Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression
Importance:Cognitive behavior therapy (CBT) has been shown to be effective in the treatment of acute depression. However, whether CBT can be effectively delivered in individual, group, telephone-administered, guided self-help, and unguided self-help formats remains unclear. Objective:To examine the...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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American Medical Association
2019
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| _version_ | 1797076101267193856 |
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| author | Cuijpers, P Noma, H Karyotaki, E Cipriani, A Furukawa, T |
| author_facet | Cuijpers, P Noma, H Karyotaki, E Cipriani, A Furukawa, T |
| author_sort | Cuijpers, P |
| collection | OXFORD |
| description | Importance:Cognitive behavior therapy (CBT) has been shown to be effective in the treatment of acute depression. However, whether CBT can be effectively delivered in individual, group, telephone-administered, guided self-help, and unguided self-help formats remains unclear. Objective:To examine the most effective delivery format for CBT via a network meta-analysis. Data Sources:A database updated yearly from PubMed, PsycINFO, Embase, and the Cochrane Library. Literature search dates encompassed January 1, 1966, to January 1, 2018. Study Selection:Randomized clinical trials of CBT for adult depression. The 5 treatment formats were compared with each other and the control conditions (waiting list, care as usual, and pill placebo). Data Extraction and Synthesis:PRISMA guidelines were used when extracting data and assessing data quality. Data were pooled using a random-effects model. Pairwise and network meta-analyses were conducted. Main Outcomes and Measures:Severity of depression and acceptability of the treatment formats. Results:A total of 155 trials with 15 191 participants compared 5 CBT delivery formats with 2 control conditions. In half of the studies (78 [50.3%]), patients met the criteria for a depressive disorder; in the other half (77 [49.7%]), participants scored above the cutoff point on a self-report measure. The effectiveness of individual, group, telephone, and guided self-help CBT did not differ statistically significantly from each other. These formats were statistically significantly more effective than the waiting list (standardized mean differences [SMDs], 0.87-1.02) and care as usual (SMDs, 0.47-0.72) control conditions as well as the unguided self-help CBT (SMDs, 0.34-0.59). In terms of acceptability (dropout for any reason), individual (relative risk [RR] = 1.44; 95% CI, 1.09-1.89) and group (RR = 1.38; 95% CI, 1.06-1.80) CBT were significantly better than guided self-help. Guided self-help was also less acceptable than being on a waiting list (RR = 0.63; 95% CI, 0.52-0.75) and care as usual (RR = 0.72; 95% CI, 0.57-0.90). Sensitivity analyses supported the overall findings. Conclusions and Relevance:For acute symptoms of depression, group, telephone, and guided self-help treatment formats appeared to be effective interventions, which may be considered as alternatives to individual CBT; although there were few indications of significant differences in efficacy between treatments with human support, guided self-help CBT may be less acceptable for patients than individual, group, or telephone formats. |
| first_indexed | 2024-03-06T23:59:22Z |
| format | Journal article |
| id | oxford-uuid:75610979-af71-4db7-8e00-693c9cbb58ce |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:59:22Z |
| publishDate | 2019 |
| publisher | American Medical Association |
| record_format | dspace |
| spelling | oxford-uuid:75610979-af71-4db7-8e00-693c9cbb58ce2022-03-26T20:09:02ZEffectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depressionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:75610979-af71-4db7-8e00-693c9cbb58ceEnglishSymplectic Elements at OxfordAmerican Medical Association2019Cuijpers, PNoma, HKaryotaki, ECipriani, AFurukawa, TImportance:Cognitive behavior therapy (CBT) has been shown to be effective in the treatment of acute depression. However, whether CBT can be effectively delivered in individual, group, telephone-administered, guided self-help, and unguided self-help formats remains unclear. Objective:To examine the most effective delivery format for CBT via a network meta-analysis. Data Sources:A database updated yearly from PubMed, PsycINFO, Embase, and the Cochrane Library. Literature search dates encompassed January 1, 1966, to January 1, 2018. Study Selection:Randomized clinical trials of CBT for adult depression. The 5 treatment formats were compared with each other and the control conditions (waiting list, care as usual, and pill placebo). Data Extraction and Synthesis:PRISMA guidelines were used when extracting data and assessing data quality. Data were pooled using a random-effects model. Pairwise and network meta-analyses were conducted. Main Outcomes and Measures:Severity of depression and acceptability of the treatment formats. Results:A total of 155 trials with 15 191 participants compared 5 CBT delivery formats with 2 control conditions. In half of the studies (78 [50.3%]), patients met the criteria for a depressive disorder; in the other half (77 [49.7%]), participants scored above the cutoff point on a self-report measure. The effectiveness of individual, group, telephone, and guided self-help CBT did not differ statistically significantly from each other. These formats were statistically significantly more effective than the waiting list (standardized mean differences [SMDs], 0.87-1.02) and care as usual (SMDs, 0.47-0.72) control conditions as well as the unguided self-help CBT (SMDs, 0.34-0.59). In terms of acceptability (dropout for any reason), individual (relative risk [RR] = 1.44; 95% CI, 1.09-1.89) and group (RR = 1.38; 95% CI, 1.06-1.80) CBT were significantly better than guided self-help. Guided self-help was also less acceptable than being on a waiting list (RR = 0.63; 95% CI, 0.52-0.75) and care as usual (RR = 0.72; 95% CI, 0.57-0.90). Sensitivity analyses supported the overall findings. Conclusions and Relevance:For acute symptoms of depression, group, telephone, and guided self-help treatment formats appeared to be effective interventions, which may be considered as alternatives to individual CBT; although there were few indications of significant differences in efficacy between treatments with human support, guided self-help CBT may be less acceptable for patients than individual, group, or telephone formats. |
| spellingShingle | Cuijpers, P Noma, H Karyotaki, E Cipriani, A Furukawa, T Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
| title | Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
| title_full | Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
| title_fullStr | Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
| title_full_unstemmed | Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
| title_short | Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
| title_sort | effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression |
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