Psych CASC / OSCE · Psychotherapy
CASC: Behavioural activation — evening withdrawal in depression
Ten-minute station: engage a patient with depression who waits for motivation, deliver outside-in BA psychoeducation, co-create a graded next-step plan, introduce TRAP/TRAC in plain language, check risk, and set homework.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
CASC: Behavioural activation — evening withdrawal in depression
Candidate instructions
You are the psychiatry registrar. Sam, 38, teacher, major depression for 4 months. PHQ-9 was 18 last week. Evenings: bed, scrolling, cancelled social plans, "I'll start when I feel motivated." No psychosis. Passive death wishes when most withdrawn; no plan or intent today. Prefers a practical therapy start rather than a long CBT wait. Tasks in 10 minutes:[14][15]
- Engage and set a collaborative agenda about low activity and mood.
- Explain BA outside-in model briefly without lecturing.
- Map one evening TRAP and co-create a TRAC alternative.
- Negotiate one graded, scheduled homework for the next 48 hours.
- Screen risk (suicide) and safety-net.
- Agree follow-up and what success looks like.
References5ShowHide
- [1]Dimidjian S, Hollon SD, Dobson KS, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression J Consult Clin Psychol, 2006.PMID 16881773
- [5]Richards DA, Ekers D, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA) Lancet, 2016.PMID 27461440
- [12]Uphoff E, Ekers D, et al. Behavioural activation therapy for depression in adults Cochrane Database Syst Rev, 2020.PMID 32628293
- [14]Dimidjian S, Barrera M Jr, Martell C, et al. The origins and current status of behavioral activation treatments for depression Annu Rev Clin Psychol, 2011.PMID 21275642
- [15]Kanter JW, Manos RC, et al. What is behavioral activation? A review of the empirical literature Clin Psychol Rev, 2010.PMID 20677369