Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients

Abstract

Cognitive behavior therapy (CBT) is by far the most examined type of psychological treatment for depression and is recommended in most treatment guide­lines. However, no recent meta‐analysis has integrated the results of randomized trials examining its effects, and its efficacy in comparison with other psychotherapies, pharmacotherapies and combined treatment for depression remains uncertain. We searched PubMed, PsycINFO, Embase and the Cochrane Library to identify studies on CBT, and separated included trials into several subsets to conduct random‐effects meta‐analyses. We included 409 trials (518 comparisons) with 52,702 patients, thus conducting the largest meta‐analysis ever of a specific type of psychotherapy for a mental disorder. The quality of the trials was found to have increased significantly over time (with increasing numbers of trials with low risk of bias, less waitlist control groups, and larger sample sizes). CBT had moderate to large effects compared to control conditions such as care as usual and waitlist (g=0.79; 95% CI: 0.70‐0.89), which remained similar in sensitivity analyses and were still significant at 6‐12 month follow‐up. There was no reduction of the effect size of CBT according to the publication year (<2001 vs. 2001‐2010 vs. >2011). CBT was significantly more effective than other psychotherapies, but the difference was small (g=0.06; 95% CI: 0‐0.12) and became non‐significant in most sensitivity analyses. The effects of CBT did not differ significantly from those of pharmacotherapies at the short term, but were significantly larger at 6‐12 month follow‐up (g=0.34; 95% CI: 0.09‐0.58), although the number of trials was small, and the difference was not significant in all sensitivity analyses. Combined treatment was more effective than pharmacotherapies alone at the short (g=0.51; 95% CI: 0.19‐0.84) and long term (g=0.32; 95% CI: 0.09‐0.55), but it was not more effective than CBT alone at either time point. CBT was also effective as unguided self‐help intervention (g=0.45; 95% CI: 0.31‐0.60), in institutional settings (g=0.65; 95% CI: 0.21‐1.08), and in children and adolescents (g=0.41; 95% CI: 0.25‐0.57). We can conclude that the efficacy of CBT in depression is documented across different formats, ages, target groups, and settings. However, the superiority of CBT over other psychotherapies for depression does not emerge clearly from this meta‐analysis. CBT appears to be as effective as pharmacotherapies at the short term, but more effective at the longer term.

Prevalence, trends and individual patterns of long-term antidepressants medication use in the adult Swiss general population, 2013 - 2021

“…[18] Psychotherapy should be considered as alternative treatment especially for long-term users, as recent meta-analyses indicate that psychotherapy is superior in longer treatment than AD treatment alone. [39,40] Our results show that long-term users across all age categories are more likely receiving psychiatric or psychotherapeutic care compared to medium-and short-term users. However, one third of long-term users did not receive psychiatric and psychotherapeutic care, which requires further investigations into the underlying reasons.…”

Putting psychological interventions first in primary health care

“…Task sharing in primary health care is vital to increase treat ment coverage for people in need, but it rarely includes providing evi dence based psychological interventions. Yet research shows that cognitive behavioral therapy (CBT), on its own or combined with antidepressants, is the first line treatment for adult depressive dis orders 2 . CBT is also first line treatment for other conditions, includ ing anxiety disorders.…”

24-Hour Rest-Activity Rhythm in Middle-Aged and Older Persons with Depression

“…In the Japanese population, the estimated numbers of inpatients and outpatients with depression in 2020 were 280,000 and 910,000 patients, respectively [ 2 ]. For those with depression, non-invasive or non-pharmacological therapeutic approaches such as exercise therapy [ 3 ], cognitive behavior therapy [ 4 ], and psychoeducation [ 5 ] are recommended clinically. Therapeutical approaches targeting specific symptoms of depression, such as night-sleep disorder and low physical activity levels in daily life, were well documented in the last few decades; one study suggested that patients with depression and a low daily physical activity level might have significantly shorter night-sleep times than healthy controls, as well as a significantly low relative amplitude (RA) between physical activity levels during daytime and those during nighttime [ 6 ].…”