Is Behavioral Activation (BA) More Effective than Cognitive Therapy (CT) in Severe Depression? A Reanalysis of a Landmark Trial

Abstract

A landmark study (Jacobson et al., JCCP, 64:295–304, 1996) suggested that behavioral activation (BA) is as effective as cognitive therapy (CT) in the treatment of major depression. A conceptual replication supported the efficacy of BA and suggested BA is more effective than CT for severe depression (Dimidjian et al., JCCP, 74:658–670, 2006), though these findings have never been replicated. Outcome data from the participants in the BA and CT condition of the Jacobson et al. (JCCP, 64:295–304, 1996) trial were analyzed with the same analytic approach used by Dimidjian et al. (JCCP, 74:658–670, 2006). The sample was stratified on the Hamilton Rating Scale for Depression (HRSD) as higher-severity (HRSD ≥ 20) and lower-severity (HRSD ≤ 19). Treatment differences in change over time on the HRSD, Beck Depression Inventory (BDI), as well as response (≥ 50% change) and remission on each scale, were examined. Tests of moderation with severity as a categorical or continuous variable were conducted, and we explored the effect of severity by treatment on relapse. The results of Dimidjian et al. (JCCP, 74:658–670, Dimidjian et al. 2006) were not replicated. Tests of moderation with severity as a continuously measured variable (with the BDI or HRSD) also failed to find that BA was more effective than CT for more severe depression. No differences by severity emerged over the follow-up period. BA and CT may be roughly equivalent in the treatment of mild, moderate, and severe depression.