The Cheaper Solution for Depression
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A simple and inexpensive therapy is equally as effective at treating depression as the "gold standard" of Cognitive behavioral Therapy (CBT), a large-scale study has concluded.
behavioral Activation (BA) is relatively simple, meaning it can be delivered by more junior staff with less training, making it a cost-effective option. It is around 20 per cent cheaper than CBT, meaning it could help ease current difficulties in accessing therapy, and could make it more realistic to deliver for a wider range of countries worldwide. BA encourages people to focus on meaningful activities driven by their own personal values as a way of overcoming depression. The study was published in The Lancet.
Professor David Richards, NIHR Senior Investigator at the University of Exeter Medical School, led the study. He said: “Effectively treating depression at low cost is a global priority. Our finding is the most robust evidence yet that behavioral Activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality. This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies.”
Clinical depression is the second largest cause of disability globally, affecting around 350 million people worldwide. The impact on economic output across the world is projected to be $5.36 trillion between 2011 and 2030. Although CBT is known to be effective, access is often restricted, with long waiting lists. In the U.S., only about a quarter of people with depression have received any type of psychological therapy in the last 12 months. Part of the reason for this is the cost of delivery. The Cost and Outcome of behavioral Activation versus Cognitive behavioral Therapy for Depression (COBRA) trial, one of the largest of its kind in the world, was designed to meet this need.
Behavioral Activation is an ‘outside in’ treatment that focuses on helping people with depression to change the way they act. BA helps people make the link between their behavior and their mood. Therapists help people to seek out and experience more positive situations in their lives. The treatment also helps people reduce the amount of times they avoid difficult situations and helps them find alternatives to unhelpful habitual behaviors.
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.
A year after the start of treatment, BA was found to be non-inferior (not worse than) than CBT, with around two-thirds of participants in both groups reporting at least a 50 percent reduction in depressive symptoms. Participants in both groups also reported similar numbers of depression free days and anxiety diagnoses, and were equally likely to experience remission. Cost of delivery for BA therapy was found to be around 20 percent cheaper than CBT.
In line with other trials of a similar nature, drop-out rates were around 20 percent and around a third of participants in both groups did not attend the minimum number of therapy sessions.
Dr. Peter Aitken, Director of Research and Development at Devon Partnership NHS Trust, said: "Research into psychological therapies and mental health is incredibly important and we are always looking for treatments and approaches that offer people better outcomes and, wherever possible, improved cost efficiency."