Time-intensive behavioural activation for depression: A multiple baseline study.

Depression is the second leading cause of disability, worldwide, and increasing access to its effective/preferred treatment requires more attention. Behavioural activation shows promise as an effective and disseminable treatment for depression. Time-intensive treatment provision is also shown to enhance treatment access and response rates, and has proven efficacy in the treatment of anxiety disorders. However, there has been limited exploration of time-intensive behavioural activation for depression, especially within outpatient settings, where depression most commonly presents. Therefore this study aimed to investigate the feasibility, effectiveness, and acceptability of time-intensive behavioural activation in primary care. It was hypothesised that the intervention would be associated with improvements in idiographic, standardised and process measures of depression and comorbid anxiety.
Eight adults with major depressive disorder were recruited from three outpatient services into a multiple baseline single-case experimental design. All participants completed time-intensive behavioural activation, consisting of up to seven bi-weekly sessions and three optional booster sessions.
Treatment recruitment, retention, and credibility/expectancy indicated that the intervention was feasible. Visual and statistical analyses showed that relative to baseline, the majority of participants (between five and seven) made significant improvements in all idiographic symptoms of depression, except anxiety. According to standardised measures of depression, four out of eight participants were considered treatment responders, with intervention effects mostly generalised to standardised measures of anxiety. Although only five participants completed follow-up measures, the majority of progress was maintained. Process measures of activation and dysfunctional attitudes showed low proportions of change. The intervention was considered highly acceptable by participants and therapists.
Overall this study provides new, but tentative evidence highlighting the potential of time-intensive BA as a feasible, effective and acceptable treatment for some adult outpatients with depression. The findings now warrant further, more rigorous evaluation of the treatment.