Workshop 5

Behavioural Activation and Beyond

David Veale, Kings College London

Depression is highly heterogenous condition for which there are many weak evidence-based treatments. This maybe because therapy it is not sufficiently modular and not always driven by a formulation of cognitive processes (e.g., ruminating, fantasying, self-criticism) or avoidance or compensatory behaviours (e.g., sleep, diet, exercise, or sex) that maintain the depression. Functional analysis can focus on these processes and within the therapeutic relationship to develop a formulation to help direct the intervention. I will include novel interventions like changing diet, use of sleep deprivation and bright light therapy that are consistent with behavioural activation.

Key learning objectives:

By the end of the workshop participants will be able to:

  1. Describe the theory, principles, and different types of Behavioural Activation (BA)
  2. Describe the principles of rumination based cognitive therapy and functional analytical psychotherapy, and how these relate to BA
  3. Perform an assessment of avoidance and compensatory strategies in people with depression including a novel self-report measure
  4. Perform a functional analysis and formulation of cognitive processes and behaviours in people with depression
  5. Devise an appropriate BA programme, including a two-week intensive programme
  6. Assess diet and recommend nutritional interventions for depression
  7. Prescribe phototherapy and triple chronotherapy for the rapid treatment of depression

David Veale, FRCPsych is a Consultant Psychiatrist and leads a national outpatient and residential unit service for people with severe treatment refractory Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD) at the South London and Maudsley Trust. He is a Visiting Professor in Cognitive Behaviour Therapies at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. He was a member of the group revising the diagnostic guidelines for ICD11 for Obsessive Compulsive and Related Disorders for the World Health Organisation. He was a member of the group that wrote the NICE guidelines on OCD and BDD in 2006. He has authored or co-authored 120 empirically based articles, six books, 15 book chapters, and 35 teaching articles or reviews. He is an Honorary Fellow of the British Association of Behavioural and Cognitive Psychotherapies, a Fellow of the British Psychological Society and Fellow of the Royal College of Psychiatrists. He is a Trustee of the national charities, OCD Action and the BDD Foundation and Emet Action.

Key References

Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, Stubbs B, Schuch FB, Carvalho AF, Jacka F, Sarris J. The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosom Med. 2019 Apr;81(3):265-280. doi: 10.1097/PSY.0000000000000673

Martell, C. R., Addis, M. E. & Jacobson, N. S. (2001) Depression in Context: Strategies for Guided Action. Norton

Veale, D. (2008). Behavioural activation for depression. Advances in Psychiatric Treatment, 14(1), 29-36. doi:10.1192/apt.bp.107.004051

Veale, D., Serfaty, M., Humpston, C., Papageorgiou, A., Markham, S., Hodsoll, J., & Young, A. (2021). Out-patient triple chronotherapy for the rapid treatment and maintenance of response in depression: Feasibility and pilot randomised controlled trial. BJPsych Open, 7(6), E220. doi:10.1192/bjo.2021.1044

Watkins, E. Rumination-Focused Cognitive-Behavioral Therapy for Depression, Guildford Press

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