Alternative depression therapy 'could cut queues'

25th July 2016 – Helping people with depression to focus on making lifestyle changes is as effective as the 'gold standard' treatment of cognitive behavioural therapy (CBT), say researchers.

The study in the medical journal The Lancet says the technique, called behavioural activation, can be delivered using more junior staff, costs 20% less and could mean shorter waiting lists for treatment.

An 'outside in' technique

Explaining the technique, Professor David Richards from the University of Exeter, who led the study, says: "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."

Professor Richards continues: "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."

So far, the National Institute for Health and Care Excellence (NICE) has stopped short of recommending behavioural activation as a first-line treatment for depression and called for more trials. The latest study claims to show that this reservation is unwarranted.

'Enormous potential'

"Our findings challenge the dominance of CBT as the leading evidence-based psychological therapy for depression", says Professor Richards in a statement. "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 trial involved 440 adults with depression recruited from 3 areas of England. The participants were randomly assigned to either receive 20 sessions of behavioural activation delivered by junior mental health workers or CBT delivered by experienced psychological therapists.

Between 20% and 30% of participants in both groups dropped out before the minimum number of 8 sessions. However, among those who remained, behavioural activation was found to be no less effective than CBT, with around two-thirds of participants in both groups reporting at least a 50% reduction in depressive symptoms a year after starting treatment.

Lower costs

The trial also found that while CBT cost an average of £1,235 for each patient, behavioural activation could be delivered for £974.

"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," says Professor Richard. "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."