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

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages11
JournalPsychological Medicine
Early online date10 Jun 2019
DOIs
DateAccepted/In press - 7 May 2019
DateE-pub ahead of print (current) - 10 Jun 2019

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.

    Research areas

  • Cognitive-behavioural therapy, depression, multimedia, network meta-analysis, systematic review

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Cambridge University Press at https://www.cambridge.org/core/journals/psychological-medicine/article/process-and-delivery-of-cbt-for-depression-in-adults-a-systematic-review-and-network-metaanalysis/E68AB70E04AC256DD6508B61B9E7E08B . Please refer to any applicable terms of use of the publisher.

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