London | A simple and inexpensive psychotherapy or talking therapy is as effective at treating depression in adults as the gold-standard cognitive behavioural therapy (CBT), a new study has found. With long waiting lists and limited access to services, many people who need CBT for depression do not get treatment, researchers said.
The findings from this new study, one of the largest trials of psychological treatment for depression till date, suggest that the behavioural activation (BA) therapy could be delivered by junior mental health workers, they said.
Our findings challenge the dominance of CBT as the leading evidence-based psychological therapy for depression, said David Richards from University of Exeter in the 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, said Richards. Depression is a common mental health disorder affecting around 350 million people worldwide.
Currently, talking therapies like CBT are delivered by specialist clinicians and therapists who are expensive to train and employ. In many countries, access is limited to people who can afford to pay, or those with health insurance, and waiting lists can be long, researchers said.
For the study, 440 adults with depression from primary care and psychological therapy services in three areas of England were recruited. Participants were randomly assigned to receive either a maximum of 20 sessions of behavioural activation treatment delivered by junior mental health workers participants, or CBT delivered by experienced psychological therapists.
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, said Richards. 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, he said. 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, researchers said.
One year after the start of treatment, behavioural activation was found to be non-inferior (not worse than) CBT, with around two-thirds of participants in both groups reporting at least a 50 per cent reduction in depressive symptoms, researchers said.
The average intervention costs were significantly lower for behavioural activation than CBT, amounting to a 20 per cent financial saving for health care systems, they said.
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