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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Vydáno v:Psychological medicine Ročník 49; číslo 12; s. 1937 - 1947
Hlavní autoři: 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.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Cambridge, UK Cambridge University Press 01.09.2019
Témata:
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
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Abstract 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.
AbstractList 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.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.
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.
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.
Author Davies, Sarah R.
Li, Jinshuo
Lewis, Glyn
Tallon, Deborah
Wu, Qi
Caldwell, Deborah M.
López-López, José A.
Welton, Nicky J.
Taylor, Abigail
Kessler, David S.
Wiles, Nicola
Dawson, Sarah
Churchill, Rachel
Peters, Tim J.
AuthorAffiliation 5 Faculty of Health Sciences , University of York , York , UK
2 Centre for Academic Mental Health , Bristol Medical School , University of Bristol , Bristol , UK
3 Department of Basic Psychology & Methodology , Faculty of Psychology , University of Murcia , Murcia , Spain
6 Division of Psychiatry , Faculty of Brain Sciences , University College London , London , UK
4 Centre for Reviews and Dissemination , University of York , York , UK
1 Department of Population Health Sciences , Bristol Medical School , University of Bristol , Bristol , UK
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– name: 6 Division of Psychiatry , Faculty of Brain Sciences , University College London , London , UK
– name: 4 Centre for Reviews and Dissemination , University of York , York , UK
– name: 3 Department of Basic Psychology & Methodology , Faculty of Psychology , University of Murcia , Murcia , Spain
– name: 1 Department of Population Health Sciences , Bristol Medical School , University of Bristol , Bristol , UK
– name: 2 Centre for Academic Mental Health , Bristol Medical School , University of Bristol , Bristol , UK
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  orcidid: 0000-0002-9655-3616
  surname: López-López
  fullname: López-López, José A.
  email: josealopezlopez@um.es
  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
– sequence: 2
  givenname: Sarah R.
  surname: Davies
  fullname: Davies, Sarah R.
  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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  surname: Caldwell
  fullname: Caldwell, Deborah M.
  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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  surname: Churchill
  fullname: Churchill, Rachel
  organization: 4Centre for Reviews and Dissemination, University of York, York, UK
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  surname: Peters
  fullname: Peters, Tim J.
  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
– sequence: 7
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  surname: Dawson
  fullname: Dawson, Sarah
  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
– sequence: 8
  givenname: Qi
  surname: Wu
  fullname: Wu, Qi
  organization: 5Faculty of Health Sciences, University of York, York, UK
– sequence: 9
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  surname: Li
  fullname: Li, Jinshuo
  organization: 5Faculty of Health Sciences, University of York, York, UK
– sequence: 10
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  surname: Taylor
  fullname: Taylor, Abigail
  organization: 1Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/31179960$$D View this record in MEDLINE/PubMed
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Copyright Copyright © Cambridge University Press 2019
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IsDoiOpenAccess true
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Issue 12
Keywords Cognitive-behavioural therapy
multimedia
depression
network meta-analysis
systematic review
Language English
License This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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These authors contributed equally to this paper.
ORCID 0000-0002-9655-3616
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PublicationTitle Psychological medicine
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  doi: 10.1016/j.eurpsy.2017.07.003
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  doi: 10.1136/bmj.331.7521.897
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Snippet Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components...
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StartPage 1937
SubjectTerms 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
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Title The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis
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