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Dissemination of behavioural activation for depression to mental health nurses: training evaluation and benchmarked clinical outcomes


D. M. Ekers, Tees, Esk and Wear Valleys NHS, Foundation Trust, Bede House, Belmont Industrial Estate, Durham DH1 1TW, UK, E-mail:


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  • • Depression is a very common condition that causes significant distress and disability to those that experience it. It results in considerable financial problems for both the individual and the society. Talking treatments are available but are limited in availability in part to the long-term training needed leading to insufficient therapist numbers.
  • • Behavioural activation is a relatively simple treatment that appears as effective as the more complex cognitive behavioural therapy and may be suitable to train staff such as mental health nurses relatively quickly.
  • • We found that staff found the training acceptable and useful and that they felt it was suitable for them. Results seen in a recent research trial using mental health nurses as therapists following 5 days' training appeared to show the same level of improvement in depression symptom level as seen when the treatment is delivered by more specialist staff with much longer training.
  • • Behavioural activation may be able to be widely disseminated with minimal time and cost among staff groups like mental health nurses. This could lead to greater access to evidence-based talking therapy for people experiencing depression.


Depression causes significant distress, disability and cost within the UK. Behavioural activation (BA) is an effective single-strand psychological approach which may lend itself to brief training programmes for a wide range of clinical staff. No previous research has directly examined outcomes of such dissemination. A 5-day training course for 10 primary care mental health workers aiming to increase knowledge and clinical skills in BA was evaluated using the Training Acceptability Rating Scale. Depression symptom level data collected in a randomized controlled trial using trainees were then compared to results from meta-analysis of studies using experienced therapists. BA training was highly acceptable to trainees (94.4%, SD 6%). The combined effect size of BA was unchanged by the addition of the results of this evaluation to those of studies using specialist therapists. BA offers a promising psychological intervention for depression that appears suitable for delivery by mental health nurses following brief training.