Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive–behavioural therapy for depression

Richards, David; Rhodes, Shelley; Ekers, David; McMillan, Dean; Taylor, Rod S; Byford, Sarah; Barrett, Barbara; Finning, Katie; Ganguli, Poushali; Warren, Fiona C; Farrand, Paul; Gilbody, Simon; Kuyken, Willem; O’Mahen, Heather; Watkins, Ed; Wright, Kim; Reed, Nigel; Fletcher, Emily; Hollon, Steven D.; Moore, Lucy; Backhouse, Amy; Farrow, Claire; Garry, Julie; Kemp, Deborah; Plummer, Faye; Warner, Faith; Woodhouse, Rebecca

doi:10.3310/hta21460

Cited by 36 publications

(44 citation statements)

References 89 publications

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“…This is unlikely to reflect a true difference in the mechanisms of change underlying the two treatments given that our parallel quantitative process evaluation did not detect such differences. 34 Rather, it is likely that participants were primed to talk about specific strategies by their experiences of therapy and the change strategies described by their therapist. We suggest that to further facilitate the delivery of BA by junior MHWs, their training should focus on the specific factors underpinning BA and on the importance of the therapeutic relationship, facilitating patients’ opportunities to learn, preparing patients for homework, problem-solving difficulties in therapy and finally how to present a more confident therapeutic demeanour to provide patients with greater reassurance in worker expertise.…”

Section: Discussionmentioning

confidence: 99%

Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation

et al. 2017

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ObjectiveTo explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists.DesignSemistructured qualitative interviews analysed using a framework approach.Participants36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial).SettingPrimary care psychological therapies services in Devon, Durham and Leeds, UK.ResultsElements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential.ConclusionsDespite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants’ lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision.Trial registration numberISRCTN27473954, 09/12/2011

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Section: Discussionmentioning

confidence: 99%

Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation

et al. 2017

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“…Concerning the perspective, 22 of the studies (42%) applied the societal perspective [ 30 , 38 , 40 – 43 , 45 , 48 , 49 , 53 – 57 , 59 , 63 , 66 , 67 , 69 , 71 – 73 , 76 ]. Eighteen studies conducted an evaluation considering both positions [ 26 – 29 , 31 , 32 , 34 , 37 , 39 , 50 , 51 , 58 , 62 , 64 , 65 , 74 , 75 , 77 ] and 12 focused on the healthcare perspective and calculated societal costs separately [ 33 , 35 , 36 , 44 , 46 , 47 , 52 , 60 , 61 , 65 , 70 , 78 ]. One study did not explain which perspective was used [ 68 ].…”

Section: Resultsmentioning

confidence: 99%

“…In 16 studies, both aspects of societal costs were included [ 29 – 33 , 35 , 44 , 49 – 51 , 58 , 68 , 71 – 73 , 76 ]. The other studies used either productivity losses [ 26 , 27 , 34 , 36 – 43 , 45 – 48 , 52 – 57 , 59 , 61 , 63 – 67 , 69 , 70 , 74 , 75 , 77 , 78 ] or costs of informal care only [ 28 , 60 , 62 ]. The approach to estimate societal costs was not always explicitly depicted.…”

Section: Resultsmentioning

confidence: 99%

Considering the societal perspective in economic evaluations: a systematic review in the case of depression

et al. 2020

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Background Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. Methods A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008–2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. Results Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. Conclusions Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.

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“…This notably included adapting the inactivity cycle of depression, to the broader "vicious cycle" which incorporates processes maintaining a spectrum of emotional distress behaviors (including anger and anxiety). Behavior activation is considered to be an effective and cost-effective technique suitable for wide-scale dissemination by non-specialists (38). However, while the strategy is commonly used to address inactivity associated with depressed mood, it has been previously noted that expanding the focus away from depressed mood and toward encompassing a broader concept of maladaptive behavior patterns interfering with valued activities, may reduce the impact of stigma related to depression, and increase cross-cultural applicability and relevance (39).…”

Section: Discussionmentioning

confidence: 99%

The Cultural and Contextual Adaptation Process of an Intervention to Reduce Psychological Distress in Young Adolescents Living in Lebanon

et al. 2020

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Armed conflict leads to increased risk of emotional distress among children and adolescents, and increased exposure to significant daily stressors such as poverty and community and family violence. Unfortunately, these increased risks usually occur in the context of largely unavailable mental health services. There is growing empirical support that evidence-based treatment techniques can be adapted and delivered by nonspecialists with high fidelity and effectiveness. However, in order to improve feasibility, applicability, and outcomes, appropriate cultural and contextual adaptation is essential when delivering in different settings and cultures. This paper reports the adaptation process conducted on a new World Health Organization psychological intervention-Early Adolescent Skills for Emotions (EASE)-for use in the north of Lebanon. Lebanon is a middle-income country that hosts the largest number of refugees per capita globally. We conducted: i) a scoping review of literature on mental health in Lebanon, with a focus on Syrian refugees; ii) a rapid qualitative assessment with adolescents, caregivers, community members, and health professionals; iii) cognitive interviews regarding the applicability of EASE materials; iv) a psychologist review to reach optimal and consistent Arabic translation of key terms; v) "mock sessions" of the intervention with field staff and clinical psychology experts; vi) gathering feedback from the Training of Trainers workshop, and subsequent implementation of practice sessions; and vii) gathering feedback from the Training of Facilitators workshop, and subsequent implementation of practice sessions.

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Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive–behavioural therapy for depression

Cited by 36 publications

References 89 publications

Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation

Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation

Considering the societal perspective in economic evaluations: a systematic review in the case of depression

The Cultural and Contextual Adaptation Process of an Intervention to Reduce Psychological Distress in Young Adolescents Living in Lebanon

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