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About 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive-behavioural therapy (CBT). To test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression. Forty-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). Adding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination. This 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.

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.

The Rouyn-Noranda Huskies prolific trio is the Quebec Major Junior Hockey League's version of a three-ring circus. Game time is 7:30 p.m. Ribeiro, Desmarais and Tremblay occupy the top three positions in the QMJHL scoring race.