According to the results of a recent study published in Lancet Psychiatry, a behavioral activation intervention (Beat-It) and a guided self-help intervention (Step UP!) have equal efficacy in decreasing depressive symptoms in people with intellectual disabilities and depression.

In this randomized controlled trial, researchers randomly assigned participants with mild to moderate intellectual disabilities and clinically significant depression to receive Beat-It (n=84) or Step UP! (n=77) psychological interventions for depression. Beat-It consisted of 12 sessions intended to increase activity, schedule activity, and address barriers to engagement in activity. Step UP! consisted of 8 sessions that incorporated self-help materials with a series of 4 booklets. Both interventions were delivered with the assistance of  a support person who provided assistance during sessions and was available for at least 2 hours per week.

Based on the Glasgow Depression Scale for people with a Learning Disability scores at 12 months, no significant difference in depression scores was noted in either the Beat-It (mean standard deviation [SD] 12.03 [7.99]) or Step UP! group (mean SD 12.43 [7.64]; P =.833).

Beat-It significantly improved mean depression scores at 12 months relative to baseline (–4.2; 95% CI –6.0 to –2.4; P <.001) with a large effect size (0.59, 95% CI 0.337-0.844). In a similar fashion, Step UP! significantly improved mean depression from baseline (–4.5; 95% CI –6.2 to –2.7; P <.001), also with a large effect size (0.627; 95% CI 0.380-0.873).

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Compared with Step UP!, Beat-It was not cost-effective, but the researchers noted substantial uncertainty in the economic analyses. They estimated that the treatment costs were between 3.6% and 6.8% of participants’ total support costs.

The study investigators concluded that the results “might help to address the inequities faced by people with intellectual disabilities, who often do not have access to psychological therapies for commonly occurring mental health problems.”


Jahoda A, Hastings R, Hatton C, et al. Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial [published online November 13, 2017]. Lancet Psychiatry. doi:10.1016/S2215-0366(17)30426-1