| dc.description.abstract | Paper One: Background: Depression following acquired brain injury (ABI) in adults is common. Psychological therapies are important for treating depression following ABI and improve overall rehabilitation gains. Previous reviews have investigated the literature on psychological therapies for depression following ABI. However, many of these therapies included in the review are not available in the UK’s NHS, nor considered ‘evidence-based’ by NICE guidance. Method: Studies conducted since NICE guidance for depression was released in October 2009 investigating ‘evidence-based’ psychological therapies for depression in a sample of adults with ABI were included in the review. A total 1,533 studies were screened, leading to the identification of five eligible studies for review. Results: Four studies investigated cognitive behavioural therapy (CBT); two one-to-one CBT studies and two CBT group studies using the Window to Hope protocol. One study investigated behavioural activation (BA). Results were mixed; though, studies reporting non-significant results were methodologically less robust and of lower quality. Two CBT studies and the BA study showed promising results, with reliable change in depression scores at post-treatment compared to baseline. Effect sizes for significant studies were ‘medium’ to ‘large’, and were ‘very small’ and ‘small’ for non-significant studies. Discussion: The findings suggest that ‘evidence-based’ therapies for depression in adults with ABI could be effective. However, more high-quality research with robust methodology is needed to reach more substantial conclusions. Suggestions for future research, including investigating other ‘evidence-based’ therapies, like behavioural couples’ therapy and interpersonal therapy, are discussed. Paper Two: Background: Adolescents with acquired brain injury (ABI) commonly experience depression due to difficulties with participation, quality of life (QoL), and performing usual activities. Brief Behavioural Activation (BBA) is a successful, values-based intervention for managing depression in typical adolescents and is investigated using a single-case experimental design with adolescents experiencing depression following ABI. Methods: Five adolescents aged 14-17 years with mild to severe ABI of various aetiologies completed a 6-week course of BBA following at least 2 weeks of baseline measurements. The primary outcome measures were mean daily activity scores out of 10 for 'achievement', 'closeness' and 'enjoyment' (MACES). After baseline MACES collection, activities aligning with participants' values were introduced or targeted during the intervention and further MACES were collected. Depression, QoL, and participation scores at post-treatment and follow-up were compared to baseline. Results: No overall statistical changes in mean activity scores for all participants were found. Though, each participant showed significant change in one area and some changes using visual inspection. All participants reported significant reliable change in depression scores at their follow-up sessions, with three showing clinically significant change. Three participants reported reliable change in QoL. All parents reported reliable change in participants' depression and QoL scores. Discussion: Despite no significant changes in MACES, increased participant insight linking valued activities, mood and positive reinforcement may have positively impacted on participants' depression and QoL outcomes. Rationale is presented for charities and services providing low-intensity interventions to consider trialling BBA for adolescents with depression following ABI. Future research suggestions are discussed. | en_GB |
