By Dr. Minal Mistry, Psychiatrist
“Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease” (World Health Organization Fact Sheet, updated April 2016).
Depression affects 350 million people worldwide. Treatment involves a biopsychosocial approach, which means that psychological and social measures should be used as well as medication. Antidepressants are effective but not in all patients. With the recent controversies about whether antidepressants do more harm than good, psychological therapy is becoming popular. We have all heard about Cognitive Behavioural Therapy (CBT), but let’s look at an alternative: Behavioural Activation (BA) – the forgotten therapy of our time.
What is BA?
“You'll never plough a field by turning it over in your mind” (Irish proverb)
The first behavioural treatment for depression was developed 40 years ago by Peter Lewinsohn (1976) who recommended that patients increase the number of activities and social interactions. BA therapy evolved from that. Rather than focusing on your cognition (internal factors), BA looks at your depression with respect to context (environmental factors).
BA involves understanding how your mood is affected by your behaviour. In other words, the more we do with physical and social activities, the better we feel. BA is a component of CBT. However, BA by itself is much simpler with less emphasis on what you are thinking when depressed, and more on what you are doing, e.g. activity scheduling, to lift you out of your depression.
Is BA making a resurgence?
COBRA - Cost and Outcome of BehaviouRal Activation (LATEST RESEARCH, JULY 2016)
Back in 2006, a North American Randomized Controlled Trial, by Sona Dimidjian and colleagues, published in the Journal of Consulting and Clinical Psychology, showed that in severe depression BA was as good as Paroxetine (an antidepressant) and more effective than cognitive therapy. This challenged the assumption that directly changing our thoughts, or even taking medication, was essential to treating moderate to severe depression.
Turn the clock forward 10 years and British researcher Prof. David Richards and colleagues have published, in The Lancet in July 2016, a ground-breaking randomized controlled trial (the gold standard research method) called the “COBRA” trial. This showed that two thirds of patients improved in both BA and CBT groups after one year. More significantly, it showed that BA was more cost-effective than CBT.
3 Reasons why BA is recommended as first-line treatment for Depression
“I have a bee in my bonnet” – about the B in CBT: Behavioural Activation
Should BA be the first treatment for depression? Perhaps now is the time to ACT to help your depression with BA because it is:
Cite this article as:
Minal Mistry (2016) Behavioural Activation(BA): The Forgotten therapy in the treatment of depression. The Beautiful Space-A Journal of Mind, Art and Poetry. August 2016: TBSB102
Below is an introduction to how BA can help your depression:
And here comes the science bit … links to the research papers discussed:
Please check author names highlighted with each article.
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