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Simple therapy could be just as effective as CBT

NHS could save 20% with easier therapy approach

Adrian O'Dowd

Monday, 25 July 2016

The simpler and cheaper psychotherapy or talking therapy known as behavioural activation (BA) appears to be just as effective at treating depression in adults as the much more commonly used approach of cognitive behavioural therapy (CBT), suggests research* published at the weekend in The Lancet.

GP leaders have welcomed the study saying its findings could help GPs to deliver better care for patients with mental health problems as long it is properly evaluated.

Depression affects around 350 million people worldwide and currently, there are long waiting lists and limited access to services, meaning that some people who need CBT for depression cannot get treatment.

Currently, talking therapies like CBT are delivered by specialist clinicians and therapists who are expensive to train and employ and NICE has said that there is insufficient evidence to recommend behavioural activation (BA) as a first-line treatment.

BA therapy encourages positive activities, such as exercise, being outdoors and re-engaging with the world, while stopping negative behaviours such as staying in bed all day.

UK researchers carried out the Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA) trial studying 440 adults with depression from primary care and psychological therapy services in three areas of England.

Around half (221) of the participants received a maximum of 20 sessions of BA treatment delivered by junior mental health workers – graduates without professional mental health qualifications or formal training in psychological therapies – who received just five days training in BA and one hour of clinical supervision every fortnight.

The other group of 219 participants received CBT delivered by experienced psychological therapists.

One year after the start of treatment, BA 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.

Participants in both groups also reported similar numbers of depression free days and anxiety diagnoses, and were equally likely to experience remission.

The researchers also found that the average intervention costs were significantly lower for BA than CBT – £975 compared with £1,235 per person respectively. This amounted to a 20% financial saving for health care systems.

Additionally, cost-effectiveness analysis showed that BA was highly cost-effective and affordable compared with CBT, mainly due to the low cost of non-specialist mental health providers.

David Richards, lead author and professor of mental health services research at the University of Exeter, said: “Our findings challenge the dominance of CBT as the leading evidence-based psychological therapy for depression.

“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.”

Dr Liz England, clinical lead for mental health for the RCGP, said: “Given that, as this study suggests, BA is more cost-effective, it is definitely something we should explore commissioning further, especially at a time when the health service is facing such intense financial pressure.

“Greater access to BA, along with the other measures to support GPs deliver the best possible care to patients with mental health problems, outlined in NHS England’s GP Forward View, could go a long way to achieving the parity of esteem between mental and physical health that the college is striving for.”

* Richards DA, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. The Lancet, published online: 22 July 2016. DOI: 10.1016/S0140-6736(16)31140-0

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