Encouraging depressed people to do the things they used to enjoy such as phoning friends or going for a walk, could save NHS trusts thousands of pounds in more complex therapies, a study has shown.

‘Behavioural Activation’ is a simple form of therapy which encourages positive activities, such as waking up early, getting outdoors and re-engaging with the world, while stopping negative behaviours such as staying in bed all day, drinking too much or taking drugs.

It is 20 per cent cheaper and requires far less training to deliver thanCognitive Behavioural Therapy (CBT) in which patients are taught to change the way they think about negative situations.

We are always looking for treatments and approaches that offer people better outcomes and, wherever possible, improved cost efficiencyDr Peter Aitken, Devon Partnership NHS Trust

Researchers at the University of Exeter found that Behavioural Activation was just as effective at treating depression as CBT, a result which could bring huge cost savings for the NHS.

“Effectively treating depression at low cost is a global priority,” said Professor David Richards, a National Institute for Health Research senior investigator at the University of Exeter Medical School.

“Our finding is the most robust evidence yet that Behavioural Activation is just as effective as CBT, meaning an effective workforce could be trained much more easily and cheaply without any compromise on the high level of quality.

“This is an exciting prospect for reducing waiting times and improving access to high-quality depression therapy, and offers hope for countries who are currently struggling with the impact of depression on the health of their peoples and economies.”

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There are around three million people suffering from depression in Britain and without ongoing treatment, four in five will relapse at some point.

In 2015 there were nearly 60 million antidepressant medicines dispensed in England – almost twice as many as in 2004. However, many anti-depressants have severe side-effects and can even lead to suicidal thoughts.

In contrast, studies have shown that talking therapies are just as effective as anti-depressants, but one in 10 patients seeking therapy waits more than a year before their needs are even assessed because NHS trusts cannot afford to employ sufficient numbers of therapists.

Behavioural Activation therapists earn an average of £10,000 a year less than CBT therapists and the cost of treatment is £260 cheaper per patient.

Yet until now the National Institute for Health and Care Excellence(Nice) has said there is insufficient evidence to recommend behavioural activation as a first-line treatment in clinical guidelines, and called for more robust research to investigate the benefits.

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The new trial recruited 440 depressed patients from Devon, Durham, and Leeds, half of whom received Behavioural Activation therapy and half CBT. The researchers found no difference between the groups at follow-up, both groups reporting a 50 per cent reduction in depressive symptoms.

Dr David Ekers, a nurse consultant who led the Durham study, said: “The practical nature of Behavioural Activation and the relative simplicity of delivery makes it an attractive option for NHS services.

“This intervention will offer a cost effective option to provide evidence based psychological interventions for depression across a range of clinical teams.”

Behavioural activation is an “outside in” treatment that focuses on helping people with depression to change the way they act. In contrast, CBT is an “inside out” treatment where therapists focus on the way a person thinks.

Dr Peter Aitken, director of research and development at Devon Partnership NHS Trust, said: “Research into psychological therapies and mental health is incredibly important and we are always looking for treatments and approaches that offer people better outcomes and, wherever possible, improved cost efficiency.

“Taking forward treatments such as Behavioural Activation is vital if our services are to keep pace with this rising demand and offer value for money.”

The research was published in The Lancet.

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