Do behavioural activation for depression work as a low intensity intervention?: Jl Affective Dis:March.2013

04.03.2013

Behavioural Activation  (BA) is a component of CBT for depression. BA attempt to explore how mood is linked to behaviours and supports the patients in a.  re-engaging with potential sources of positive reinforcement b. setting task-focused goals c. in diminishing patterns of negative reinforcement d. reducing avoidance. Avoidance behaviours, withdrawal and inactivity  often result in the disruption of routine and of a healthy lifestyle that generally contribute to mood stability.Increased participation in enjoyable activities boosts levels of positive affect and that could be sufficient to decrease depressive symptoms.

Typical targets or goals for treatment may be  1. help the client re-engage in activities that were previously pleasurable 2.scheduling activities that can provide a sense of accomplishment 3. problem-solving 4.simply re-activating the patient towards a healthy lifestyle and routine.

Does it work well? 

BA as a stand-alone intervention seems to be as effective as other forms of psychotherapy, including full CBT.  Meta-analysis of 16 studies by Cuijpers et al. (2007) concluded that the pooled effect size of behavioural activation was 0.87 when compared with control groups and was statistically equally effective as CBT.Another metaanalysis by same author (2008) revealed that BA was comparable in efficacy for the treatment of mild to moderate depression to other psychotherapies. Meta analysis by Ekers et al. (2008) concluded that BA  was significantly superior to controls, brief psychotherapy, supportive therapy, and equal to CBT.  Mazzucchelli et al. (meta analysis 2009) also showed BA as equally effective as cognitive therapy and CBT, even for as long as 24 months post- intervention.

In treatment of depressive disorders, low intensity interventions ie those that require less therapist contact/time, have a special place given the magnitude of the problem in the population.These can be the only affordable interventions for mild to moderate depression in many countries.Self help approaches and internet based therapies are examples of effective low intensity interventions.BA appears to have the qualities to become another effective low intensity intervention.

Evidence for BA as a low intensity intervention: Authors search resulted in only 3 citations.

Dozeman et al., 2011: Evaluated activity-scheduling as a guided self-help intervention for the prevention of depression and anxiety in 129 elderly participants.They were randomized in either an activity scheduling guided self-help intervention or in a usual care condition.”Activity scheduling’’ module in the intervention group invited  them to monitor their moods and plan pleasurable activities. They were supported by ‘‘coaches’’ who visited them two to five times. 23% of the participants in the guided self-help activity scheduling intervention considered the intervention to be very useful.Reduction in depressive and anxiety symptoms was greater in the self-help intervention.However, only 21% completed the intervention.

Guirguis-Younger et al, (2008):  In this pilot study,participants received this self-help intervention for a duration of 6 weeks, with minimal support (15-min per week) provided by home care nurses. This study suggests that pleasant activities might be the active ingredient responsible for the improvement of depressive symptoms in BA.

Conclusions: There is increasing interest in low intensity interventions. These are promising as they offer greater reach with minimal resources. They are particularly of interest in mild and moderate depression. However, adherence is likely to be less and optimal therapist support is essential for success. There are far few studies  on BA as a low intensity intervention. At the moment the evidence base is weak for  low intensity intervention models of BA  in depression.

Summary of the article:

Behavioural activation for depressionEfficacyeffectiveness and dissemination. Soucy Chartier I, Provencher MD. J Affect Disord. 2013 Mar 5;145(3):292-9.

 

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