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

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.

School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis

“…Our typology of interventions and control conditions was based on previous literature, [29][30][31][32]35 piloting, and discussion in our team. Nevertheless, we acknowledge that the process of categorising complex interventions is subjective 40 and future work should agree on a process for node-making as well as agreeing on a taxonomy for classifying psychological interventions.…”

“…Intervention and control descriptions are provided in the appendix (p 15). Following classifications adopted in previous reviews,16,[29][30][31][32][33] the content of psychological and psychosocial interventions was classified into five broad intervention types: cognitive behavioural therapy (CBT), behavioural…”

The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis

“…Reviews have shown CBT is effective in reducing depression outcomes for people with clinical depression (López-López et al, 2019 ; NICE, 2009 ). However, when we examined the heterogeneity of effects upon depression outcomes across reviews of CBT for clinical depression, we found the review effects varied greatly and we could not pool across these reviews.…”

Development and Validation of the Cognitive Behavioral Therapy Skills Scale Among Japanese College Students

“…The present ndings contribute to the literature by developing a useful instrument that is necessary to determine the yet to be discovered optimal CBT components and combinations [5], [6], [7]. The results of the EFA showed that SM, BA, CR, AT, and PS could indeed be classi ed as distinct factors representing separate CBT skills.…”

“…The rst direction is to derive skills, or combination of skills, that are effective for the entire population of depressed patients. Such optimal combination is yet to be discovered [5] [6] [7]. Towards this solution, several research groups are currently conducting fully factorial randomized controlled trials of CBT optimization [8] [9].…”