Article Text
Abstract
Objective To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists.
Design Semistructured qualitative interviews analysed using a framework approach.
Participants 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial).
Setting Primary care psychological therapies services in Devon, Durham and Leeds, UK.
Results Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential.
Conclusions Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants’ lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision.
Trial registration number ISRCTN27473954, 09/12/2011
- Mental health
- Depression and mood disorders
- Qualitative research
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Footnotes
Contributors DAR, DE, DMc, PAF, HAO’M, ERW and KAW designed the COBRA trial and were responsible for its conduct. SR, EF and KF were responsible for trial data collection management. KF, RW and FW collected qualitative data. KF, DAR and LM performed the qualitative data analysis. KF drafted the first version of the manuscript. All authors contributed and approved the final manuscript.
Funding This work was funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment programme grant number 10/50/14. DAR is also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Disclaimer The views expressed in this publication are those of the authors and not necessarily of the NIHR or UK Department of Health.
Competing interests All authors report grants from the UK National Institute for Health Research (NIHR) during the course of the study. DAR reports grants from the European Science Foundation. HAO’M reports grants from the UK Department of Health (DoH), Medical Research Council and Economic and Social Research Council and is an executive committee member of the BPS Perinatal Faculty and DoH Perinatal Clinical Reference Guideline. KAW is a clinical academic who teaches the theory and practice of BA and CBT.
Ethics approval South West Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.