Behavioral activation ‘as good as’ cognitive behavioral therapy in depression

Written by Alice Weatherston

Cognitive behavioral therapy (CBT) is considered the ‘gold standard’ for treatment of depression. However, recent results from a multicenter study coordinated by researchers at the University of Exeter (UK) have revealed that the comparatively simple and inexpensive psychological therapy option of behavioral activation (BA) may be just as effective for treating patients with depression.

The results were collated as part of the COBRA study, which is one of the largest studies worldwide investigating psychological treatments of depression through randomized controlled trials. In total 440 individuals took part at three sites in the UK with 219 receiving CBT and 221 receiving BA.

BA is a relatively simple therapeutic option in comparison to CBT, concentrating on encouraging individuals to focus on activities guided by their own values as a pathway to dealing with depression. In contrast, CBT concentrates internally, encouraging depression patients to indentify and challenge their thoughts about themselves and the world.

This simplicity means that experts are not necessarily needed in order to deliver the therapy and consequently costs can be reduced by approximately 20% for health services. In addition, this may help to improve patient access to psychological therapies for depression across the world.

Within the trial all participants were followed up and assessed at six, 12 and 18 months following treatment. Importantly, the researchers found no difference between the outcomes of patients receiving BA or CBT, providing some of the clearest evidence for the use of BA as a first-line treatment for depression, to date. Specifically, around two-thirds of patients in both groups reported at least a 50% reduction in depressive symptoms.

Senior investigator, David Richards (University of Exeter), explained the findings: “Effectively treating depression at low cost is a global priority. This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide and offers hope for countries who are currently struggling with the impact of depression on the health of their people and economies.”

Source: University of Exeter press release 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. DOI: