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[Comment] Global dissemination and implementation of behavioural activation

In The Lancet, David Richards and colleagues1 present the Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA) trial—one of the largest randomised controlled trials so far of psychotherapy for depression—comparing junior, low-cost mental health workers delivering a simple treatment (behavioural activation [BA]) to experienced psychological therapists delivering the gold-standard treatment (cognitive behavioural therapy [CBT]). Results identified BA as non-inferior to (mean difference 0·1 Patient Health Questionnaire 9 points [95% CI −1·3 to 1·5], p=0·89) and more cost-effective than (incremental cost-effectiveness ratio –£6865) CBT.