A meta-analysis of randomized trials of behavioural treatment of depression

Abstract

Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. Background. Depression is a common, disabling condition for which psychological treatments, in particular cognitive behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for depression, determine the effect of such interventions and examine any moderators of such effect.Method. Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/ dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were extracted and analysed using meta-analysis and meta-regression respectively.Results. Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls [standardized mean difference (SMD) x0.70, 95 % CI x1.00 to x0.39, k=12, n=459], brief psychotherapy (SMD x0.56, 95 % CI x1.0 to x0.12, k=3, n=166), supportive therapy (SMD x0.75, 95 % CI x1.37 to x0.14, k=2, n=45) and equal to cognitive behavioural therapy (SMD 0.08, 95 % CI x0.14 to 0.30, k=12, n=476).Conclusions. The results in this study indicate behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues of parsimony of such interventions.

CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness

“…The effectiveness of this psychological approach is now well demonstrated. 27 Behavioural activation can be readily delivered by a trained case manager either over the telephone or face to face for those who experience difficulty using or accessing telephone-based therapy. 28 …”

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

“…For example, behavioural activation (BA), whereby activity scheduling is used to increase the individual's exposure to rewarding stimuli in order to lift mood, has well-established efficacy in the treatment of depression (Cuijpers, van Straten, & Warmerdam, 2007;Ekers, Richards, & Gilbody, 2008;Mazzucchelli, Kane, & Rees, 2009), and may be just as effective as more complex CBT interventions (Jacobson et al, 1996). A pilot study trialling BA for psychosis (Mairs, Lovell, Campbell, & Keeley, 2011) reported promising results from 8 patients indicating feasibility, treatment adherence and initial outcomes: non-significant improvements in depression, positive symptoms and negative symptoms.…”

Cognitive and Behavioral Changes Related to Symptom Improvement Among Patients with a Mood Disorder Receiving Intensive Cognitive-behavioral Therapy

“…In the cognitive model, Beck and his colleagues 6 posit that decreased maladaptive cognitions mediate symptom alleviation, whereas in Lewinsohn's behavioral model, 7 increased contact with reinforcing environmental contingencies (i.e., behavioral activation) results in symptom improvement. Recent mediational and component analyses have yielded support for both behavioral 8,9 and cognitive 10--13 mechanisms of change in the amelioration of mood symptoms; however, several studies investigating the relative importance of This document has undergone peer review. This is a non-final version of an article published in final form in Journal of Psychiatric Practice:…”