Going out for dinner, learning to tap dance or seeing friends are all effective treatments for depression, according to recent research published in the Lancet. These activities even have a therapeutic name – behavioural activation. The research says it works as well as established treatments, such as cognitive behavioural therapy (CBT). But how does it work?

The solution

Activities that reduce isolation and are enjoyable are at the heart of behavioural activation. This therapy – promoted by Neil S Jacobson at the University of Washington in the 1990s – works on the premise that, when people are depressed, they avoid interacting with others, which reinforces the depression.

“People with depression will often think they feel down all the time, but their mood will go up and down, depending on what they are doing,” says Professor David Richards of Exeter University, lead author of the Lancet paper. “When we stop doing things that make us human and we close in on ourselves, that’s what keeps depression going.”

Behavioural activation is an “outside-in” therapy, in which people with depression are encouraged to experience mood-enhancing activities and monitor how they feel. CBT is “inside-out” and focuses on how people think and challenges their beliefs. The research reported in the Lancet randomly allocated 440 people with depression to either behavioural activation or CBT. After a year, there was no difference between the two groups. Two-thirds of people in each group reported a 50% reduction in their symptoms of depression. Richards says that behavioural activation works as well as antidepressants and can be used for mild, moderate and even severe depression. It is not suitable for people who are suicidal.

Behavioural activation is not a soft option. “It is actually difficult,” says Richards. “We are not minimising the restrictive effect of depression. We ask people to actively monitor what they are doing and their connection with their mood. This helps them to establish that how they act influences how they feel.”

People often tell themselves they will do an activity when they “feel more like it”. In depression, that can take a long time. So behavioural activation gets people to schedule activities a week in advance. They must then do them, even in an unmotivated way, and record their mood afterwards. The Lancet findings support a meta-analysis of the effectiveness of behavioural activation published in PLOS one, a medical journal. This combined results of 26 randomised trials and concluded that the therapy was effective. Depression often needs more than one therapeutic intervention – behavioural activation may be a tough but useful option.