Behavioural Activation (BA) encourages people to focus on meaningful activities driven by their own personal values as a way of overcoming depression. In contrast, CBT is an ‘inside out’ treatment where therapists focus on the way a person thinks.
BA can be delivered by more junior staff with less training, making it a cost-effective option. It is around 20% cheaper than CBT, meaning it could help ease current difficulties in accessing therapy, and could make it more realistic to deliver for countries worldwide.
The COBRA trial recruited one third of its participants in Yorkshire and was led by Dr Dean McMillan and Professor Simon Gilbody from the York Mental Health and Addictions Research Group (MHARG) at the University of York.
Dr McMillan said: “Depression is a very common and debilitating condition and we were pleased to be able to offer people from Yorkshire the opportunity to take part in this ground-breaking study.”
The wider COBRA study, led by the University of Exeter, is one of the largest in the world to assess psychological treatments of depression through a randomised controlled trial, by comparing different treatments between groups.
Professor Simon Gilbody, Director of the University of York’s MHARG, said: “This trial has the potential to change practice and could ensure that psychological therapy is more widely available, even within the financial constraints faced by the NHS.”
Clinical depression is the second largest cause of disability globally, affecting around 350 million people worldwide. The impact on economic output across the world is projected to be $5.36 trillion between 2011 and 2030. Although CBT is known to be effective, access is often restricted, with long waiting lists.
Until now, the UK’s National Institute for Health and Clinical Excellence (NICE), has said there is insufficient evidence to recommend behavioural activation as a first-line treatment in clinical guidelines, and has called for more robust research to investigate the benefits. The COBRA trial, one of the largest of its kind in the world, was designed to meet this need.
‘Cost and Outcome of Behavioural Activation versus Cognitive Behaviour Therapy for Depression (COBRA): results of a non-inferiority randomised controlled trial’ is published in The Lancet