A More Cost-Effective Tx for Depression?

We here at Sound are big fans of accessibility. One of the many things that attracted us to Salvador Minuchin’s work was his emphasis on community-based access to care. As director of the Philadelphia Child Guidance Clinic in the 60s and 70, Minuchin spearheaded “lay therapists,” community members with no formal degree who were trained to do family therapy. In addition to the benefits families received from working with persons who were from their same socio-cultural context, the treatment was more affordable and accessible for both the families and the clinic.

So our interest was piqued when we came across this Lancet article publishing the findings comparing behavioral activation treatment and cognitive behavioral treatment for depression for adults. Sure, it is interesting that behavioral activation, a treatment that focuses on helping people with depression to change the way they act (rather than change the way they think), did just as well regarding effectiveness than CBT. What’s really interesting is that the behavioral activation treatment cost twenty percent less.


Why, you may ask? Well, like the “lay therapists” at Minuchin’s PCGC, the behavioral activation treatment was provided by lay professionals. The CBT, on the other hand, was provided by licensed professionals.

The authors of the study, including David Richards of the University of Exeter in England, contend that these findings show that behavioral activation could increase the availability of effective therapy, as well as reduce the need for costly professional training.

Does everyone with a ‘mental disorder’ diagnosis need treatment?

A study that came out this past summer found that many people diagnosed with substance abuse, anxiety, or depressive disorders recover within a year of diagnosis without treatment. “This study further supports the argument that meeting diagnostic criteria for a mental disorder does not necessarily indicate a need for mental health treatment,” the researchers, led by Jitender Sareen from the University of Manitoba, writes.


This study, which reviewed data from the Netherlands Mental Health Survey and Incidence Study (NEMESIS, N=5,618), is consistent with past research that indicates that cases of mental distress can be temporary and remit without treatment.

Similar research conducted by some of the same authors of this study found that a substantial portion of individuals diagnosed with ‘severe mental disorders’ no longer met the criteria for their diagnosis one year later, whether they had treatment or not.

The data of this current study reveals that over half of the 5,618 no longer met the criteria for their disorder at follow-up without receiving any mental health services. However, these individuals had lower quality of life compared to healthy individuals.

This data point regarding the lower quality of life is a curious one. The authors portend that it indicates the negative impact on the presence of residual symptoms from the diagnosis. As firm believers in supporting people to pursue meaning and fulfillment in their lives alongside uncomfortable experiences (symptomatic or otherwise), we applaud this research for questioning the common assumption that a diagnosis is a signal for the need for treatment. We also would like to turn the question on its head: must a person need to qualify for a diagnosis in order to engage in therapy?

Diversity in Couple and Family Therapy

Hello and happy new year to all.

A quick post to announce that we, the founders of Sound Behavioral Health, Matt Wofsy and Brian Mundy, have a new publication out. We were honored to write a chapter on diverse couple and family forms (chapter 13) in the wonderful Shalonda Kelly, PhD’s edited tome Diversity in Couple and Family Therapy.



We had a lot of fun writing this chapter, which includes family structures such as kinship families, same sex surrogate families, and adoptive families. One of the pleasures of working in New York City is being able to learn about and work with many diverse family forms.