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Improving outcomes via treatment augmentations to behavioural activation for depression in routine practice: a cohort comparison study

Published online by Cambridge University Press:  14 January 2025

Melanie Simmonds-Buckley ,
Stephen Kellett Open the ORCID record for Stephen Kellett [Opens in a new window] ,
Jennie Hague  and
Glenn Waller Open the ORCID record for Glenn Waller [Opens in a new window]
Melanie Simmonds-Buckley
Affiliation:
Rotherham Doncaster and South Humber NHS Foundation Trust, UK University of Sheffield, Sheffield, UK
Stephen Kellett*
Affiliation:
Rotherham Doncaster and South Humber NHS Foundation Trust, UK University of Sheffield, Sheffield, UK
Jennie Hague
Affiliation:
University of Sheffield, Sheffield, UK
Glenn Waller
Affiliation:
University of Sheffield, Sheffield, UK
*
Corresponding author: Stephen Kellett; Email: [email protected]
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Abstract

Whilst behavioural activation (BA) is an empirically supported treatment for depression, some patients do not benefit. The aim of this study was to evaluate the effectiveness of two treatment augmentations to an extant manualized 8-session group version of BA. The two treatment augmentations were (a) dose–response psychoeducation to improve attendance and (b) implementation intentions to improve clinical outcomes. A cohort comparison design in routine practice comparing standard group BA (n=31, drawn from a sample of n=161, from 22 BA groups) with treatment-augmented group BA (n=31 from 3 BA+ groups). There was no effect of the two treatment augmentations on attendance or in overall mean reductions to depression (mean improvement difference=2.2), anxiety (mean improvement difference=1.9) or impaired functioning (mean improvement difference=1.5). Rates of reliable improvement in depression were significantly higher for augmented BA (odds ratio=3.21 for BA+ compared with BA). Efforts should be made to still improve outcomes for empirically supported interventions, with any treatment augmentations tested in well-controlled studies.

Key learning aims

  1. (1) To learn about the utility of adapting existing treatments as opposed to developing new treatments.

  2. (2) To learn about the potential of propensity score matching in the analysis of routinely collected datasets.

  3. (3) To learn about delivery of behavioural activation in groups.

  4. (4) To better understand how to enhance and evaluate treatment protocols using theoretically informed and low-cost treatment augmentations.

Keywords

behavioural activationeffectivenessImproving Access to Psychological Therapies (IAPT) programme
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 18 , 2025 , e3
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2022). Behavioral Activation for Depression, Second Edition; A Clinician’s Guide. Guilford Press.Google Scholar
Kanter, J. W. Busch, A. M., Laura, C., & Rusch, L. C. (2009). Behavioral Activation: Distinctive Features. Routledge.CrossRefGoogle Scholar
Veale, D. (2008). Behavioral activation for depression. Advances in Psychiatric Treatment, 14, 29–36.CrossRefGoogle Scholar

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