New talking therapy for depression could be more effective and cheaper than CBT

A new talking therapy for depression has shown encouraging early signs of being more effective and cheaper to deliver than the current best practice of Cognitive Behavioural Therapy (CBT).

A pilot trial from the University of Exeter, funded by the National Institute of Health and Care Research (NIHR) and published in Lancet EClinical Medicine, has found Augmented Depression Therapy (ADepT) could be a significant advance in depression care.

A core feature of depression is anhedonia (reduced interest or pleasure) and wellbeing deficits, but current depression psychotherapies like CBT fail to adequately target these components. ADepT has been developed to pay just as much attention to building wellbeing as it does reducing depressive symptoms.

Professor of Clinical Psychology, Barney Dunn, from the University of Exeter led the trial and said: “Depression is widespread and a significant contributor to global disability, resulting in extensive social and economic costs. Only around 60 percent of people will recover during our current best treatments like CBT and about half of those will relapse within two years. In ADepT, we encourage clients to take a new perspective to their difficulties, aiming to learn to live well alongside depressed mood.  The primary goal is to help clients identify what is important to them in key life areas, take steps towards living a life in a way that is consistent with these values, and to take opportunities and manage challenges while they do so that they can experience wellbeing and pleasure.”

Katie has lived experience of ADepT and said: “I’ve got a fairly long history of using mental health services and that’s almost become my identity over the years. My focus in treatment before had always been on trying to eliminate symptoms of mental illness. ADepT has changed my outlook to help me take steps to gain wellbeing, as well as allowing me to be more authentic and act in a way more aligned to my values. ADepT is helping me make decisions which feel right and giving me more of an identity outside of mental illness, which is amazing. I’ve learnt to be able to enjoy the good things in life that give me pleasure, even when I am having a difficult week. It really has changed things for me.”

This is the first pilot randomised controlled trial evaluating the effects of ADepT. 82 adults with moderate to severe depression and exhibiting features of anhedonia took part and were primarily recruited from NHS Talking Therapy (formerly known as Improving Access to Psychological Therapy) service waiting lists in Devon, UK. Participants were randomly assigned to either 20 individual sessions of ADepT or CBT, delivered in the University of Exeter AccEPT clinic and supported by Devon Partnership NHS Trust, Exeter Collaboration for Academic Primary Care (APEx), and University of Exeter Psychology Department. Participants were assessed by researchers at the beginning of the pilot, as well as after six, 12, and 18 months.

Results suggested that ADepT was definitely not worse than, and showed potential to be better than, CBT at building wellbeing and reducing depression at the end of treatment and over longer-term follow-up. Results also suggested ADepT was cost-effective, costing the same amount to deliver as CBT but resulting in greater gains in quality of life. If these findings can be replicated in a subsequent definitive trial, it would suggest that ADepT can have both clinical and economic benefits in healthcare settings. ADepT has also been designed so that existing CBT therapists will be able to deliver it with minimal additional training.

The paper is entitled “Primary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial” and is published in Lancet EClinical Medicine.