With long waiting lists and limited access to services, many people who need CBT for depression cannot get treatment. The study suggests that behavioural activation therapy could be delivered by junior mental health workers, leading to considerable savings for the NHS and other health services.
“Our findings challenge the dominance of CBT as the leading evidence-based psychological therapy for depression,” said lead author David Richards from the University of Exeter, UK. “Behavioural activation should be a front-line treatment for depression in the UK and has enormous potential to improve reach and access to psychological therapy worldwide.”
The Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA) trial recruited 440 adults with depression from primary care and psychological therapy services in three areas of England. Participants were randomly assigned to receive either a maximum of 20 sessions of behavioural activation treatment delivered by junior mental health workers (221 participants), or CBT delivered by experienced psychological therapists (219). Between 20-30 percent of participants in each group did not attend the minimum number of 8 therapy sessions or dropped out, a common problem in psychological therapy services, and were not included in the analysis.
“Behavioural activation is an ‘outside in’ treatment that focuses on helping people with depression to change the way they act. The treatment helps people make the link between their behaviour and their mood. Therapists help people to seek out and experience more positive situations in their lives. The treatment also helps people deal with difficult situations and helps them find alternatives to unhelpful habitual behaviours,” explained Richards.
He added, “In contrast, CBT is an ‘inside out’ treatment where therapists focus on the way a person thinks. Therapists help people to identify and challenge their thoughts and beliefs about themselves, the world, and their future. CBT helps people to identify and modify negative thoughts and the beliefs that give rise to them.”
According to Professor Richards, “Our findings indicate that health services worldwide, both rich and poor, could reduce the need for costly professional training and infrastructure, reduce waiting times, and increase the availability of psychological therapies. However, more work still needs to be done to find ways to effectively treat up to a third of people with depression who do not respond to CBT or behavioural activation.”