Reducing stasis outcomes in depression (Version 1.0)
Research type
Research Study
Full title
Effect of treatment augmentations embedded in behavioural activation group therapy on reducing drop-out and stasis rates in depression
IRAS ID
202197
Contact name
Melanie Simmonds-Buckley
Contact email
Sponsor organisation
University of Sheffield
Duration of Study in the UK
1 years, 2 months, 29 days
Research summary
Research Summary:
Depression is one of the most common mental health disorders and it is estimated up to 50% of patients do not respond to evidenced-based psychotherapy treatment for depression, recording a ‘stasis’ outcome. However, research has previously overlooked this population, meaning a considerable number of people continue to psychologically suffer. This research aims to 1) identify depression ‘stasis’ prevalence and predictors in an existing evidenced-based group treatment for depression, 2) test whether an embedded intervention based on theoretical and clinical practice evidence can help reduce patient depression ‘stasis’ and drop-out rates and 3) understand what aspect of therapy produces change (or prevents change in ‘stasis’). The study will be based on behavioural activation (BA) therapy delivered in an eight-session group format in an Improving Access to Psychological Therapies (IAPT) service. BA is one of the most effective psychotherapies available for depression and focuses on helping patients to increase their engagement with valued activities to help break out of the cycle of depression. The study will firstly analyse an archived anonymised dataset of routine depression measures from patients who have previously received the existing group BA treatment delivered in the Sheffield IAPT service. Secondly, the group BA treatment delivered to patients from January – December 2017 will be enhanced with two treatment augmentations. One augmentation will target ‘stasis’ outcomes through the addition of specific ‘if-then’ planning (known as implementation intentions) when setting between-session homework and the other augmentation will target patient drop-out by informing patients about group BA effectiveness and therapy-dose evidence. The ‘stasis’ outcomes and drop-out rates from the enhanced treatment will be compared with the archived outcomes to see if the intervention has had an effect and the relationship between engaging in valued living as a mechanism of change for depression symptoms will be examined in the context of ‘stasis’.
Summary of results:
Depression is a widely prevalent, debilitating disorder that causes significant suffering for those affected. Behavioural activation (BA) is an evidence-based psychological treatment for depression. The evidence base for BA is largely grounded in individual delivery, with far less known about BA delivered in groups. Given rising demand for treatment, groups represent an attractive delivery strategy for services. Despite good rates of treatment outcomes for evidenced-based psychological treatments, considerable numbers of patients do not benefit and remain in a state of depression ‘stasis’ (i.e., their symptoms are relatively unchanged, despite receiving treatment). Study 1 sought to investigate the effectiveness and efficacy of group BA, the reasons why stasis might occur and also how stasis can be reduced. An analysis of BA treatment response investigated the effect of intervention intensity, format and duration on stasis outcomes. BA is seen to be effective at reducing depression (in 4-9 sessions) regardless of format, with larger effects seen for more intensive versions. ‘Stasis patients’ are distinguishable from ‘improvers’ after 2 sessions. Risk of a BA stasis outcome was predicted by attending fewer sessions, greater impaired functioning prior to treatment, and less severe depression. Building on these findings, Study 2 tested an augmented group BA treatment to determine whether drop-out and stasis outcomes can be reduced. Whilst treatment retention remains stable, significantly fewer patients experience a stasis outcome after the augmented treatment, due to increased rates of improvement. A mediation analysis evaluated whether increasing behaviour in accordance with life values (valued living) is a BA change mechanism. Discrepancies in valued-living were not related to depression severity, nor did valued-living increase as a result of group BA. Exploratory analyses showed valued living does not mediate reductions in depression symptom clusters (somatic or affective) during group BA therapy.
Findings were fed back to the service, presented at the British Association for Behavioural and Cognitive Psychotherapy (BABCP) conference and published in The Cognitive Behaviour Therapist journal (https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fdoi.org%2F10.1017%2FS1754470X24000412&data=05%7C02%7Cleedseast.rec%40hra.nhs.uk%7Cd5f6d0c2903845d9a7ce08dda1b03615%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638844500379597367%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=25l7X%2BbdlUISj3svXRYFVIMp18OeBK9dh4MdLRaZr2A%3D&reserved=0).
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
16/YH/0324
Date of REC Opinion
5 Aug 2016
REC opinion
Favourable Opinion