Behavioral activation versus treatment as usual in naturalistic sample of psychiatric patients with depressive symptoms: a benchmark controlled trial

Abstract

BackgroundMore systematic use of evidence-based brief therapies is needed in the treatment of depression within psychiatric care. The aim of this study was to explore the impact of behavioral activation therapy (BA) for patients with depressive symptoms in a routine clinical setting of secondary psychiatric care.MethodsThe BA-treated intervention group (n = 242) comprised patients with depressive symptoms (Beck Depression Inventory (BDI) score ≥ 17 at baseline). The control group (n = 205) patients received treatment as usual in the same catchment area. The groups were matched at baseline using BDI and Alcohol Use Disorders Identification Test scores and inpatient/outpatient status. The groups were compared at 6-, 12- and 24-month follow-up points on functional outcome (Global Assessment of Functioning scale), service use, dropout and deaths. The Montgomery–Åsberg Depression Rating Scale was used to assess depressive symptoms in the intervention group.ResultsThe estimated difference in GAF score between intervention and control group patients was significant at 12- and 24-months follow-up points in favor of intervention group (GAF score difference 4.85 points, p = 0.006 and 5.71 points, p = 0.005, respectively; estimate for patient group 2.26, p = 0.036). The rates of dropout, mortality and service use were similar between the groups. Among the intervention group patients, the estimated improvement in MADRS score compared to baseline was statistically significant throughout the follow-up (p < 0.001 at all follow-up points).ConclusionsThe systematic use of BA among secondary psychiatric care depressive patients provides encouraging results despite the patients had various comorbid non-psychotic disorders.Trial registrationClinicalTrials.gov, Identifier NCT02520271, Release Date: 06/27/2015, retrospectively registered.

What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme

“…However, the clinical effectiveness study ODS recently showed that BA were beneficial in comparison with treatment-as-usual in regard to patient outcomes (33). It is also appropriate to note that there are several other factors, many of them complex or multidimensional, which are influential in implementation programmes but not controlled for in the present study.…”

Activity and subsequent depression levels: a causal analysis of behavioural activation group treatment with weekly assessments over 8 weeks

“…The method has been designated an empirically validated treatment (e.g., NICE, ), and several meta‐analyses have demonstrated BA to be an effective treatment for depression (e.g., Cuijpers, Karyotaki, de Wit, & Ebert, ; Ekers et al, ). BA is easy to administer (see Richards et al, ) and efficacious within many diverse patient populations (e.g., Alexopoulos et al, ; Folke et al, ; Luoto et al, ; Ryba, Lejuez, & Hopko, ; Xie et al, ) in individual as well as in group treatment formats (Ekers et al, ). Given its parsimonious and straightforward rationale, BA is considered highly suitable for large scale dissemination (see Richards et al, ).…”

Importance of internal consistency in implementation programmes. A qualitative study of focus-group interviews.

“…A quantitative evaluation of the ODS-I showed that a third of the target group of the programme were active adopters of MI and BA (20). The ODS was intended to study the effectiveness of MI and BA in a naturalistic setting and the results were positive (21).…”