ABOUT THIS EPISODE
How do we make effective therapy for depression more widely available without losing quality or compassion?
In this episode, Rachel Handley is joined by Professor David Ekers, a leading researcher and clinician specialising in behavioural activation (BA).
David shares the story of how his clinical experience with long waiting lists led him to focus on scalable, evidence-based approaches to care. The conversation explores the development of behavioural activation, the evidence underpinning low intensity delivery, and key findings from major trials including the COBRA and BASIL studies. David explains why behavioural activation is a robust, practical intervention that can be delivered effectively by a range of practitioners, without losing therapeutic depth or compassion.
David reflects on common myths about low intensity work, the importance of supervision and therapeutic relationships, and the challenges services face when balancing access, outcomes, and relapse prevention.
Further resources:
David's University of York webpage can be found here which details all his publications and research projects
Papers and links to further information about the trials mentioned in this episode are listed below:
COBRA:
Finning, K., Richards, D. A., Moore, L., Ekers, D., McMillan, D., Farrand, P. A., O'Mahen, H. A., Watkins, E. R., Wright, K. A., Fletcher, E., Rhodes, S., Woodhouse, R., & Wray, F. (2017). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation. BMJ Open, 7(4), e014161. https://doi.org/10.1136/bmjopen-2016-014161
Richards, D. A., Rhodes, S., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Barrett, B., Finning, K., Ganguli, P., Warren, F., Farrand, P., Gilbody, S., Kuyken, W., O'Mahen, H., Watkins, E., Wright, K., Reed, N., Fletcher, E., Hollon, S. D., & Moore, L. (2017). Cost and Outcome of BehaviouRal Activation (COBRA): a randomised controlled trial of behavioural activation versus cognitive–behavioural therapy for depression. Health Technology Assessment, 21(46), 1–366. https://doi.org/10.3310/hta21460
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., Barrett, B., Farrand, P. A., Gilbody, S., Kuyken, W., O'Mahen, H., Watkins, E. R., Wright, K. A., Hollon, S. D., Reed, N., Rhodes, S., Fletcher, E., & Finning, K. (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority Trial. The Lancet, 388(10047), 871–880. https://doi.org/10.1016/s0140-6736(16)31140-0
BASIL:
Gilbody, S., Littlewood, E., McMillan, D., Atha, L., Bailey, D., Baird, K., Brady, S., Burke, L., Chew-Graham, C. A., Coventry, P., Crosland, S., Fairhurst, C., Henry, A., Hollingsworth, K., Newbronner, E., Ryde, E., Shearsmith, L., Wang, H.-I., Webster, J., & Woodhouse, R. (2024). Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial. The Lancet Healthy Longevity, 5(2), e97–e107. https://doi.org/10.1016/s2666-7568(23)00238-6
Littlewood, E., McMillan, D., Graham, C. C., Bailey, D., Gascoyne, S., Sloane, C., Burke, L., Coventry, P., Crosland, S., Fairhurst, C., Henry, A., Hewitt, C., Baird, K., Ryde, E., Shearsmith, L., Traviss-Turner, G., Woodhouse, R., Webster, J., Meader, N., & Churchill, R. (2022). Can we mitigate the psychological impacts of social isolation using behavioural activation? Long-term results of the UK BASIL urgent public health COVID-19 pilot randomised controlled trial and living systematic review. Evidence-Based Mental Health. https://doi.org/10.1136/ebmental-2022-300530
More information and publications related to the study can be found www.BASILStudy.org
CASPER:
Gilbody, S., Lewis, H., Adamson, J., Atherton, K., Bailey, D., Birtwistle, J., Bosanquet, K., Clare, E., Delgadillo, J., Ekers, D., Foster, D., Gabe, R., Gascoyne, S., Haley, L., Hamilton, J., Hargate, R., Hewitt, C., Holmes, J., Keding, A., & Lilley-Kelly, A. (2017). Effect of Collaborative Care vs Usual Care on Depressive Symptoms in Older Adults With Subthreshold Depression. JAMA, 317(7), 728. https://doi.org/10.1001/jama.2017.0130
Lewis, H., Adamson, J., Atherton, K., Bailey, D., Birtwistle, J., Bosanquet, K., Clare, E., Delgadillo, J., Ekers, D., Foster, D., Gabe, R., Gascoyne, S., Haley, L., Hargate, R., Hewitt, C., Holmes, J., Keding, A., Lilley-Kelly, A., Maya, J., & McMillan, D. (2017). CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technology Assessment, 21(8), 1–196. https://doi.org/10.3310/hta21080
DiaDeM:
More information and publications related to the programme can be found here
Insika Yomama:
Rochat, T. J., Dube, S., Herbst, K., Hoegfeldt, C. A., Redinger, S., Khoza, T., Bland, R. M., Richter, L., Linsell, L., Desmond, C., Yousafzai, A. K., Craske, M., Juszczak, E., Abas, M., Edwards, T., Ekers, D., & Stein, A. (2021). An evaluation of a combined psychological and parenting intervention for HIV-positive women depressed in the perinatal period, to enhance child development and reduce maternal depression: study protocol for the Insika Yomama cluster randomised controlled trial. Trials, 22(1). https://doi.org/10.1186/s13063-021-05672-0
MODS:
More information and publications related to the study can be found www.MODSStudy.org
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If you enjoyed this episode, check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT – Research Matters for more discussions on evidence-based therapy.
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This podcast was edited by Steph Curnow
