Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.

Summary & key facts

This randomized, placebo-controlled trial enrolled 241 adults with major depressive disorder and compared behavioral activation, cognitive therapy, and antidepressant medication. The study found that for patients who started with more severe depression, behavioral activation worked about as well as antidepressant medication, and both of these treatments worked better than cognitive therapy. The trial also tested whether initial depression severity changed which treatment worked best.

Key facts:

• The trial included 241 adults diagnosed with major depressive disorder (N = 241).
• Participants were randomly assigned to one of three treatments: behavioral activation, cognitive therapy, or antidepressant medication, in a placebo-controlled design.
• The researchers examined initial depression severity as a moderator of treatment outcome (they tested whether how severe symptoms were at the start changed which treatment was most effective).
• Among the more severely depressed patients, behavioral activation and antidepressant medication had similar outcomes.
• In that more severe group, both behavioral activation and antidepressant medication significantly outperformed cognitive therapy.

Abstract

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Topics

Mental Health Research Topics Psychotherapy Techniques and Applications Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Alternative medicine Antidepressant Anxiety Behavioral activation Clinical psychology Cognition Cognitive behavioral therapy Cognitive restructuring Cognitive therapy Depression (economics) Economics Internal medicine Macroeconomics Major depressive disorder Medicine Pathology Placebo Psychiatry Psychology Psychosocial Randomized controlled trial

Conditions & symptoms

Anxiety Depression Lack of energy or motivation Sadness or low mood