Treatment for depression and other mental disorders is not effective if it isn’t accessible for everyone A recent study, carried out by the researchers at University of Exeter, aimed to tackle this problem. By comparing the cost effectiveness of two different depression treatments, namely cognitive behavioral therapy (CBT) and behavioral activation (BA), the study determines which has better worldwide applications. Researchers found BA to be equally effective but more cost-friendly than CBT.

Major depressive disorder (commonly known as depression) is a debilitating and highly prevalent mental disorder that afflicts almost 6.7% of US citizens each year. Depression not only causes a person to be in a persistent low mood and feeling of worthlessness but they also have difficulty in concentrating or thinking in everything they do. According to a health survey conducted by World Health Organization (WHO) in 2012, it was estimated that in 17 different countries, on an average, 1 in 20 people reported having a depressive episode in the past year. With 350 million people suffering from depression worldwide, this disorder has become a cause for economic and social burden globally. This economic burden has been estimated to total around US 5.36 trillion dollars from 2011 to 2030, an exceedingly high economic output on treatment for depression.

One of the treatment options that have been proven successful is cognitive behavioral therapy. A therapy that focuses on improving the person by helping them change their negative beliefs and thoughts about themselves. This therapy is reportedly more effective than taking anti-depressant medications. The medication, while cheap and accessible worldwide, has its associated side effects and also has the risk of people not following through on their medication dosages. If they are not consistent with their medication, the results of the drug would not be effective. On the flipside, the success of CBT is dependent on the proper conductance of therapy sessions by highly qualified and trained psychologists. And therein lies the dilemma. The training of such skilled psychologists requires proper infrastructure and all of this is very costly. This economic strain is something many underdeveloped countries, where depression is prevalent, are not able to handle.

This economic stress to the treatment for depression is what the study, led by David A Richards, aimed to resolve. It explained that another effective treatment for depression exists that not only would offer the same results as CBT but will be more cost-effective. The positives of opting for behavioral activation, the cost-effective alternative to CBT, include the fact that the psychological treatment is simple in its process. CBT requires highly trained professionals, a skill set that means only a handful of such psychologists exist. BA, on the other, is simple and effective enough that this treatment can be carried out by junior mental health workers, who are in a greater number than CBT specialists. Moreover, another major difference between CBT and BA is their opposite approach to the treatment.

Behavioral 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 David A Richards

To check if the outset of both therapautic treatments reveals the same result, the researchers in University of Exeter chose 440 participants that were from the ages of 18 and above and met the criteria of major depressive disorder. It was made sure that the participants, while diagnosed with depression, were not suffering from suicidal tendencies, had bipolar disorders or any other form of psychosis. To further increase test accuracy, the participants were randomly divided into two groups. 221 of the participants were assigned to the certified CBT professionals for 20 sessions of treatment, while 219 remaining participants were given the same number of treatment sessions of BA by junior health workers. The participants were told that they would be receiving the same treatment so that no preconceived bias or judgment would form in the patients’ mind, ensuring the accuracy of the outcome.

After the duration of the treatments was completed, follow up assessments were made 6, 12 and then 18 months after the therapy sessions had ended. Interestingly, the outcome of both the treatments was more or less quite similar. The study stated that two-thirds of the total 440 participants revealed that their depressive symptoms had lessened after their treatments by 50% or more. It indicates that both treatments, though offered by differently skilled professionals and used different approaches in therapy, resulted in the same response. The difference in results, it seems, only appeared when analyzing the cost incurred by both forms of treatment. It was shown that a 20% difference in cost exists between CBT and BA, where CBT professionals earn 1,235 pounds for every 935 pounds a BA earns. This showed that while BA is not inferior to CBT, as the study proves, it has greater advantages in lessening the economic strain than its counterpart.

Getting treatment for a disease or a disorder is the right of every individual and yet everyone cannot afford this luxury either due to lack of resources, or in this case, a lack of affordable prices. Behavioral Assessment treatment is not only cost effective but also offers a greater number of workers who can offer such treatments to those who need it. With an 80-90% treatment gap in low income countries, a large number of resources and affordable options can lead to a better treatment for depression, which is currently the world’s leading cause of disability.