How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence

Abstract

We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g50.75 for MDD to g50.80 for GAD, g50.81 for PAD, and g50.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g50.59) and MDD (adjusted g50.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g50.61) and SAD (g50.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.Key words: Cognitive behavior therapy, major depression, generalized anxiety disorder, panic disorder, social anxiety disorder, meta-analysis, publication bias, quality of trials, waiting list control groups (World Psychiatry 2016;15:245-258) Every year almost 20% of the general population suffers from a common mental disorder, such as depression or an anxiety disorder 1 . These conditions not only result in personal suffering for patients and their families, but also in huge economic costs, in terms of both work productivity loss and health and social care expenditures 2-6 .Several evidence-based treatments are available for common mental disorders, including pharmacological and psychological interventions. Many patients receive pharmacological treatments, and these numbers are increasing in high-income countries 7 . Psychological treatments are equally effective in the treatment of depression 8 and anxiety disorders [9][10][11] . However, they are less available or accessible 12 , especially in low-and middle-income countries. At the same time, about 75% of patients prefer psychotherapy over the use of medication 13 . The most extensively tested form of psychotherapy is cognitive behavior therapy (CBT). Dozens of trials and several meta-analyses have shown that CBT is effective in treating depression 8,14 and anxiety disorders 9-11 . However, in recent years, it has become clear that the effects of CBT and other psychotherapies have been considerably ...

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

“…Since the 1970s, several hundreds of randomized trials have shown that these interventions are effective [11][12][13][14] , although their effects are modest and have been overestimated because of the low quality of many trials 15 and publication bias 16,17 . The effects of psychotherapies have been found to be comparable to those of pharmacotherapy 18 , and probably last longer 19 .…”

Science is what we need in the treatment of anxiety disorders

“…In their response, they did not provide any evidence for either the poor(er) quality of studies of PDT for anxiety, nor for superiority of CBT. A recent meta-analysis by Cuijpers et al 2 found that more than 80% of CBT trials in anxiety disorders used waiting-list control groups, a weak comparator. Only 17% (21 of 121)…”

“…2 This led these authors to conclude that CBT is only "probably effective" in anxiety disorders, and that "because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution". 2 Note the marked difference in conclusion by a group of authors that includes major proponents of CBT. Furthermore, recent meta-analyses have found PDT to be as efficacious as CBT in anxiety disorders 3 and across mental disorders.…”

Hjärnan formas av psykologisk behandling

“…CBT is a therapeutic approach consisting of numerous models using a broad set of techniques targeting different psychiatric (Cuijpers, Cristea, Karyotaki, Reijnders, & Huibers, 2016) and somatic (Ljótsson et al, 2013) disorders. Within the scope of cognitive interventions there are computerised tasks such as ABM.…”