Improving outcomes via treatment augmentations to behavioural activation for depression in routine practice: a cohort comparison study

Whilst behavioural activation (BA) is an empirically supported treatment for depression, some patients do not benefit. The aim of this study was to evaluate the effectiveness of two treatment augmentations to an extant manualized 8-session group version of BA. The two treatment augmentations were (a) dose–response psychoeducation to improve attendance and (b) implementation intentions to improve clinical outcomes. A cohort comparison design in routine practice comparing standard group BA (n=31, drawn from a sample of n=161, from 22 BA groups) with treatment-augmented group BA (n=31 from 3 BA+ groups). There was no effect of the two treatment augmentations on attendance or in overall mean reductions to depression (mean improvement difference=2.2), anxiety (mean improvement difference=1.9) or impaired functioning (mean improvement difference=1.5). Rates of reliable improvement in depression were significantly higher for augmented BA (odds ratio=3.21 for BA+ compared with BA). Efforts should be made to still improve outcomes for empirically supported interventions, with any treatment augmentations tested in well-controlled studies.