for declining to be contacted about a study of the effectiveness of cognitive behavioural therapy as a treatment for depression. DESIGN AND SETTING: Questionnaire and telephone interview in general practices in England and Scotland. METHOD: Patients completed a short questionnaire about their reasons for not taking part in research. Semi-structured telephone interviews were conducted with a purposive sample to further explore reasons for declining. RESULTS: Of 4552 patients responding to an initial invitation to participate in research involving a talking therapy, 1642 (36%) declined contact. The most commonly selected reasons for declining were that patients did not want to take part in a research study (n = 951) and/or did not want to have a talking therapy (n = 688) (more than one response was possible). Of the decliners, 451 patients agreed to an interview about why they declined. Telephone interviews were completed with 25 patients. Qualitative analysis of the interview data indicated four main themes regarding reasons for non-participation: previous counselling experiences, negative feelings about the therapeutic encounter, perceived ineligibility, and misunderstandings about the research. CONCLUSION: Collecting information about those who decline to take part in research provides information on the acceptability of the treatment being studied. It can also highlight concerns and misconceptions about the intervention and research, which can be addressed by researchers or recruiting GPs. This may improve recruitment to studies and thus ultimately increase the evidence base.

20 Article Cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: the CoBalT randomised controlled trial protocol. 2012

Thomas, Laura J / Abel, Anna / Ridgway, Nicola / Peters, Tim / Kessler, David / Hollinghurst, Sandra / Turner, Katrina / Garland, Anne / Jerrom, Bill / Morrison, Jill / Williams, Chris / Campbell, John / Kuyken, Willem / Lewis, Glyn / Wiles, Nicola. ·School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK. L.J.Bridges@bristol.ac.uk ·Contemp Clin Trials · Pubmed #22101205.

ABSTRACT: BACKGROUND: Antidepressants are often the first-line treatment for depression but only one third of patients respond fully to pharmacotherapy. This paper describes the protocol for a randomised controlled trial (RCT) designed to evaluate the clinical and cost effectiveness of cognitive behavioural therapy (CBT) as an adjunct to pharmacotherapy for patients with treatment resistant depression in primary care. METHODS/DESIGN: CoBalT is a two parallel group multi-centre pragmatic RCT. Eligible participants were those who: (i) were aged 18-75years; (ii) were currently taking antidepressant medication (for at least 6weeks at an adequate dose); (iii) scored ≥14 on the Beck Depression Inventory (BDI-II); (iv) had adhered to their medication; and (v) met ICD-10 criteria for depression (assessed using the Clinical Interview Schedule - revised version). Those who gave written informed consent were randomised to one of two treatment groups: usual care or usual care plus CBT. The primary outcome is depressive symptoms assessed using the BDI-II at 6months post-randomisation. Secondary outcomes measured at 6 and 12months include quality of life, antidepressant use and health care utilisation. Outcomes will be analysed on an intention-to-treat basis. DISCUSSION: The CoBalT trial will provide evidence on the clinical and cost effectiveness of CBT as an adjunct to antidepressant medication in the treatment of depression that has not responded to pharmacotherapy. Given the move to widen access to 'talking therapies', the results of this study will be timely.

21 Minor Cognitive behavioural therapy for treatment-resistant depression - Authors' reply. 2013

Wiles, Nicola / Lewis, Glyn / Peters, Tim / Kuyken, Willem / Williams, Chris. · ·Lancet · Pubmed #23706799.

ABSTRACT: -- No abstract --