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dc.contributor.authorFinning, K
dc.contributor.authorRichards, DA
dc.contributor.authorMoore, L
dc.contributor.authorEkers, D
dc.contributor.authorMcMillan, D
dc.contributor.authorFarrand, PA
dc.contributor.authorO'Mahen, HA
dc.contributor.authorWatkins, ER
dc.contributor.authorWright, KA
dc.contributor.authorFletcher, E
dc.contributor.authorRhodes, S
dc.contributor.authorWoodhouse, R
dc.contributor.authorWray, F
dc.date.accessioned2017-05-09T08:07:49Z
dc.date.issued2017-04-13
dc.description.abstractOBJECTIVE: To explore participant views on acceptability, mechanisms of change and impact of behavioural activation (BA) delivered by junior mental health workers (MHWs) versus cognitive behavioural therapy (CBT) delivered by professional psychotherapists. DESIGN: Semistructured qualitative interviews analysed using a framework approach. PARTICIPANTS: 36 participants with major depressive disorder purposively sampled from a randomised controlled trial of BA versus CBT (the COBRA trial). SETTING: Primary care psychological therapies services in Devon, Durham and Leeds, UK. RESULTS: Elements of therapy considered to be beneficial included its length and regularity, the opportunity to learn and not dwelling on the past. Homework was an important, although challenging aspect of treatment. Therapists were perceived as experts who played an important role in treatment. For some participants the most important element of therapy was having someone to talk to, but for others the specific factors associated with BA and CBT were crucial, with behavioural change considered important for participants in both treatments, and cognitive change unsurprisingly discussed more by those receiving CBT. Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves, self-care, work and relationships. Barriers to therapy included work, family life and emotional challenges. A subset (n=2) of BA participants commented that therapy felt too simple, and MHWs could be perceived as inexperienced. Many participants saw therapy as a learning experience, providing them with tools to take away, with work on relapse prevention essential. CONCLUSIONS: Despite barriers for some participants, BA and CBT were perceived to have many benefits, to have brought about cognitive and behavioural change and to produce improvements in many domains of participants' lives. To optimise the delivery of BA, inexperienced junior MHWs should be supported through good quality training and ongoing supervision. TRIAL REGISTRATION NUMBER: ISRCTN27473954, 09/12/2011.en_GB
dc.description.sponsorshipThis work was funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment programme grant number 10/50/14. DAR is also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.en_GB
dc.identifier.citationVol. 7, Iss. 4, pp. e014161en_GB
dc.identifier.doi10.1136/bmjopen-2016-014161
dc.identifier.otherbmjopen-2016-014161
dc.identifier.urihttp://hdl.handle.net/10871/27436
dc.language.isoenen_GB
dc.publisherBMJ Publishing Groupen_GB
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/28408544en_GB
dc.rightsArticle author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/en_GB
dc.subjectDepression and mood disordersen_GB
dc.subjectMental healthen_GB
dc.subjectQualitative researchen_GB
dc.titleCost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation.en_GB
dc.typeArticleen_GB
dc.date.available2017-05-09T08:07:49Z
exeter.place-of-publicationEnglanden_GB
dc.descriptionPublished onlineen_GB
dc.descriptionJournal Articleen_GB
dc.descriptionThis is the final version of the article. Available from BMJ Publishing Group via the DOI in this record.en_GB
dc.identifier.eissn2044-6055
dc.identifier.journalBMJ Openen_GB


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