Many people with depression struggle to get treatment for the condition, in part because “talk therapy” can be expensive, and there aren’t enough qualified therapists to deliver it.
But now, a new study suggests that a simple and relatively cheap type of talk therapy may work just as well at treating depression as the current “gold standard” treatment. The findings suggest that using this simpler therapy — called behavioral activation — on a wide scale could improve access to treatment for depression and reduce health care costs, the researchers said.
“Our findings indicate that health services worldwide, both rich and poor, could reduce the need for costly professional training and infrastructure, reduce waiting times, and increase the availability of psychological therapies” by using behavioral activation, said David Richards, a professor of mental health services research at the University of Exeter in the United Kingdom, who led the study. [7 Ways Depression Differs in Men and Women]
Behavioral activation is what’s known as an “outside-in” treatment: It aims to help people with depression change the way they act, Richards said. The premise behind the treatment is that people’s mood and behavior are linked, and that depression can be reduced by increasing engagement in activities that the person finds meaningful. At the same time, people also work to reduce behaviors that may result in isolation or avoidance of certain situations, which can worsen depression.
In contrast, the current gold standard treatment for depression, called cognitive behavioral therapy (CBT) is an “inside-out” treatment that focuses on the way people think, Richards said. Therapists using CBT help people challenge their own thoughts and beliefs, and test out their new thinking, Richards said.
The new study involved 440 adults with depression who were randomly assigned to undergo either behavioral activation treatment or CBT, for 16 weeks. The behavioral activation treatment was delivered by mental health workers who didn’t have formal training in psychological therapies, and CBT was delivered by experienced psychological therapists who were certified to provide the therapy.
One year after the start of the study, participants in the two groups saw similar improvements; about two-thirds of the people in both groups reported at least a 50 percent reduction in their symptoms of depression.
But behavioral activation was cheaper to deliver; the treatment cost $1,277 (975 British pounds) per person, on average, compared to $1,618 (1,235 British pounds) per person for CBT, a 20 percent cost savings.
Because behavioral activation is a less complex treatment, it’s easier to train people to deliver the therapy, which means it’s less expensive.
“It is easier for both patients and health workers to understand the essentially simple message that your mood and your behavior are linked,” Richards told Live Science. In contrast, CBT requires a close examination of thoughts and beliefs, and asks therapists to challenge their patients’ way of thinking. “This is intellectually quite challenging and difficult to train people to do well,” Richards said.
Still, the study does not suggest that behavioral activation (BA) should replace CBT, or that CBT therapists should stop treating their patients, Richards said.
But health systems that have a shortage of psychologists could begin to identify and train health workers in behavioral activation, he said.
And even in areas where there are a lot of therapists trained in CBT, there could still be a benefit to training health care workers in behavioral activation, to increase the choices of care available to patients, Richards said. “We are not arguing for the replacement of CBT by BA, but for some measure of balance, and to challenge the current dominance of CBT in health systems,” Richards said.
Dr. Victor Fornari, director, division of child and adolescent psychiatry, Zucker Hillside Hospital in Glen Oaks, New York, who was not involved in the study, said the findings suggest that behavioral activation should be disseminated in areas where people don’t have access to depression treatment.
“Even though cognitive behavioral therapy is really effective, many people don’t have access, because there aren’t adequate resources in their communities or in their regions,” Fornari said. “Studies like this will stimulate more programs to train clinicians in behavioral activation,” he said.
However, Fornari said he thinks more studies are needed before behavioral activation could be considered a “first-line” treatment to use even when CBT is available. “If both treatments are available, we still need more studies to demonstrate that indeed behavioral activation is equally effective as cognitive behavioral therapy,” Fornari said.