Behavioural activation delivered by the non-specialist: phase II randomised controlled trial

Background Behavioural activation appears as effective as cognitive-behaviour therapy (CBT) in the treatment of depression. If equally effective, then behavioural activation may be the preferred treatment option because it may be suitable for delivery by therapists with less training. This is the first randomised controlled trial to look at this possibility. Aims To examine whether generic mental health workers can deliver effective behavioural activation as a step-three high-intensity intervention. Method A randomised controlled trial (ISRCTN27045243) comparing behavioural activation (n = 24) with treatment as usual (n = 23) in primary care. Results Intention-to-treat analyses indicated a difference in favour of behavioural activation of -15.79 (95% Cl -24.55 to -7.02) on the Beck Depression Inventory-II and Work and Social Adjustment Scale (mean difference -11.12, 95% Cl -17.53 to -4.70). Conclusions Effective behavioural activation appears suitable for delivery by generic mental health professionals without previous experience as therapists. Large-scale trial comparisons with an active comparator (CBT) are needed.