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GPs buried under trusts' workload dump

New cheaper therapy could reduce depression referral times

A cheaper therapy option to CBT could reduce referral to treatment waiting times for patients with depression, according to British researchers.

A large study has found that behavioural activation (BA) is as effective at treating depression as cognitive behavioural therapy (CBT), and much more cost-effective.

The therapy option, which helps patients overcome depression by encouraging them to focus on meaningful activities driven by their own personal values, is around 20% cheaper to deliver than CBT because it can be delivered by more junior healthcare staff.

The alternative treatment could save £260 per patient as it costs £975 per participant, compared to £1,235 for CBT.

The study, published in the Lancet, saw treatments given in three mental health trusts around the country (Devon, County Durham and Leeds). Out of a large cohort of 440 patients, around half received CBT and the other half BA, with follow ups at six, 12 and 18 months showing there were no differences between the two groups - both of which showed a 50% reduction in depressive symptoms.

The study concluded: 'We found that BA, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT.

'Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals.'

Study leader Professor David Richards, NIHR senior investigator at the University of Exeter medical school, said the finding was 'the most robust evidence yet that BA 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, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies,' he said.

Readers' comments (3)

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  • Maybe, just maybe the passing of time helped those depressed patients get better. Just maybe.

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  • The problem with a study of this sort is that there are no controls. The patients were split into two groups (219CBT, 221BA), over several sites. There is no control group, so there is no way to know if the practitioners affected the patients in any way (so it could judst be a badly flawed study). Imagining that some might have benefited in each group, they have not been swapped over to the other therapy. The sample sizes may seem large in days of low budgets, but they are in fact small for psychological research if you want any kind of confidence in the conclusion. There are other flaws, not the least the obvious fact that 'good' staff tend to produce positive outcomes regardless of treatment type, whereas 'bad' staff do the reverse - so that often the trial is of staff, not treatment. This is something that dogs research into education practice, for example. But without a largte control group given the same assessments bythe same people, the whole trial is meaningless, a problem that dogs psychological research.
    However, the obvious thought that doing something in which you are interested and which has a positive feel-good factor, as opposed to doing little of interest and trying to follow an enforced therapeutic regime, has occured to people before.

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