Abstract
The COVID-19 pandemic highlighted the need for mental health interventions that can be easily disseminated during a crisis. Behavioural activation (BA) is a cost-effective treatment that can be administered by non-specialists; however, it is unclear whether it is still effective during a time of lockdown and social distancing, when opportunities for positive activity are significantly constrained. Between May and October 2020, we randomised 68 UK participants with mild to moderate low mood to either a 4-week online programme of non-specialist administered BA or to a passive control group. Before and after the intervention, we collected self-report data on mood and COVID-related disruption, as well as measuring emotional cognition as an objective marker of risk for depression. In comparison to the control group, the BA group showed a significant decrease in depression, anxiety and anhedonia after the intervention, as well as an increase in self-reported activation and social support. Benefits persisted at 1-month follow-up. BA also decreased negative affective bias on several measures of the Facial Emotion Recognition Task and early change in bias was associated with later therapeutic gain. Participants rated the intervention as highly acceptable. This study highlights the benefits of online BA that can be administered by non-specialists after brief training. These findings can help inform the policy response towards the rising incidence of mental health problems during a crisis situation such as a pandemic. They also highlight the use of objective cognitive markers of risk across different treatment modalities.
Highlights
The COVID-19 pandemic has brought about unprecedented disruption in most areas of society
Contracting COVID-19 has itself been associated with psychiatric sequelae (Taquet, Luciano, Geddes, & Harrison, 2021), which may increase the rate of mental health issues further
Previous work has suggested that emotional cognitive measures can be sensitive to the therapeutic effects of antidepressant medication prior to effects on mood and may represent an early marker of response (Harmer, Duman, & Cowen, 2017). These markers have not been explored in Behavioural activation (BA) for depression and it is unknown whether interventions largely targeting behaviour would influence these kinds of cognitive processes. In this randomised controlled study, we investigated whether a 4-week course of remote non-specialist administered BA can reduce depression and anxiety and increase activation during a period of social distancing restrictions
Summary
The COVID-19 pandemic has brought about unprecedented disruption in most areas of society. Bland et al (2021) examined emotional cognition between April and May 2020 in a sample with no previous mental health problems and found significantly reduced recognition of happy faces, in those who experienced greater disruption of social contact This further supports the evidence that psychological vulnerability has increased during COVID-19 and can be detected using objective cognitive markers. This study highlights the benefits of online BA that can be administered by nonspecialists after brief training These findings can help inform the policy response towards the rising incidence of mental health problems during a crisis situation such as a pandemic. They highlight the use of objective cognitive markers of risk across different treatment modalities
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