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Effectiveness of Group Behavioural Activation for Depression: A Pilot Study

Published online by Cambridge University Press:  13 March 2017

Stephen Kellett ,
Mel Simmonds-Buckley ,
Paul Bliss  and
Glenn Waller
Stephen Kellett*
Affiliation:
Centre for Psychological Services Research, University of Sheffield, UK and Sheffield Health and Social Care NHS Foundation Trust, UK
Mel Simmonds-Buckley
Affiliation:
University of Sheffield, UK
Paul Bliss
Affiliation:
University of Sheffield, UK
Glenn Waller
Affiliation:
University of Sheffield, UK
*
Correspondence to Stephen Kellett, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK. E-mail: [email protected]
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Abstract

Background: The evidence base for behavioural activation (BA) is mainly grounded in the individual delivery method, with much less known about the impact of group delivery. Aims: To conduct a pilot study of behavioural activation in groups (BAG) for depression delivered in a routine service setting, in order to explore acceptability, effectiveness and predictors of outcome. Methods: The manualized group treatment format was delivered in a Primary Care mental health setting, at step three of an Improving Access to Psychological Therapies (IAPT) service. BAG was facilitated by cognitive behavioural psychotherapists, and outcome measures (depression, anxiety and functional impairment) were taken at each session. Seventy-three participants were referred and treated within nine groups. Results: BAG was an acceptable treatment generating a low drop-out rate (7%). Significant pre–post differences were found across all measures. There was a moderate to large depression effect size (d+ = 0.74), and 20% met the criteria for a reliable recovery in depression. Greater severity of initial depression and attendance of at least four BAG sessions predicted better outcomes. Conclusions: BAG appears to be an effective depression treatment option that shows some clinical promise. Further larger and more controlled studies are nevertheless required.

Keywords

depressionbehavioural activationgroup therapypilotclinical effectivenessIAPT
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 4 , July 2017 , pp. 401 - 418
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Addis, M. E. and Martell, C. M. (2004). Overcoming Depression One Step at a Time. Oakland, Harbinger Publications.Google Scholar
Ahern, K. and Le Brocque, R. (2005). Methodological issues in the effects of attrition: Simple solutions for social scientists. Field Methods, 17, 53–69.Google Scholar
Alfonsson, S., Parling, T. and Ghaderi, A. (2015). Group behavioral activation for patients with severe obesity and binge eating disorder: A randomized controlled trial. Behavior Modification, 39, 270–294. doi:10.1177/0145445514553093 Google Scholar
American Psychiatric Association (2000). Diagnostic and statisitcal manual of mental disorders (4th edn, text revision). Washington, DC.Google Scholar
Cahill, J., Barkham, M., Hardy, G., Rees, A., Shapiro, D. A., Stiles, W. B. and Macaskill, N. (2003). Outcomes of patients completing and not completing cognitive therapy for depression. British Journal of Clinical Psychology, 42, 133–143. doi:10.1348/014466503321903553 Google Scholar
Chan, S. W. Y. and Adams, M. (2014). Service use, drop-out rate and clinical outcomes: A comparison between high and low intensity treatments in an IAPT service. Behavioural and Cognitive Psychotherapy, 42, 747–759. doi:10.1017/s1352465813000544 Google Scholar
Chu, B. C., Colognori, D., Weissman, A. S. and Bannon, K. (2009). An initial description and pilot of group behavioral activation therapy for anxious and depressed youth. Cognitive and Behavioral Practice, 16, 408–419.Google Scholar
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23, 318–327. doi:10.3109/09540261.2011.606803 Google Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi:10.1037/0033-2909.112.1.155 Google Scholar
Cuijpers, P., van Straten, A. and Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27, 318–326. doi:10.1016/j.cpr.2006.11.001 Google Scholar
Cuijpers, P., van Straten, A. and Warmerdam, L. (2008). Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis. European Journal of Psychiatry, 22, 38–51.Google Scholar
Curran, J., Ekers, D., McMillan, D. and Houghton, S. (2012). Behavioural activation. In Dryden, W. (ed), Cognitive Behaviour Therapies (pp. 236–260). London, UK: Sage Publications.Google Scholar
Daughters, S. B., Braun, A. R., Sargeant, M. N., Reynolds, E. K., Hopko, D. R., Blanco, C. and Lejuez, C. W. (2008). Effectiveness of a brief behavioral treatment for inner-city illicit drug users with elevated depressive symptoms: The Life Enhancement Treatment for Substance Use (LETS Act!). Journal of Clinical Psychiatry, 69, 122–129.Google Scholar
Delgadillo, J., Kellett, S., Ali, S., McMillan, D., Barkham, M., Saxon, D. et al. (2016). A multi-service practice research network study of large group psychoeducational cognitive behavioural therapy. Behaviour Research and Therapy, 87, 155–161. Available at: http://dx.doi.org/10.1016/j.brat.2016.09.010 Google Scholar
Dimidjian, S. and Davis, K. J. (2009). Newer variations of cognitive behavioral therapy: Behavioral activation and mindfulness-based cognitive therapy. Current Psychiatry Reports, 11, 453–458.Google Scholar
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., Atkins, D. C., Dunner, D. L. and Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.Google Scholar
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D. and Gilbody, S. (2014). Behavioural activation for depression; An update of meta-analysis of effectiveness and sub group analysis. Plos One, 9, 11. doi:10.1371/journal.pone.0100100 Google Scholar
Firth, N., Barkham, M., Kellett, S. and Saxon, D. (2015). Therapist effects and moderators of effectiveness and efficiency in psychological wellbeing practitioners: A multilevel modelling analysis. Behaviour Research and Therapy, 69, 54–62. doi:10.1016/j.brat.2015.04.001 CrossRefGoogle ScholarPubMed
Gilbody, S., Richards, D., Brealey, S. and Hewitt, C. (2007). Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): A diagnostic meta-analysis. Journal of General Internal Medicine, 22, 1596–1602.Google Scholar
Green, H., Barkham, M., Kellett, S. and Saxon, D. (2014). Therapist effects and IAPT Psychological Wellbeing Practitioners (PWPs): A multilevel modelling and mixed methods analysis. Behaviour Research and Therapy, 63, 43–54. doi:10.1016/j.brat.2014.08.009 Google Scholar
Hedges, L. and Olkin, I. (1985). Statistical Methods for Meta-Analysis. New York, NY: Academic Press.Google Scholar
Hopko, D. R., Lejuez, C. W., LePage, J. P., Hopko, S. D. and McNeil, D. W. (2003). A brief behavioral activation treatment for depression – a randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification, 27, 458–469. doi:10.1177/0145445503255489 Google Scholar
Houghton, S., Curran, J. and Saxon, D. (2008). An uncontrolled evaluation of group behavioural activation for depression. Behavioural and Cognitive Psychotherapy, 36, 235–239. doi:10.1017/s1352465808004207 Google Scholar
Howard, L. and Thornicroft, G. (2006). Patient preference randomised controlled trials in mental health research. British Journal of Psychiatry, 188, 303–304. doi:10.1192/bjp.188.4.303 Google Scholar
Huntley, A. L., Araya, R. and Salisbury, C. (2012). Group psychological therapies for depression in the community: Systematic review and meta-analysis. British Journal of Psychiatry, 200, 184–190. doi:10.1192/bjp.bp.111.092049 Google Scholar
Improving Access to Psychological Therapies (IAPT) (2014). Measuring improvement and recovery. Available at: http://webarchive.nationalarchives.gov.uk/20160302154833/http://www.iapt.nhs.uk/silo/files/measuring-recovery-2014.pdf Google Scholar
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E. and Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64, 295–304. doi:10.1037//0022-006x.64.2.295 CrossRefGoogle ScholarPubMed
Jacobson, N. S. and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. doi:10.1037//0022-006x.59.1.12 Google Scholar
Kellett, S., Clarke, S. and Matthews, L. (2007). Delivering group psychoeducational CBT in Primary Care: Comparing outcomes with individual CBT and individual psychodynamic-interpersonal psychotherapy. British Journal of Clinical Psychology, 46, 211–222. doi:10.1348/014466506x146188 Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9 – validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi:10.1046/j.1525-1497.2001.016009606.x Google Scholar
Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53–70.Google Scholar
Löwe, B., Spitzer, R. L., Williams, J. B., Mussell, M., Schellberg, D. and Kroenke, K. (2008). Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. General Hospital Psychiatry, 30, 191–199.Google Scholar
Martell, C. R., Addis, M. E. and Jacobson, N. S. (2001). Depression in Context: Strategies for Guided Action. New York, NY: W.W. Norton & Company Inc.Google Scholar
Mazzucchelli, T., Kane, R. and Rees, C. (2009). Behavioral activation treatments for depression in adults: A meta-analysis and review. Clinical Psychology: Science and Practice, 16, 383–411.Google Scholar
Mohr, D. C. (1995). Negative outcome in psychotherapy: A critical review. Clinical Psychology: Science and Practice, 2, 1–27.Google Scholar
Morris, S. B. and DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 105–125.Google Scholar
Mundt, J. C., Marks, I. M., Shear, M. K. and Greist, J. H. (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464. doi:10.1192/bjp.180.5.461 Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2009). Depression: The Treatment and Management of Depression in Adults (update). Clinical Guideline 90. London. Available at: www.nice.org.uk/CG90.Google Scholar
North East Public Health Observatory (NEPHO). (2010). Improving Access to Psychological Therapies: a review of the progress by the sites in the first roll-out year. Stockton on Tees, UK: NEPHO.Google Scholar
Oldham, M., Kellett, S., Miles, E. and Sheeran, P. (2012). Interventions to increase attendance at psychotherapy: A meta-analysis of randomised controlled trials. Journal of Consulting and Clinical Psychology, 80, 928–939.Google Scholar
Porter, J. F., Spates, C. R. and Smitham, S. (2004). Behavioral activation group therapy in public mental health settings: A pilot investigation. Professional Psychology: Research and Practice, 35, 297–301. doi:10.1037/0735-7028.35.3.297 Google Scholar
Richards, D. A. and Borglin, G. (2011). Implementation of psychological therapies for anxiety and depression in routine practice: Two year prospective cohort study. Journal of Affective Disorders, 133, 51–60. doi:10.1016/j.jad.2011.03.024 Google Scholar
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., Barrett, B., Farrand, P. A., Gilbody, S., Kuyken, W., O'Mahen, H., Watkins, E. R., Wright, K. A., Hollon, S. D., Reed, N., Rhodes, S., Fletcher, E. and Finning, K. (2016). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): A randomised, controlled, non-inferiority trial. The Lancet, 388, 871–880. doi:10.1016/S0140-6736(16)31140-0 Google Scholar
Ross, J., Kaye, S., Mills, K., Dore, G., Lejuez, C., Deady, M. and Ewer, P. (2012). Group behavioural activation therapy for the treatment of depression among opioid replacement therapy clients: A pilot study. Drug and Alcohol Review, 31, 20–20. doi:10.1111/j.1465-3362.2012.00514.x Google Scholar
Salkovskis, P. M. (1995). Demonstrating specific effects in cognitive and behavioural therapy. In Aveline, M. and Shapiro, D. A. (eds), Research Foundations for Psychotherapy Practice (pp. 191–228). Chichester, UK: Wiley.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. W. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder – The GAD-7. Archives of Internal Medicine, 166, 1092–1097. doi:10.1001/archinte.166.10.1092 Google Scholar
Strupp, H. H., Hadley, S. W. and Gomes-Schwartz, B. (1977). Psychotherapy for Better or Worse: The Problem of Negative Effects. New York, NY: Aronson.Google Scholar
Sturmey, P. (2009). Behavioral activation is an evidence-based treatment for depression. Behavior Modification, 33, 818–829. doi:10.1177/0145445509350094 CrossRefGoogle ScholarPubMed
Swinson, R. P. (2006). The GAD-7 scale was accurate for diagnosing generalised anxiety disorder. Evidence-Based Medicine, 11, 184–184. doi:10.1136/ebm.11.6.184 Google Scholar
Tourangeau, R. and Yan, T. (2007). Sensitive questions in surveys. Psychological Bulletin, 133, 859–883.Google Scholar
Wampold, B. E. (2015). Routine outcome monitoring: Coming of age – with the unsual developmental challenges. Psychotherapy, 52, 458–462. doi:10.1037/pst0000037 Google Scholar
Wright, T. (2002). The effectiveness of behavioral activation group therapy: Treating comorbid depression on a specialized inpatient post-traumatic stress disorder unit for combat veterans. Dissertation Abstracts International, 64, 436B (UMI no. 3077387).Google Scholar
Yalom, I. D. and Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy (5th edn). New York, NY: Basic Books.Google Scholar
Zbozinek, T. D., Rose, R. D., Wolitzky-Taylor, K. B., Sherbourne, C., Sullivan, G., Stein, M. B., Roy-Byrne, P. P. and Craske, M. G. (2012). Diagnostic overlap of generalized anxiety disorder and major depressive disorder in a primary care sample. Depression and Anxiety, 29, 1065–1071.Google Scholar
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