Effectiveness of cognitive–behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis

Cognitive-behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. To (a) compare the effectiveness of core, complex and ultra-complex CBT against oth...

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Bibliographic Details
Published in:British journal of psychiatry 2022-08, Vol.221 (2), p.459-467
Main Authors: Angelakis, Ioannis, Huggett, Charlotte, Gooding, Patricia, Panagioti, Maria, Hodkinson, Alexander
Format: Article
Language:English
Subjects:
Behavior modification
Bias
Cognitive ability
Cognitive behavioral therapy
Cognitive-behavioral factors
Comorbidity
Complex
Confidence intervals
Drugs
Health care
Health problems
Intervention
Managerial skills
Medical personnel
Mental depression
Mental disorders
Mental health
Mental health professionals
Mental Health Services
Meta-analysis
Problem solving
Psychiatry
Psychological intervention
Review
Skill development
Social skills
Specialists
Systematic review
Therapists
Therapy
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Summary:Cognitive-behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, medication, treatment-as-usual and no treatment in reducing depression at post-treatment and in the long term and (b) explore important factors that could moderate the effectiveness of these interventions. MEDLINE, PsycInfo, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched to November 2021. Only randomised controlled trials were eligible for the subsequent network meta-analysis. We included 107 studies based on 15 248 participants. Core (s.m.d. = -1.14, 95% credible interval (CrI) -1.72 to -0.55 [m.d. = -8.44]), complex (s.m.d. = -1.24, 95% CrI -1.85 to -0.64 [m.d. = -9.18]) and ultra-complex CBT (s.m.d. = -1.45, 95% CrI -1.88 to -1.02 [m.d. = -10.73]) were all significant in reducing depression up to 6 months from treatment onset. The significant benefits of the ultra-complex (s.m.d. = -1.09, 95% CrI -1.61 to -0.56 [m.d. = -8.07]) and complex CBT (s.m.d. = -0.73, 95% CrI -1.36 to -0.11 [m.d. = -5.40]) extended beyond 6 months. Ultra-complex CBT was most effective in individuals presenting comorbid mental health problems and when delivered by non-mental health specialists. Ultra-complex and complex CBT were more effective for people younger than 59 years. For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people
ISSN:0007-1250
1472-1465
DOI:10.1192/bjp.2022.35