Behavioural activation therapy can stave off major depression

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A psychological treatment known as behavioural activation can help prevent older people with mild symptoms of depression from developing more severe, clinical, depression, a study has found.

The treatment, which encourages social interactions and engagement in rewarding activities, reduced patients’ anxiety levels and improved their quality of life, the researchers from the University of Leeds, University of York, and Durham University discovered.

Dr Gemma Traviss-Turner, a senior research fellow in the School of Medicine at the University of Leeds and one of the trial co-ordinators, said: “The activities we do are related to how we feel.

“Behavioural activation uses a brief psychological approach which helps people re-engage with social activities that bring pleasure.

“If people are unable to do the things they used to enjoy, perhaps because their body will no longer allow it, they are encouraged to think about alternative ways to remain mentally and physically active.

“This can prevent them from withdrawing from society, which is common in those suffering depression and can make things worse.”

The trial, called CASPER, involved 705 people aged 65 and older with mild symptoms of depression who were at high risk of becoming clinically depressed.

Half of the participants were randomised to the Collaborative Care group, in which they received the behavioural activation treatment. The other half were randomised to a control group who visited their GP as usual.

The Collaborative Care group were given eight weekly 30-minute sessions of behavioural activation administered by a case manager with a background in mental health nursing or psychology. The first session was delivered face to face and subsequent sessions were delivered over the phone, which helped ensure accessibility.

At the four-month follow-up, 17.2% of the Collaborative Care group had clinical depression, compared to 23.5% in the control group.

“Older people found Collaborative Care to be an acceptable way of accessing help,” said Della Bailey, one of the therapists working on the study.

“We mostly worked with people over the telephone and found that participants appreciated this approach. This also meant that older people did not have to travel to hospital to receive psychological care.”

Those who suffer from loneliness and long-term illnesses are more likely to develop depression, and as both of these factors affect older people disproportionately, finding ways to treat this age group are very important, the researchers said.

Being depressed can also make health problems worse and older people with depression are at an increased risk of dying, the researchers added.

The study team, whose research is published in the Journal of the American Medical Association, are now planning to train NHS therapists in Collaborative Care to ensure that older people all over the UK can benefit from this low-cost intervention.

“There is currently very little in the way of psychological treatment offered for older people,” said chief investigator Professor Simon Gilbody, from the University of York.

“We are very grateful to the National Institute for Health Research, which funded our work, and to the hundreds of older people who participated in the study.

“We hope that our research will improve the lives of older people throughout the UK.”


Journalists can contact Sophie Freeman in the University of Leeds press office on 0113 343 8059 or email

The study, entitled "Effect of Collaborative Care vs Usual Care on Depressive Symptoms in Older Adults With Subthreshold Depression" has been published in JAMA: The Journal of the American Medical Association

JAMA is one of the leading healthcare journals in the world. The journal’s Impact Factor (37.68) is one of the highest in medicine and science.