Behavioral Activation: A Game-Changer in Managing Depression and Anxiety

Highlights:

Behavioral Activation (BA), a brief therapy, is proven effective in managing depression and anxiety among patients with noncommunicable diseases (NCDs)
The BA therapy encourages patients to gradually restart their routine and recreational activities, fostering a positive attitude and a sense of accomplishment
This novel approach helps bridge the significant treatment gap in mental health care, especially in low- and middle-income countries

A study conducted by researchers from NIMHANS and the University of York in the United Kingdom to address the rising burden of depression and anxiety in patients with noncommunicable diseases (NCD) discovered that brief psychological therapies such as behavioral activation (BA) are effective in managing these issues.

The study, which has been submitted for publication in a peer-reviewed journal, was conducted to assess the feasibility and efficacy of BA in an Indian community environment where the burden of NCDs is high.

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‘Unlocking the potential of Behavioral Activation in managing #depression and #anxiety among patients with noncommunicable diseases. A groundbreaking approach to #MentalHealth care. #NCDs #HealthcareInnovation ’

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“A systematic review of 96 studies conducted in India, Bangladesh, and Pakistan done by our team revealed that 40% of patients with diabetes, cancer, hypertension, stroke, and chronic obstructive pulmonary disease (COPD) have depression while 30% with these chronic conditions have anxiety,” said Arun Kandasamy, Professor of Psychiatry at NIMHANS.

According to the National Mental Health Survey of India, there is a significant disparity between the number of persons who have common mental illnesses and the number of people who have received treatment for those illnesses ().

“One of the reasons for the same is a dearth of trained mental health professionals and simpler interventions. So we understood the need to develop such an intervention which can be delivered by non-mental health professionals within the existing health care system itself,” he said.

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“We did a pilot study involving 56 patients from primary health centres (PHCs) in Kolar district. We intended to first develop an intervention that can be used by those handling patients in the NCD clinics in the Indian setting and test the feasibility of integrating the same into our existing healthcare system. We came out with the behavioural activation counselling for the treatment of depression in non-communicable disease (BEACON) module,” he said.

“BA is a brief therapy that helps the patient to do regular activities (routine and necessary as well as social and pleasurable) that he/she has stopped or reduced due to health conditions. Under the BEACON module, the patient needs to do a little bit of these activities every day and increase the time and number of activities gradually,” said Dr. Kandasamy, who is the lead author of the study.

“The fact that the patients with NCDs cannot complete routine activities due to their health condition or having a chronic medical illness can make them depressed. Also as they tend to get tired easily, they gradually stop doing routine and recreational activities and this only worsens their depression. So we have trained NCD counsellors in community health centres of the Kolar district to help such patients gradually restart these activities. This sets in a positive attitude and a sense of accomplishment in these patients, which in turn help in reducing the depression,” the doctor explained.

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Adapting Behavioral Activation for Integrated Mental and NCD Care

“For example, people with NCDs are two-three times more likely to experience depression. The presence of depression worsens NCD symptoms, adversely impacts quality of life, and increases the financial burden for patients and their families. Therefore, it is important to recognize and treat depression to improve the overall management of NCDs and improve health, quality of life and economic outcomes for these patients,” the doctor said.

Dr. Kandasamy asserted that there is an identified need to integrate mental health care in NCD care settings to help address the high burden of co-morbid depression with NCDs. He said, “However, there is a notable gap worldwide between the number of people in need of mental health care and those who receive treatment. This treatment gap is especially high in low- and middle-income countries (LMICs).”

“Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural and resource context) for delivery in the PHCs. The intervention was also adapted for potential remote delivery via telephone as the pilot study was through the pandemic,” he said.

“This was a pilot trial and we are planning to take up the trial in a bigger way in multiple places,” he added.

Reference:

National Mental Health Survey of India 2015-2016 - (https://pubmed.ncbi.nlm.nih.gov/28529357/)

Source-Medindia

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