The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination

Blackburn, I. M.; Bishop, Sue Marquis; Glen, A.I.M.; Whalley, Lawrence J.; Christie, J. E.

doi:10.1192/bjp.139.3.181

Cited by 510 publications

(197 citation statements)

References 24 publications

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“…For depression studies, 21 studies were included [7,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] with 1,095 patients randomized to medication and 932 patients randomized to therapy. Forest plots of posttreatment CBT minus medication effect sizes are shown in Figures 2 and 3 for anxiety and depression, respectively.…”

Section: Resultsmentioning

confidence: 99%

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

et al. 2011

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Background: Little is known about whether cognitive behavioral therapy (CBT) or pharmacotherapy is relatively more advantageous for depressive versus anxiety disorders. Methods: We conducted a meta-analysis wherein we searched electronic databases and references to select randomized controlled studies comparing CBT and pharmacotherapy, with or without placebo, in adults with major depressive or anxiety disorders. The primary effect size was calculated from disorder-specific outcome measures as the difference between CBT and pharmacotherapy outcomes (i.e., positive effect size favors CBT; negative effect size favors pharmacotherapy). Results: Twenty-one anxiety (N 5 1,266) and twenty-one depression (N 5 2,027) studies comparing medication to CBT were included. Including all anxiety disorders, the overall effect size was .25 (95% CI: À0.02, 0.55, P 5.07). Effects for panic disorder significantly favored CBT over medications (.50, 95% CI: 0.02, 0.98). Obsessive-compulsive disorder showed similar effects-sizes, though not statistically significant (.49, 95% CI: À0.11, 1.09). Medications showed a nonsignificant advantage for social anxiety disorder (À.22, 95% CI: À0.50, 0.06). The overall effect size for depression studies was .05 (95% CI: À0.09, 0.19), with no advantage for medications or CBT. Pooling anxiety disorder and depression studies, the omnibus comparison of the relative difference between anxiety and depression in effectiveness for CBT versus pharmacotherapy pointed to a nonsignificant advantage for CBT in anxiety versus depression (B 5 .14, 95% CI: À0.14, 0.43). Conclusions: On balance, the evidence presented here indicates that there are at most very modest differences in effects of CBT versus pharmacotherapy in the treatment of anxiety versus depressive disorders. There seems to be larger differences between the anxiety disorders in terms of their relative responsiveness to pharmacotherapy versus CBT. Depression and Anxiety 28:560-567, 2011.

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Section: Resultsmentioning

confidence: 99%

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

et al. 2011

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“…Gloaguen et al (1998) found that CBT was significantly better than antidepressant medication. This conclusion may overstate the case for CBT since Gloaguen et al (1998) included some early studies comparing CT with medications, which had methodological features that favored CT. One study (Rush, Beck, Kovacs, & Hollon, 1977) started tapering medications 1 week prior to the end of therapy, and another study (Blackburn, Bishop, Glen, Whalley, & Christie, 1981) was an effectiveness study in which the comparison group showed an unusually low response to medication. More recently, however, a major high-quality controlled trial comparing CT with a commonly prescribed serotonin reuptake inhibitor (paroxetine) found that cognitive therapy was equally effective for the initial treatment of moderate to severe major depression .…”

Section: Depressionmentioning

confidence: 99%

The empirical status of cognitive-behavioral therapy: A review of meta-analyses

Butler

Chapman

Forman

et al. 2006

Clinical Psychology Review

2,723

1,541

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This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT. D 2005 Elsevier Ltd. All rights reserved.Cognitive-behavioral therapy is one of the most extensively researched forms of psychotherapy. Over 120 controlled clinical trials were added to the literature in the eight years between 1986(Hollon & Beck, 1994 and this proliferation has continued (Dobson, 2001). There are now over 325 published outcome studies on cognitive-behavioral interventions. This growth is due in part to the ongoing adaptation of CBT for an increasingly wider range of disorders and problems (Beck, 1997;Salkovskis, 1996). Yet, many questions remain regarding the overall effectiveness of CBT, its differential effectiveness by disorder, the nature of the control groups by which its effectiveness has been established, and the extent to which its effects persist following the cessation of treatment. In this paper we review evidence from meta-analyses that address these questions. Our approach is unique in that we systematically summarize findings across high-quality meta-analyses for 16 different disorders. We focus on direct comparisons of CBT to alternative treatments wherever possible.A review of meta-analyses on CBT outcomes is particularly relevant to the ongoing debate about the comparative efficacy of different treatments (Rounsaville & Carroll, 2002). For instance, a recent review of meta-analyses and 0272-7358/$ -see front matter D

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“…1. Thirty-five studies met inclusion criteria [2][3][4]5,6,8,[15][16][17][18]20,21,24,27,31,33,34,[40][41][42][43]45,46,[50][51][52][53][56][57][58][60][61][62]65,66]. Fig.…”

Section: Selection and Inclusion Of Studiesmentioning

confidence: 99%

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

et al. 2015

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BackgroundRandomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias.MethodsWe searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses.ResultsWe did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = −0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = −0.13; NNT = 14).ConclusionsStudies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy.

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The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination

Cited by 510 publications

References 24 publications

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

The empirical status of cognitive-behavioral therapy: A review of meta-analyses

The Effects of Blinding on the Outcomes of Psychotherapy and Pharmacotherapy for Adult Depression: a Meta-Analysis

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