Podcast: Behavioural activation therapy for depression in adults

Depression affects vast numbers of people around the world and our collection of relevant reviews was added to in July 2020 with a new review of the effects of a therapy known as behavioural activation. We asked the lead author, Eleonora Uphoff from the Cochrane Common Mental Disorders Group based at the University of York in the UK to tell us about the findings.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Depression affects vast numbers of people around the world and our collection of relevant reviews was added to in July 2020 with a new review of the effects of a therapy known as behavioural activation. We asked the lead author, Eleonora Uphoff from the Cochrane Common Mental Disorders Group based at the University of York in the UK to tell us about the findings.

Eleonora: Behavioural activation is one of the types of psychological therapy that might be used to treat depression, and we set out to assess whether it is an effective and acceptable treatment for depression in adults. 
The therapy has been widely studied in randomised trials, and we were able to include 53 studies  from across 14 different countries, which had tested it against different comparators including other therapies. 
As the starting point, when we pooled the results from more than 1500 patients in 7 trials, we found that behavioural activation may be more effective in treating depression than treatment as usual. It also seems to be more effective than humanistic therapy, but we found no difference in effectiveness between behavioural activation and cognitive behavioural therapy, or CBT, which is a commonly used treatment for depression.
We also found no obvious differences when it was compared to third-wave CBT, psychodynamic therapy or medication, but the evidence was less certain for these comparisons.
The acceptability of behavioural activation to patients, as measured by the number of participants who dropped out of the studies, was similar between behavioural activation and most of the other treatments, but it might be lower than for treatment as usual.
This review may be used to inform decisions about recommending or providing behavioural activation for the treatment of depression in adults, but we are cautious about drawing conclusions because of the strength of the evidence. Alongside our findings, people with depression may wish to consider factors other than treatment efficacy and acceptability, such as the likelihood of side effects, the availability of different treatment formats, and the time commitment required. Future research could contribute to this and we’d also like to see high quality trials conducted in different countries and settings with different groups of people. These would help to show where, and for whom, behavioural activation can be an effective and acceptable treatment.

Monaz: If you’d like to find out more about the findings of this review, and watch for updates if new studies become available, simply go online and search 'behavioural activation for depression in Cochrane' to get a link to the review.

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