Cognitive Therapy or Behavioral Activation for Major Depressive Disorder in Dutch Mental Health Care: Pilot Effectiveness and Process Trial

Few studies have investigated the association between psychotherapeutic approaches and their processes in routine psychological practice. We compared cognitive therapy (CT) and behavioral activation (BA) on their effectiveness and change processes. Forty-three depressed patients participated in our trial. Scores on depression and specific and nonspecific factors were collected at seven time points and analyzed using RM-ANOVA and multiple linear regressions. No differences in depression reduction emerged between conditions. Most processes changed during therapy. Only measures of negative cognitions and behavioral activation interacted with treatment condition. Change on the processes did not predict symptom alleviation. Similarly, reductions in depression were not followed by change on any of the process measures. Both psychotherapeutic approaches led to significant and comparable symptom reduction. There was no clear evidence of differential change with respect to purported underlying mechanisms. The results are discussed in the context of therapy and research.