Behavioural activation for depression; An update of meta-analysis of effectiveness and sub group analysis

Research output: Contribution to journalArticle

  • David Ekers
  • Lisa Webster
  • Annemieke Van Straten
  • Pim Cuijpers
  • David Richards
  • Simon Gilbody
Original languageEnglish
Article numbere100100
JournalPLoS ONE
Issue number6
Publication statusPublished - 17 Jun 2014
Externally publishedYes

Background: Depression is a common, disabling condition for which psychological treatments are recommended. Behavioural activation has attracted increased interest in recent years. It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect. Method: Randomised trials of behavioural activation for depression versus controls or anti-depressant medication were identified using electronic database searches, previous reviews and reference lists. Data on symptom level and study level moderators were extracted and analysed using meta-analysis, sub-group analysis and meta-regression respectively. Results: Twenty six randomised controlled trials including 1524 subjects were included in this meta-analysis. A random effects meta-analysis of symptom level post treatment showed behavioural activation to be superior to controls (SMD - 0.74 CI -0.91 to -0.56, k = 25, N = 1088) and medication (SMD -0.42 CI -0.83 to-0.00, k = 4, N = 283). Study quality was low in the majority of studies and follow- up time periods short. There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size. Conclusions: The results in this meta-analysis support and strengthen the evidence base indicating Behavioural Activation is an effective treatment for depression. Further high quality research with longer term follow-up is needed to strengthen the evidence base.


  • PLoS ONE 9_6_e100100

    Rights statement: © 2014 Ekers et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Final published version, 654 KB, PDF document

External organisations

  • Tees, Esk and Wear Valleys NHS Foundation Trust
  • Durham University
  • Vrije Universiteit Amsterdam
  • University of Exeter
  • York University

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