Scheduling fun activities ‘just as effective as CBT’ for depression

New research claims that behavioural activation therapy — in which patients are encouraged to take part in scheduled activities — is as effective against depression as cognitive behavioural therapy (CBT).

Both are ‘talking therapies’. CBT is based on altering negative thought and behavioural patterns and requires an experienced therapist.

Behavioural activation therapy aims to stop patients becoming isolated and withdrawn by encouraging them to do activities they enjoy — anything from exercising or going out to dinner to learning new skills. It also encourages work-related goals and the re-setting of a good eating and sleeping routine.

Because it is more simple than CBT, it can be delivered by junior members of staff. The therapy is 20 per cent cheaper for the NHS, according to the study at the University of Exeter.

CBT therapists can earn over £40,000, while a behavioural activation therapist earns just £22,000. An average session is £260 cheaper per patient.

During the study, 440 patients with depression were given either CBT or behavioural activation therapy. After six months the researchers found no difference between the two groups. After one year, two thirds of participants reported a 50 per cent reduction in depressive symptoms.

The study’s lead author, Professor David Richards, said: ‘Effectively treating depression at a low cost is a global priority.

‘Our finding is the most robust evidence yet that behavioural activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality.

‘This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy worldwide.’

‘It offers hope for countries that are currently struggling with the impact of depression on the health of their peoples and economies.’

Instant analysis
No one these days is unhappy, but many people are depressed, at least if the scientific literature is to be believed (which it isn’t). The result is that in some western countries, one in seven adults is taking anti-depressants, mostly with doubtful benefit. More recently, cognitive behaviour therapy (CBT) has been seen as the panacea, the sovereign way to make everyone feel good.

A paper in the Lancet compares CBT for people complaining of depression with a simpler, less expensive technique called behavioural activation. This involves encouraging depressed people to undertake enjoyable or other activities that they avoid because they are depressed. The trial was not double-blind: neither the researchers nor the patients could be unaware of which treatment they received. The results nevertheless showed that there was little difference between them: about two thirds of people felt better 12 months later.

My own view, which is heretical, is that this paper demonstrates that most unhappiness called depression is not an illness.
TD
Research score: 3/5