Occupational Therapy News OTnews January 2019 | Page 18

FEATURE MENTAL HEALTH
Delivering behavioural
activation to beat depression
Lynsey Drysdale and Claire Boyle explain why and how NHS Lanarkshire’s mental
health occupational therapy service has been delivering behavioural activation groups
N
HS Lanarkshire’s mental health occupational
therapy service has been delivering
behavioural activation, an evidence-based
psychological therapy for the treatment of
mild to moderate depression, since 2014.
The core principles of behavioural activation are
aligned with occupational therapists’ core values and
skills, which include client centeredness, engagement
in activity or ‘doing’ to promote recovery, and being a
mentor to set graded goals (Doody 2011).
According to Dimidjain et al (2006): ‘Behavioural
activation has been shown to produce comparable
results to a full cognitive therapy treatment.’
Within Lanarkshire, behavioural activation
groups have been delivered across all 10 localities.
Occupational therapists had previous experience
of delivering individual behavioural activation as per
Martell’s 10 core principles, following NHS Education
Scotland (NES) training. Subsequently, a cohort
of occupational therapists completed behavioural
activation group training in collaboration with Improving
Access to Psychological Therapies (IAPT) and NES.
Occupational therapists receive regular supervision
to support the delivery of behavioural activation from
clinical associates in applied psychology.
The project has been registered through NHS
Lanarkshire’s Clinical Quality Team. you do and how it makes you feel;

• challenge the activities that maintain depression;
• learn how to approach difficult situations rather than
avoid them;

• support people to make small changes in their daily
routine, based on their values and interests;

• discuss rumination and the impact this has on
depression cycle;
• support people to self-manage and look at situations
that may cause relapse;
• begin to address larger life issues that may put you at
risk of developing depression again in the future; and

• set graded goals to promote small behavioural
change.
This is an eight-week programme, with group
sessions that last for two hours a week, with a maximum
of 12 participants. There are two facilitators and
participants are given homework tasks.
The outcome measures used include the Patient
Health Questionnaire-9, the Clinical Outcomes in Routine
Evaluation Outcome Measure, the Clinical Outcome in
Routine Evaluation 10, a short version of the CORE-OM,
and the Behavioural Activation for Depression Scale,
a self-administered questionnaire that is designed to
measure changes in avoidance and activation over the
course of behavioural activation for depression.
Aims of the project Over the eight weeks, participants cover the following
topics: Learn your patterns and start to change them
(week one); Getting out of TRAPS (trigger, response,
avoidance pattern) and back on TRAC (trigger,
response, alternative coping) (week two); Taking action:
a problem solving approach (week three); Values: the
guide to who we are (week four); Developing responses
to thinking, worry and rumination (week five); Making
changes one step at a time (week six); Freeing yourself
from mood dependence (week seven); Building the
relationships you want, tying it all together (week eight).
Between January 2016 and Spring 2018, a total of
128 people commenced behavioural activation groups,
with 61 people completing a group and showing
significant statistical reduction in CORE-OM scores.
The main aims of the project are to: deliver behavioural
activation, which is an evidence based, structured,
goal-focused therapeutic approach, to groups of
individuals with mild to moderate depression; provide
early intervention treatment to improve mental health
and wellbeing within tier two services; embed the use
of outcome measures in the delivery of low intensity
psychological therapies across NHS Lanarkshire; and
measure the value of delivering behavioural activation in
groups to individuals within mental health services.
The aims of the group are to:
• support the understanding of how depression works
and the depression loop;
• encourage consideration of the link between what
18 OTnews January 2019
Structure and progress