Effectiveness of Group Behavioural Activation for Depression: A Pilot Study.

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.

Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site.

BACKGROUND: There are national policy drivers for mental health services to demonstrate that they are effectively meeting the psychological needs of people with long-term health conditions/medically unexplained symptoms (LTC/MUS). AIMS: To evaluate the implementation of a stepped-care service delivery model within an Improving Access to Psychological Therapies (IAPT) service for patients with depression or anxiety in the context of their LTC/MUS. METHOD: A stepped-care model was designed and implemented. Clinical and organizational impacts were evaluated via analyses of LTC/MUS patient profiles, throughputs and outcomes. RESULTS: The IAPT service treated N = 844 LTC and N = 172 MUS patients, with the majority (81.81%) receiving a low intensity intervention. Dropout across the service steps was low. There were few differences between LTC and MUS outcome rates regardless of step of service, but outcomes were suppressed when compared to generic IAPT patients. CONCLUSIONS: The potential contribution of IAPT stepped-care service delivery models in meeting the psychological needs of LTC/MUS patients is debated.