Cognitive behavioral therapy for primary care depression and anxiety: a secondary meta-analytic review using robust variance estimation in meta-regression

Zhang, Anao; Borhneimer, Lindsay A.; Weaver, Addie; Franklin, Cynthia; Hai, Audrey Hang; Guz, Samantha; Шен, Ли

doi:10.1007/s10865-019-00046-z

Cited by 76 publications

(47 citation statements)

References 114 publications

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“…Similar findings have been reported for CBT use in the older population with and without generalized anxiety or depressive disorders. 33,34,66 Previous systematic reviews reporting meta-regression for CBT interventions in older people with and without COPD have included combinations of variables reflecting characteristics of the CBT intervention (ie, number of sessions, duration of program, individual or group), 12,33,34,66 the comparator (passive or active), 33,34 study quality (sample size, appraisal scores) 12,33,34 and/or participants (age, sex, presence of anxiety/depression symptoms). 12,33,34 Few variables have been identified which significantly predict effect sizes for CBT interventions (treatment durationlonger duration, smaller effect sizes 34 ), type of control group (non-active vs active 33 ), sessions per week (>1 per week 66 ) and complexity of the CBT intervention (CBT augmented by motivational interviewing vs CBT alone 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…31 In selecting our predictor variables, we were guided by prior meta-regression of CBT interventions specific to people with COPD 12 or older adults. 33,34 Given the variability in the way CBT has been delivered, our primary interest was to explore predictors of effect size reflecting resource intensity dyads, and protocol components of both the CBT intervention and comparator, rather than participant characteristics. 12,33,34 Models were run separately for each outcome category, unless the number of studies was too low (<10).…”

Section: Data Management and Synthesismentioning

confidence: 99%

“…33,34 Given the variability in the way CBT has been delivered, our primary interest was to explore predictors of effect size reflecting resource intensity dyads, and protocol components of both the CBT intervention and comparator, rather than participant characteristics. 12,33,34 Models were run separately for each outcome category, unless the number of studies was too low (<10). 32 Analyses were done separately for quality-of-life mental wellbeing and physical domains, with overall scores being used in both analyses for studies for which subdomain scores were not available.…”

Section: Data Management and Synthesismentioning

confidence: 99%

See 2 more Smart Citations

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

Williams¹,

Johnston²,

Paquet³

2020

COPD

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Cognitive behavioral therapy (CBT) is increasingly recommended in the management of people living with chronic obstructive pulmonary disease (COPD). This rapid review presents the evidence base for CBT for people with COPD and describes 1) the nature of CBT interventions and comparators in controlled trials (high or low resource intensity); and 2) factors influencing intervention effects on health outcomes (anxiety, depression, breathlessness, quality of life and exercise capacity). Primary studies reporting CBT interventions in adults with COPD were identified with data extracted by a single reviewer (20% of studies checked for data accuracy). Studies were synthesized descriptively with meta-analyses (random effects models) of controlled trials undertaken to report mean standardized effect sizes (95% CI) for health outcomes. Random effects meta-regression models explored whether CBT target, intervention dosage, intensity, facilitator profession, delivery mode, clinically significant anxiety/depression, trial design/quality and sample size predicted effect size. The search identified 33 primary studies published between 1996 and 2019 (controlled trials n=24, single group cohort n=6, case exemplars n=2, phenomenological n=1). Controlled trials frequently compared high-intensity CBT interventions against enhanced/ usual care (n=12) or high-intensity CBT interventions against high-intensity comparators (n=11). When all controlled studies were included, small, significant improvements favoring CBT were evident across all health outcomes (SMD ranged from −0.27 to 0.35, p<0.05). When intensity dyads were considered, significant improvements were evident only when high-intensity CBT interventions were compared to enhanced usual care/usual care (SMDs ranged from −0.45 to 0.54, p <0.05). No other variable consistently predicted intervention effect sizes across all health outcomes. Overall, the evidence base supports the use of CBT for a range of health outcomes in people with COPD. Consistent benefits were evident when high-resource-intensive CBT interventions were compared to usual care. Low-resourceintensity CBT warrants further investigation in settings where cost of comprehensive care is prohibitive.

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Section: Discussionmentioning

confidence: 99%

Section: Data Management and Synthesismentioning

confidence: 99%

Section: Data Management and Synthesismentioning

confidence: 99%

See 1 more Smart Citation

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

Williams¹,

Johnston²,

Paquet³

2020

COPD

View full text Add to dashboard Cite

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“…Meta-analyses indicate that psychological interventions for depression outperform waitlist, sham, or usual care control comparisons in primary care, with effect sizes ranging from small to medium [22][23][24][25][26][27][28]. There is some evidence that psychotherapy provided in research studies or specialty clinics is associated with larger effect sizes, which could be due to enhanced personalization, longer treatment length, patient characteristics, or provider availability and experience [26,27]. Barriers to psychotherapy are similar to pharmacotherapy and include poor treatment attendance and adherence, limited access to psychotherapy in primary care, and inconsistent use of measurement-based care across practices.…”

Section: Components Of Depression Treatment In the Pcmhmentioning

confidence: 99%

The Role of the Patient-Centered Medical Home in Treating Depression

Bogucki

Williams

Solberg

et al. 2020

Curr Psychiatry Rep

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Purpose of Review This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. Recent Findings Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. Summary The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.

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“…Cognitive behavioral therapy (CBT) has been substantially proven to be an effective psychosocial treatment in managing depression and anxiety [3,4]. However, some reviews showed that the effect sizes of CBT for depression have steadily decreased since its inception four decades ago [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial on the Comparative Effectiveness of Mindfulness-Based Cognitive Therapy and Health Qigong-Based Cognitive Therapy Among Chinese People With Mood Disorders

Chan

Chao

et al. 2020

Preprint

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Background: The goal of this study was to investigate treatment outcome and related intervention processes of mindfulness-based cognitive therapy (MBCT) versus health qigong-based cognitive therapy (HQCT) versus waitlist control (WC) among individuals with mood disorders.Methods: A total of 187 individuals with mood disorders were randomized and allocated into MBCT, HQCT, or WC groups. All participants were assessed at three time points with regard to mood symptoms, physical and mental health status, perceived stress, sleep quality, and self-efficacy. Linear mixed models analysis was used to test the individual growth model by studying the longitudinal data.Results: MBCT and HQCT both produced greater improvements on most outcome measures as compared with WC. Relatively, more reductions of mood symptoms were observed in the HQCT group as compared with the MBCT group. HQCT is more conducive to physical health status whereas MBCT has more favorable mental health outcomes. Individual growth curve models indicated that alternations in perceived stress was the common predictor of mood changes in both intervention groups. Conclusions: The predominant emphasis on physical health in HQCT makes it more acceptable and effective than MBCT as applied in Chinese individuals with mood disorders. The influence of Chinese culture is discussed. Trial registration: HKU Clinical Trials Registry. Identifier: HKUCTR-2558. Registered 21st Nov 2018.

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Cognitive behavioral therapy for primary care depression and anxiety: a secondary meta-analytic review using robust variance estimation in meta-regression

Cited by 76 publications

References 114 publications

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

<p>Cognitive Behavioral Therapy for People with Chronic Obstructive Pulmonary Disease: Rapid Review</p>

The Role of the Patient-Centered Medical Home in Treating Depression

A Randomized Controlled Trial on the Comparative Effectiveness of Mindfulness-Based Cognitive Therapy and Health Qigong-Based Cognitive Therapy Among Chinese People With Mood Disorders

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