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Depressed? Do what you like

Depression is a mood disorder that severely impairs functioning. It turns out that treatments focused on changing behavior achieve just as good results as treatments designed to change thoughts

A fun and beloved activity may replace expensive mental therapy or anti-depressants. Illustration:
A fun and beloved activity may replace expensive mental therapy or anti-depressants. Illustration:

By Daisy Yuhas, the article is published with the approval of Scientific American Israel and the Ort Israel Network 27.11.2016

About 350 million people worldwide suffer from depression. To help them, the therapists can use many different methods, but the most effective method according to the evidence available today is the method known as "cognitive-behavioral therapy" (CBT). This method works "from the inside out": it mainly focuses on thinking patterns and teaches patients to identify problematic thoughts and change them. But depression specialists now have another option. A growing body of evidence shows that a method known as "behavioral activation" (BA) is just as effective as cognitive-behavioral therapy.

Behavioral activation works "from the outside to the inside". It focuses on changing the actions the patients do rather than changing their thoughts. "The idea is that there is a connection between what we do and how we feel," he says David Richards, a health services researcher from the University of Exeter in England. If a particular patient is a person who loves nature and family, for example, the therapist should encourage him to go for a walk in the park with his grandchildren every day. Such activity increases the positive reward resulting from involvement with the outside world, a difficult task for people suffering from depression. It can also take the place of more negative leisure activities such as pondering things that are lost and gone. The use of behavioral activation has been widespread for decades, and some of its elements are also used in the framework of cognitive-behavioral therapy, but until now it has never been tested to the extent and with the rigorous systematicity necessary to evaluate its relative merits as an approach that stands on its own.

In one of the largest studies of its kind, Richards led a joint project of 18 researchers from three mental health centers in Great Britain with the aim of testing the two methods against each other, cognitive-behavioral therapy versus behavioral activation. In the study, 440 people who suffered from depression were examined, during which each of them received treatment using one of the methods for 16 weeks. The researchers followed the progress of the patients six, 12 and 18 months after the start of treatment. In this study, Published On the website of the journal Lancet in July 2016, the researchers found that both treatments were equally effective. One year later, two-thirds of the patients from both groups reported that the symptoms they suffered from had decreased by 50%.

These findings may change the guidelines regarding the treatment of depression. For example, patients with depression can start with simpler treatments such as behavioral activation, and continue with specialized treatments only if this treatment does not achieve a good response. The success rate of antidepressants is close to that of these two methods and the transition approach in their use is similar. "We believe that behavioral activation is good as a first step in treatment, and this article highlights this," he says George Oleksopoulos, a geriatric psychiatrist at Cornell University School of Medicine, who was not involved in the study.

Richards and his research partners also found that even junior therapists were able to treat depression sufferers with behavioral activation after a short training period. Behavioral activation therapy is therefore cheaper than cognitive-behavioral therapy, which requires therapists with a high degree of expertise. This difference gives the behavioral activation a great advantage in developing countries, where the resources allocated to mental treatments are very limited.

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