The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis

Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of...

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Bibliographic Details
Published in:Psychological medicine Vol. 49; no. 12; pp. 1937 - 1947
Main Authors: López-López, José A., Davies, Sarah R., Caldwell, Deborah M., Churchill, Rachel, Peters, Tim J., Tallon, Deborah, Dawson, Sarah, Wu, Qi, Li, Jinshuo, Taylor, Abigail, Lewis, Glyn, Kessler, David S., Wiles, Nicola, Welton, Nicky J.
Format: Journal Article
Language:English
Published: Cambridge, UK Cambridge University Press 01.09.2019
Subjects:
Adult
Adults
Cognitive ability
Cognitive behavioral therapy
Cognitive Behavioral Therapy - methods
Collaboration
Combination therapy
Components
Depression - therapy
Depressive Disorder, Major - therapy
Effectiveness
Humans
Intervention
Medical diagnosis
Medical research
Medical treatment
Mental depression
Meta-analysis
Multimedia
Performance evaluation
Public health
Randomized Controlled Trials as Topic
Review
Systematic review
Technology
Therapists
Therapy
Waiting Lists
Cognitive-behavioural therapy
multimedia
depression
network meta-analysis
systematic review
ISSN:0033-2917, 1469-8978, 1469-8978
Online Access:Get full text
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Summary:Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
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These authors contributed equally to this paper.
ISSN:0033-2917
1469-8978
1469-8978
DOI:10.1017/S003329171900120X