COMMENTARY

A Simpler, Less Costly Behavioral Therapy for Depression

Peter M. Yellowlees, MBBS, MD

Disclosures

November 23, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

Depression is a common, debilitating, and expensive disorder for which the best-evidence therapy, cognitive-behavioral therapy (CBT), is complex and costly. Now a team of investigators[1] from the University of Exeter in England have undertaken a noninferiority, randomized controlled study to compare the clinical efficacy and cost-effectiveness of a simpler behavioral activation (BA) approach with CBT in adults with depression. Over a 2-year period, 440 adults (18 years of age or older) meeting criteria for major depressive disorder were recruited from primary care and randomly assigned to BA or CBT (50% of participants in each group). The researchers found that BA delivered by junior mental health workers with less intensive and costly training was noninferior to CBT delivered by psychological therapists as measured on the primary endpoint, the Patient Health Questionnaire 9. They concluded that effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals.

Given that CBT-trained therapists are often not easy to find, and that CBT itself is difficult to deliver, this study has substantial implications for practicing clinicians treating depressed patients. It may be that BA, which in reality is a core component of many CBT programs, is a major factor that makes CBT effective, perhaps more than we have understood previously. Certainly, as a physician who sends many patients off to the gym, yoga, and other fitness and relaxation-related activities, I am going to continue this practice and will be on the lookout for more studies that examine separate components of CBT.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.

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