Behavioral activation for depression: A comprehensive systematic review and meta-analysis

No recent comprehensive meta-analysis has integrated the results of randomized controlled trials of Behavioral activation (BA), one of the most important treatments of depression.

We used the data from our meta-analytic research domain of randomized controlled trials on the treatment of depression and selected all trials on BA in all age and target groups, settings and comparators.

We included 105 trials (13,933 patients), including 40 with low risk of bias. The standardized mean difference (SMD) of BA for adult outpatients compared with control conditions was 0.67 (95% confidence interval [CI]: 0.54 to 0.80; k = 61) with high heterogeneity (I² = 71%; 95% CI: 63% to 78%) and a broad 95% prediction interval (PI; -0.11 to 1.46). This remained significant in most sensitivity analyses, and at 12 months after randomization. We found no significant difference between BA and other therapies (k = 27; SMD = 0.04; 95% CI: -0.10 to 0.18). Self-guided BA was also effective (k = 15; SMD = 0.36; 95% CI: 0.20 to 0.51), as was BA in institutional settings (k = 10; SMD = 0.36; 95% CI: 0.17 to 0.55). Too few trials were available to estimate the effects of BA in children and adolescents (k = 4) and when compared to pharmacotherapy in adults (k = 4).

BA is an efficacious treatment of depression in adults and its effect is significant up to 12 months after randomization. BA has smaller but significant effects in a self-guided format and in institutional settings.