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Can non-specialists provide effective depression therapy?

February 17, 2011
by News release
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New preliminary research findings suggest that depression could be treated effectively with psychotherapy by mental health nurses with minimal training,

Led by Durham University's Mental Health Research Centre, the study contends that patients with severe depression can be treated successfully with behavioral activation—a psychotherapy for depression—by non-specialist mental health staff which could potentially lead to considerable cost-savings.

In the study, mental health nurses received five days training in behavioral activation and one hour of clinical supervision every two weeks. Currently, psychotherapies such as behavioral activation are delivered by specialist clinicians and therapists.

Although the findings are preliminary, the researchers say they could pave the way for increasing access to psychological therapies for people with depression and could help to alleviate the shortage of specialist therapists.

Researchers compared behavioral activation treatment delivered by mental health nurses with usual care delivered by general practitioners. There were 47 participants in the trial. The research, conducted by Durham University, University of Exeter, and the University of York, is published in the British Journal of Psychiatry.

Patients treated with behavioural activation by the nurses showed significantly more signs of recovery, were functioning better and were more satisfied with the treatment compared to the group who received what is classed as 'usual care' by their general practitioner, researchers found.

Behavioral activation is a practical treatment where the focus is on pinpointing which elements in someone's life influence their moods.

Changes over time in these person-environment relationships are explored and worked on to help the person engage in a more rewarding daily structure. This is done through self monitoring, scheduling and exploring difficult situations and the person's responses to these.

"This is a small-scale study and certainly more research with bigger trials is needed but it shows some very promising early findings," said David Ekers, lead author of the study.

"The results indicate that with limited training, generic mental health workers can be trained to deliver clinically effective behavioral activation to people with long-standing depression."

Ekers, an Honorary Clinical Lecturer at Durham University and Nurse Consultant at Tees, Esk and Wear Valleys NHS Foundation Trust, added that behavioral activation therapy has already been shown to be equally effective as cognitive behavioural therapy—but previous studies were conducted with experienced psychotherapists.

"This is the first time it has been shown that behavioral activation can be an effective treatment when delivered by 'inexperienced' therapists," he explained. "All of this is particularly relevant in the current economic climate whereby there may be increased risk of depression, and demands on the NHS in that area could become heavier."

According to Colin Walker, Policy and Campaigns Manager for mental health charity Mind, stated that the organization has found evidence that one in five people with mental health problems are waiting over a year between asking for help and receiving access to talking therapies.

"Expanding the types of therapies on offer and how they are delivered might be an effective way of reducing the time that people wait to receive support but much more research is necessary to ensure that this approach is truly effective," said Walker.

"It's vital that mental health workers inexperienced in providing talking therapies are adequately trained to deliver such services and that this is not just adopted as a cost saving exercise to replace other types of treatments," he added.

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