Effectiveness of an add-on brief group behavioral activation treatment for depression in psychiatric care: A randomized clinical trial

Abstract

Objective: Behavioral activation (BA) is an effective treatment for depression. Weinvestigated the effectiveness of add-on group-format BA and peer support (PS)with treatment as usual (TAU) in a registered randomized clinical trial inpsychiatric outpatient settings (ISRCTN10647845).Methods: Adult outpatients (N = 140) with major depressive disorder (MDD) andPatient Health Questionnaire (PHQ-9) score ≥10 were randomized into a) groupBA, consisting of eight 90-minute weekly group sessions plus TAU; b) group PS,including eight 90-minute weekly group sessions plus TAU; or c) TAU alone. Theprimary outcome was a within-individual change in PHQ-9 score betweenbaseline and 8 weeks. Secondary outcomes were 1) response, 2) remission,and 3) functional impairment at 8 weeks, plus 4) change in PHQ-9 at 6 months.Results: Of the randomized patients, 100 (71.4%) completed treatments,including 29/45 (64.4%) patients in the BA group, 39/49 (79.6%) in the PSgroup, and 32/46 (69.6%) in the TAU group. By 8 weeks, PHQ-9 scoresdeclined most in the TAU group [BA −0.28 (95% CI −2.48, 1.92), PS −0.58(−2.09, 0.94) vs. TAU −3.32 (−5.21, −1.44); group-difference test, p = 0.034].The secondary outcomes in the BA or PS arms did not significantly differ fromthose in TAU. Videotaped sessions revealed marked variation in briefly trainedtherapists’ adherence to the treatment manual.Conclusions: In this randomized trial, the effectiveness of treatments with theadded BA and PS groups did not exceed that of TAU alone. The preconditions inwhich brief BA or PS group interventions benefit outpatients with depression inpsychiatric settings warrant critical investigation.