The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) – a pilot randomised controlled trial

Ailsa Russell, Daisy M. Gaunt, Kate Cooper, Stephen Barton, Jeremy Horwood, David Kessler, Chris Metcalfe, Ian Ensum, Barry Ingham, Jeremy R. Parr, Dheeraj Rai, Nicola Wiles

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Low-intensity cognitive behaviour therapy including behavioural activation is an evidence-based treatment for depression, a condition frequently co-occurring with autism. The feasibility of adapting low-intensity cognitive behaviour therapy for depression to meet the needs of autistic adults via a randomised controlled trial was investigated. The adapted intervention (guided self-help) comprised materials for nine individual sessions with a low-intensity psychological therapist. Autistic adults (n = 70) with depression (Patient Health Questionnaire-9 score ⩾10) recruited from National Health Service adult autism services and research cohorts were randomly allocated to guided self-help or treatment as usual. Outcomes at 10-, 16- and 24-weeks post-randomisation were blind to treatment group. Rates of retention in the study differed by treatment group with more participants attending follow-up in the guided self-help group than treatment as usual. The adapted intervention was well-received, 86% (n = 30/35) of participants attended the pre-defined ‘dose’ of five sessions of treatment and 71% (25/35) attended all treatment sessions. The findings of this pilot randomised controlled trial indicate that low-intensity cognitive behaviour therapy informed by behavioural activation can be successfully adapted to meet the needs of autistic people. Evaluation of the effectiveness of this intervention in a full scale randomised controlled trial is now warranted. Depression is a mental health condition. It is unknown if psychosocial treatments found to be effective for depression meet the needs of autistic people, who have social communication and neurocognitive difference. We developed a guided self-help treatment for depression adapted for autism. We investigated the feasibility of delivering this treatment using a randomised controlled trial. Guided self-help comprised materials for nine individual sessions, training and a manual for therapists to support people in their use of the materials. Seventy autistic adults with depression randomly allocated to guided self-help or treatment as usual completed measures of depression, anxiety and other relevant factors. They were asked to repeat the measures 10, 16 and 24 weeks later and were invited to take part in interviews about their experience. Most people allocated to guided self-help attended all of the treatment sessions and told us that they found it helpful. More of the people attending guided self-help stayed in the study and completed the follow-up measures compared to the treatment as usual group. Almost half the people in treatment as usual did not attend follow-up. It will be important to improve the rate of follow-up measurement in treatment as usual in any future study. The findings of this feasibility study state that it is feasible to develop and deliver a guided self-help treatment that is acceptable to autistic adults with depression. The findings recommend a larger trial to find out if guided self-help is effective in treating depression co-occurring with autism.

Original languageEnglish
Pages (from-to)1360-1372
Number of pages13
JournalAutism
Volume24
Issue number6
DOIs
StatePublished - 1 Aug 2020
Externally publishedYes

Keywords

  • adults
  • autism
  • cognitive behaviour therapy
  • depression

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