Behavioral Activation: Now, the Psychological Treatment of Choice for Depression?

Summary and Comment |
August 11, 2016

Behavioral Activation: Now, the Psychological Treatment of Choice for Depression?

  1. Peter Roy-Byrne, MD

Behavioral activation was as effective as CBT, easier to implement, and by using junior therapists without advanced training, less costly.

  1. Peter Roy-Byrne, MD

Many depressed patients prefer psychological treatments, which often have longer-lasting effects than medication after its discontinuation. Behavioral activation (BA), an effective component of cognitive-behavioral therapy (CBT), aims to get the inactive depressed patient to increase personally meaningful and enjoyable activities. It has been found by itself to improve depression and is simpler than CBT for therapists to teach and patients to learn. In this U.K. noninferiority study, researchers enrolled 440 adults with depression, drawn from primary-care or psychological-clinic rolls, and compared clinical effectiveness and costs of CBT (done by therapists with professional training) and BA (done by junior therapists without professional training).

Both therapies involved ≤20 hourlong sessions in 16 weeks. At 12 months, noninferiority of BA to CBT was shown; the two groups improved an identical 8.4 points on the Patient Health Questionnaire–9, with 61% and 62% of the BA and CBT groups having ≥50% reductions in scores. BA was more cost-effective than CBT because of the lower cost of the junior nonprofessional therapists.

Comment

This important study shows that the easy-to-implement BA is just as effective as the more complex CBT requiring advanced-degree training and experience. BA can treat a large population of depressed patients effectively and cheaply. It will be increasingly used in resource-poor countries. In developed countries looking for the smartest way to use limited mental health resources, it is an obvious “first step” treatment (most likely in collaborative, integrated-care models). In the U.S., licensing barriers and guild issues may limit utilization of novice therapists with only college degrees, even though these findings suggest they would be effective first-step therapists.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH–National Institute of Mental Health Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Immediate Past-President)

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Reader Comments (1)

Simmons, Paul Physician, Family Medicine/General Practice, residency faculty

A psychiatrist mentor of mine once said "Depression is a movement disorder, you must get the patient moving" and this study suggests he was right.

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