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Behave yourself

By Timothy Cocks Science and the world 02 Aug 2016

Interesting Explainer in The Conversation today

Explainer: what is behavioural activation for depressions?

A recent study from the United Kingdom found a simple form of therapy called behavioural activation (BA) is as effective in treating depression as more complex psychological treatments and even medication.

The aim of BA is to reverse the cycle of depression by increasing engagement in valued activities, which increases our chances of deriving pleasure and a sense of achievement from life. BA has been used for decades as a stand-alone treatment for depression, or as the “behavioural” component of cognitive behaviour therapy (CBT).

The cognitive component of CBT teaches skills for challenging negative thoughts that worsen depressed mood. University of Exeter mental health researcher Professor David Richards‘ finding that BA was as effective at treating depression as CBT means it may be unnecessary to directly challenge negative thinking. Modifying behaviour may be enough to improve our outlook on life.

The recent study is an open access paper from The Lancet Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trialThe authors’ interpretation is quite striking:

We found that BA [Behavioural Activation], a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals.

This might ruffle some feathers amongst the CBT community.

It is not inconceivable (to me at least) that at some point a study may be published suggesting something similar in the domain of pain…. “we found that X, a simpler treatment than (extensive, manipulative, specialised) physiotherapy/occupational therapy/exercise therapy (etc etc) can be delivered by junior allied health workers with less intensive and costly training, with no lesser effect than PT/OT/ET. Effective treatment for pain can be delivered without the need for costly and highly trained professionals.Would certainly ruffle some more feathers. Maybe I’m just dreaming.

-Tim Cocks


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  1. Michael Sullivan at Magill University has long championed the idea that the initial focus on guided and graded behavioral change (Progressive Goal Attainment Program, PGAP) can be more effective in treating a number of problems (pain, depression, addiction, etc.) than an initial focus on a change in mind state (CBT). He has produced a remarkable amount of really good research to back up his concept. This work sounds similar to his. Given that CBT has been shown to have positive effects, I wonder if there might be personality or individual behavioral differences that might favor one approach over another in a given cohort of patients. Could one patient group be better reached by focusing on activity/behavior and another patient group be best reached by first focusing on the mind state? That could be valuable finding.

  2. This is great to hear! This is the very heart of what we do as Occupational Therapists. We have long believed in the healing power of participating/engaging in valued activities, whether it be simply engaging in the daily practice of taking a shower or resuming a beloved sport. I have a client currently who has been held captive by intense fear of vehicles since she was involved in an MVA last year. She has barely left her house, has lost valued relationships, and finds that she can think of nothing but the accident. When I started working with her, we began introducing activity with just a tiny garden directly outside her front door (so she would not have to go far from her home). She found this one activity incredibly engaging and motivating. She was confounded because at first, she did not believe that this one activity could help her depression. Now, she is going to the gym several days a week and plans one easy outing with friends per week. She’s astounded at how much better she feels and how many fewer hours she spends worrying. I am not saying this just to toot my own horn as an OT, but because I truly believe in the value of simply getting active in meaningful ways!

    I also think it would be wonderful to come across a similar finding for pain! I believe it is Greg Lehman who argues for simplicity when it comes to pain management. Maybe general exercise is a fine option for pain management over complicated, specific exercises? I need to delve further into Mr. Lehman’s work, but so far, I like his idea that simple may be better.

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