Finning Katie, Richards David A, Moore Lucy, Ekers David, McMillan Dean, Farrand Paul A, O'Mahen Heather A, Watkins Edward R, Wright Kim A, Fletcher Emily, Rhodes Shelley, Woodhouse Rebecca, Wray Faye
University of Exeter Medical School, Exeter, UK
University of Exeter Medical School, Exeter, UK.
BMJ Open. 2017 Apr 13;7(4):e014161. doi: 10.1136/bmjopen-2016-014161.
To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists.
Semistructured qualitative interviews analysed using a framework approach.
36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial).
Primary care psychological therapies services in Devon, Durham and Leeds, UK.
Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential.
Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision.
ISRCTN27473954, 09/12/2011.
探讨参与者对由初级心理健康工作者提供的行为激活疗法（BA）与专业心理治疗师提供的认知行为疗法（CBT）的可接受性、改变机制及影响的看法。
采用框架法分析半结构化定性访谈。
从BA与CBT的随机对照试验（COBRA试验）中，有目的地抽取36名患有重度抑郁症的参与者。
英国德文郡、达勒姆郡和利兹市的初级保健心理治疗服务机构。
被认为有益的治疗要素包括治疗的时长和规律性、学习的机会以及不纠结于过去。家庭作业是治疗中一个重要但具有挑战性的方面。治疗师被视为在治疗中发挥重要作用的专家。对一些参与者来说，治疗最重要的要素是有人可以交谈，但对另一些人来说，与BA和CBT相关的特定因素至关重要，行为改变对两种治疗的参与者都很重要，而接受CBT的参与者对认知改变的讨论更多，这并不奇怪。两种疗法都被认为对抑郁症状以及生活的其他方面有积极影响，包括对自身的感受、自我护理、工作和人际关系。治疗的障碍包括工作、家庭生活和情绪挑战。一部分（n = 2）接受BA治疗的参与者表示治疗感觉太简单，且初级心理健康工作者可能被认为缺乏经验。许多参与者将治疗视为一种学习经历，为他们提供了可以带走的工具，预防复发的工作至关重要。
尽管对一些参与者存在障碍，但BA和CBT被认为有许多益处，带来了认知和行为改变，并在参与者生活的许多领域产生了改善。为了优化BA的实施，应通过高质量培训和持续监督来支持缺乏经验的初级心理健康工作者。
ISRCTN27473954，2011年12月9日。
