The talk first study (Korero i te tuatahi when translated in to Maori): A comparison of the efficacy of Behavioural Activation (BA) compared to Sertraline (a medication) in the treatment of low mood.

The intervention is based on the work of Kirk Strosahl, who developed the therapy known as Focused Acceptance and Commitment Therapy (FACT) which is modified Acceptance and Commitment therapy for primary care. Each eligible intervention patient will get a work/love/play assessment (available from www.brucearroll.com free of charge) which checks on a 1 to 10 scale for how daily life (work, study etc.) is going, love as in friends, love as in intimates, love as in family and play (recreation hobbies etc.). This will be done by the research assistant or one of the investigators on a one on one basis. There will also be open-ended questions on exercise, smoking, sleep, recreational drugs, alcohol, gambling issues in self or family, violence, citizenship/community involvement and if there is a spiritual/religious component to their lives and if they have any unresolved trauma. The purpose of this assessment is to determine the avoidance e.g. not seeing their friends or escape behaviours (e.g. excessive alcohol) and to reverse some or all of those behaviours. Motivational interviewing techniques will be used to reverse these behaviours and patients will be asked what they would be willing to change (based on their work love play responses) and then how likely on a scale of 1 to 10 they will do this in the next 1 -2 weeks. A score of 7 or more is required; otherwise the interviewer will renegotiate the activity until they get a score of 7 or more. The avoidance and escape behaviours will be used as a target for behavioural change using a task sheet for homework. This is a blank piece of paper on which the researcher writes "Task list" and asks the patient what they are willing to change (focusing on the behaviours and escapes that need reversing. Up to four behaviours will be recorded on the list and the score out of 10 for how likely they are to be done. The intervention will be done on the day of enrolment and face to face where possible. Where this is not possible, it will be done either by phone or by a later face to face appointment. The duration of the intervention will be about 10 minutes, with an additional 10 minutes to complete the study documentation forms and questionnaires. The interviews will be done in a GP clinic in a separate room. At two weeks and six weeks, a repeat of the intervention will be given to those who score ten or more on the PHQ 8 at those visits or in any patient who would like a further intervention. Fidelity to the intervention protocol will be done on 10% of participants via a consented recording.