How effective is psychotherapy for depression

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Last Updated: 08/30/2022

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Activating behavioral therapy for depression in adults

Review question

In this Cochrane review, we wanted to know how effective activating behavioral therapy is for depression in adults.

Why is this important?

Depression is a common mental health problem that can cause persistent feelings of sadness and loss of interest in people, activities and things that were once enjoyable. A person with depression may feel tearful, irritable, or tired most of the time, and may have trouble sleeping, concentrating, and remembering. These and other symptoms can make daily life difficult.

Treatment for depression includes medication (antidepressants) and psychotherapy (talking therapy). Behavioral activation is a type of psychological therapy that encourages a person to develop or return to activities that are meaningful to him. Psychotherapy included scheduling activities and behavior monitoring, as well as considering specific situations in which changing these behaviors and activities might be beneficial. The therapist may provide assistance in person, over the phone, or online, usually over several sessions.

It is important to know whether behavioral activation can be an effective and acceptable treatment for people with depression.

What we did

In January 2020, we searched for studies on behavioral activating psychotherapy for depression in adults (over 18 years of age). We looked for randomized controlled trials in which treatments were assigned randomly to participants; these studies provide the most reliable evidence.

We included 53 studies with 5495 participants. Studies have compared behavioral activation with no treatment, standard or usual care, sham treatment (placebo), medication, being on a waiting list for treatment, or other types of psychotherapy (cognitive behavioral therapy (CBT), third wave CBT, humanistic therapy, psychodynamic therapy). and integrative therapy).

Studies conducted in 14 countries; most of them are in the USA (27 studies). Most studies lasted between four and 16 weeks.

As a result, we focused on how well the treatment works and whether it is acceptable to the participants. How well a treatment worked (effectiveness) was measured by the number of people who responded well to treatment or no longer met criteria for depression at the end of treatment. Eligibility was measured by counting how many people dropped out of the study.

What did we find?

Behavioral activation may treat depression better than conventional care. We were not sure whether behavioral activation worked better than medication or being on a waiting list, and we found no evidence for this outcome when comparing behavioral activation to no treatment or placebo treatment.

We found no difference between behavioral activation and CBT in the treatment of depression. Although we did not find sufficient evidence to compare behavioral activation with other types of psychotherapy, it may work better than humanistic therapy, and we found no difference between behavioral activation and third wave CBT or psychodynamic therapy. There was no evidence available comparing behavioral activation with integrative therapy.

Behavioral activation is probably less acceptable to people than regular help. We found no difference in acceptability of behavioral activation compared with being on a waiting list, no treatment, antidepressants, or placebo. We also found no difference in acceptability between behavioral activation and other psychotherapies studied (CBT, third wave CBT, humanistic therapy, integrative therapy). To compare behavioral activation with psychodynamic therapy, we did not find any evidence for the acceptability of the treatment.


Behavioral activation may be an effective and acceptable treatment for depression in adults. Patients with depression who are prescribed this psychotherapy option will have more choice of treatment, and different formats and types of care can be explored to meet the demand for mental health support. Our confidence in these findings is limited due to concerns about the certainty of the evidence.

Most of the results were short term, which means that we cannot be sure that behavioral activation will be beneficial for people with depression in the long term.

Certainty of evidence

Our confidence in the evidence is generally low to moderate. Some results are based on only a few poorly reported studies in which participants knew which treatment they were receiving. Therefore, we are not sure how reliable the results are. Our conclusions may change if more research is done.

Translation notes:

Translation: Minin Anton Viktorovich. Editing: Yudina Ekaterina Viktorovna. Russian translation project coordination: Cochrane Russia - Cochrane Russia, Cochrane Geographic Group Associated to Cochrane Nordic. For questions related to this translation, please contact us at: [email protected].

Psychotherapy for depression: comparing the effectiveness of cognitive and dynamic approaches


Bezsheiko V.G.

  • Publishing house "MORION"

Summary. Results of new randomized clinical trial

To date, the effectiveness of cognitive therapy for depression has been proven in many randomized clinical trials and confirmed by Cochrane systematic reviews. Leading guidelines for the treatment of depression recommend cognitive therapy as the first line treatment for this disorder. However, the effectiveness of many other psychotherapeutic areas is questionable due to the lack of a good evidence base.

A group of scientists from the University of Pennsylvania, USA, decided to fill this gap and conducted a randomized study on the comparative effectiveness of cognitive and dynamic psychotherapy. To do this, Mary Gibbons, together with colleagues, used the “noninferioty trial” format, that is, the goal was to prove that dynamic therapy is no worse than cognitive therapy for major depressive disorder.

The study selected 237 patients with depression and randomly distributed them into two equal groups with the appointment of one or another type of psychotherapy. The treatment process had the following features:

  • Duration was 5 months, during which patients completed 16 sessions.
  • Psychotherapy sessions were conducted by certified specialists.
  • Patients' baseline status and treatment efficacy were assessed using valid scales such as HAM-D (Hamilton Depression Rating Scale), SF-36 (Quality of Life Scale) and some others.
  • Psychodynamic therapy (PT) included building a positive working alliance between therapist and patient, using expressive techniques to help the patient understand repetitive ineffective relationship building patterns, and additional work with interpersonal conflicts with a focus on achieving intrapersonal goals.
  • Cognitive therapy included behavioral activation and the identification and challenge of irrational beliefs associated with depression.

It should be noted that the researchers themselves indicate that only cognitive therapy was carried out. However, among these techniques, behavioral activation appears - this is a specific behavioral intervention, which consists in the gradual adaptation of the patient to the usual activities that he was forced to abandon due to depression (for example, cleaning the apartment, meeting with friends, walking in the park, communicating with family, etc.). Thus, it would be fair to call this approach Cognitive Behavioral Therapy (CBT).

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