Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial
This large British trial compared two psychological treatments for depression, with a question about cost as much as efficacy. Cognitive behavioural therapy is the best-evidenced treatment and requires expensively trained therapists. Behavioural activation is much simpler: it works by getting people to re-engage with activity rather than by examining thinking, and can be delivered by junior mental health workers. Adults meeting diagnostic criteria for major depression were randomly assigned to one or the other and followed for a year, with outcome assessors kept unaware of which treatment each person had received. The trial was designed to test whether the simpler treatment was not meaningfully worse, and that is what it found, at substantially lower cost. The implication is about access rather than about which therapy is better: a treatment that works when delivered by less specialised staff can reach far more people. A well-designed trial published in a leading medical journal.
This large British trial compared two psychological treatments for depression, with a question about cost as much as efficacy. Cognitive behavioural therapy is the best-evidenced treatment and requires expensively trained therapists. Behavioural activation is much simpler: it works by getting people to re-engage with activity rather than by examining thinking, and can be delivered by junior mental health workers. Adults meeting diagnostic criteria for major depression were randomly assigned to one or the other and followed for a year, with outcome assessors kept unaware of which treatment each person had received. The trial was designed to test whether the simpler treatment was not meaningfully worse, and that is what it found, at substantially lower cost. The implication is about access rather than about which therapy is better: a treatment that works when delivered by less specialised staff can reach far more people. A well-designed trial published in a leading medical journal.
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440 adults, 221 to behavioural activation and 219 to CBT; non-inferior at 12 months, both groups at a mean PHQ-9 of 8.4, with lower delivery cost for behavioural activation.
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The source
https://doi.org/10.1016/S0140-6736(16)31140-031140-0)
DOI: 10.1016/S0140-6736(16)31140-0