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Meta-Analysis
. 2013 Oct 16;2013(10):CD008696.
doi: 10.1002/14651858.CD008696.pub2.

Behavioural therapies versus other psychological therapies for depression

Kiyomi Shinohara  1 , Mina Honyashiki, Hissei Imai, Vivien Hunot, Deborah M Caldwell, Philippa Davies, Theresa H M Moore, Toshi A Furukawa, Rachel Churchill
Affiliations
Meta-Analysis

Behavioural therapies versus other psychological therapies for depression

Kiyomi Shinohara et al. Cochrane Database Syst Rev. .

Abstract

Background: Behavioural therapies represent one of several categories of psychological therapies that are currently used in the treatment of depression. However, the effectiveness and acceptability of behavioural therapies for depression compared with other psychological therapies remain unclear.

Objectives: 1. To examine the effects of all BT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all BT approaches compared with different psychological therapy approaches (CBT, third wave CBT, psychodynamic, humanistic and integrative psychological therapies) for acute depression.

Search methods: We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR, 31/07/2013), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies.

Selection criteria: Randomised controlled trials that compared behavioural therapies with other psychological therapies for acute depression in adults.

Data collection and analysis: Two or more review authors independently identified studies, assessed trial quality and extracted data. We contacted study authors for additional information.

Main results: Twenty-five trials involving 955 participants compared behavioural therapies with one or more of five other major categories of psychological therapies (cognitive-behavioural, third wave cognitive-behavioural, psychodynamic, humanistic and integrative therapies). Most studies had a small sample size and were assessed as being at unclear or high risk of bias. Compared with all other psychological therapies together, behavioural therapies showed no significant difference in response rate (18 studies, 690 participants, risk ratio (RR) 0.97, 95% confidence interval (CI) 0.86 to 1.09) or in acceptability (15 studies, 495 participants, RR of total dropout rate 1.02, 95% CI 0.65 to 1.61). Similarly, in comparison with each of the other classes of psychological therapies, low-quality evidence showed better response to cognitive-behavioural therapies than to behavioural therapies (15 studies, 544 participants, RR 0.93, 95% CI 0.83 to 1.05) and low-quality evidence of better response to behavioural therapies over psychodynamic therapies (2 studies, 110 participants, RR 1.24, 95% CI 0.84 to 1.82).When compared with integrative therapies and humanistic therapies, only one study was included in each comparison, and the analysis showed no significant difference between behavioural therapies and integrative or humanistic therapies.

Authors' conclusions: We found low- to moderate-quality evidence that behavioural therapies and other psychological therapies are equally effective. The current evidence base that evaluates the relative benefits and harms of behavioural therapies is very weak. This limits our confidence in both the size of the effect and its precision for our key outcomes related to response and withdrawal. Studies recruiting larger samples with improved reporting of design and fidelity to treatment would improve the quality of evidence in this review.

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Conflict of interest statement

TAF has received honoraria for speaking at CME meetings sponsored by Asahi Kasei, Eli Lilly, GlaxoSmithKline, Mochida, MSD, Otsuka, Pfizer, Shionogi and Tanabe‐Mitsubishi. He is a diplomate of the Academy of Cognitive Therapy. He has received royalties from Igaku‐Shoin, Seiwa‐Shoten and Nihon Bunka Kagaku‐sha. He serves on advisory boards for Sekisui Chemicals and Takeda Science Foundation. The Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labor and Welfare and the Japan Foundation for Neuroscience and Mental Health have funded his research projects.

RC leads and has responsibility for the Cochrane Depression, Anxiety and Neurosis Group which has supported parts of the review process and is funded by a grant from the National Institute of Health and Research (NIHR) in the UK.

All of the other review authors have no conflicts of interest to declare.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary.
3
3
Forest plot of comparison: 1 BT vs all other psychological therapies, outcome: 1.1 Response.
4
4
Forest plot of comparison: 1 BT vs all other psychological therapies, outcome: 1.4 Dropouts for any reason.
5
5
Funnel plot of comparison: 1 BT vs all other psychological therapies outcome: 1.1 Response.
6
6
Funnel plot of comparison: 13 BT vs all other psychological therapies (follow up within 6 months), outcome: 13.1 Response.
1.1
1.1. Analysis
Comparison 1 BT vs all other psychological therapies, Outcome 1 Response.
1.2
1.2. Analysis
Comparison 1 BT vs all other psychological therapies, Outcome 2 Remission.
1.3
1.3. Analysis
Comparison 1 BT vs all other psychological therapies, Outcome 3 Depression severity.
1.4
1.4. Analysis
Comparison 1 BT vs all other psychological therapies, Outcome 4 Dropouts for any reason.
1.5
1.5. Analysis
Comparison 1 BT vs all other psychological therapies, Outcome 5 Anxiety.
1.6
1.6. Analysis
Comparison 1 BT vs all other psychological therapies, Outcome 6 Social adjustment.
2.1
2.1. Analysis
Comparison 2 BT‐Lewinsohn vs all other psychological therapies, Outcome 1 Response.
2.2
2.2. Analysis
Comparison 2 BT‐Lewinsohn vs all other psychological therapies, Outcome 2 Dropouts for any reason.
3.1
3.1. Analysis
Comparison 3 BT‐Jacobson vs all other psychological therapies, Outcome 1 Response.
3.2
3.2. Analysis
Comparison 3 BT‐Jacobson vs all other psychological therapies, Outcome 2 Dropouts for any reason.
4.1
4.1. Analysis
Comparison 4 BT‐SST/assertiveness vs all other psychological therapies, Outcome 1 Response.
4.2
4.2. Analysis
Comparison 4 BT‐SST/assertiveness vs all other psychological therapies, Outcome 2 Dropouts for any reason.
5.1
5.1. Analysis
Comparison 5 BT‐Relaxation vs all other psychological therapies, Outcome 1 Response.
5.2
5.2. Analysis
Comparison 5 BT‐Relaxation vs all other psychological therapies, Outcome 2 Dropouts for any reason.
6.1
6.1. Analysis
Comparison 6 BT vs all other psychological therapies (Best/worst case scenario), Outcome 1 Response (best case scenario).
6.2
6.2. Analysis
Comparison 6 BT vs all other psychological therapies (Best/worst case scenario), Outcome 2 Response (worst case scenario).
7.1
7.1. Analysis
Comparison 7 Sensitivity analysis: BT vs all other psychological therapies (treatment fidelity)　, Outcome 1 Response.
7.2
7.2. Analysis
Comparison 7 Sensitivity analysis: BT vs all other psychological therapies (treatment fidelity)　, Outcome 2 Depression severity.
7.3
7.3. Analysis
Comparison 7 Sensitivity analysis: BT vs all other psychological therapies (treatment fidelity)　, Outcome 3 Dropouts for any reason.
8.1
8.1. Analysis
Comparison 8 Sensitivity analysis: BT vs all other psychological therapies (excluding imputed data), Outcome 1 Response.
8.2
8.2. Analysis
Comparison 8 Sensitivity analysis: BT vs all other psychological therapies (excluding imputed data), Outcome 2 Remission.
8.3
8.3. Analysis
Comparison 8 Sensitivity analysis: BT vs all other psychological therapies (excluding imputed data), Outcome 3 Depression severity.
9.1
9.1. Analysis
Comparison 9 Sensitivity analysis: BT vs all other psychological therapies (pharmacotherapy not allowed), Outcome 1 Response.
9.2
9.2. Analysis
Comparison 9 Sensitivity analysis: BT vs all other psychological therapies (pharmacotherapy not allowed), Outcome 2 Depression severity.
9.3
9.3. Analysis
Comparison 9 Sensitivity analysis: BT vs all other psychological therapies (pharmacotherapy not allowed), Outcome 3 Dropouts for any reason.
10.1
10.1. Analysis
Comparison 10 Sensitivity analysis: BT vs all other psychological therapies (excluding other subcategories), Outcome 1 Response.
10.2
10.2. Analysis
Comparison 10 Sensitivity analysis: BT vs all other psychological therapies (excluding other subcategories), Outcome 2 Depression severity.
10.3
10.3. Analysis
Comparison 10 Sensitivity analysis: BT vs all other psychological therapies (excluding other subcategories), Outcome 3 Dropouts for any reason.
11.1
11.1. Analysis
Comparison 11 Sensitivity analysis: BT vs all other psychological therapies (major depression only), Outcome 1 Response.
11.2
11.2. Analysis
Comparison 11 Sensitivity analysis: BT vs all other psychological therapies (major depression only), Outcome 2 Depression severity.
11.3
11.3. Analysis
Comparison 11 Sensitivity analysis: BT vs all other psychological therapies (major depression only), Outcome 3 Dropouts for any reason.
12.1
12.1. Analysis
Comparison 12 Sensitivity analysis: BT vs all other psychological therapies (fewer than 13 sessions), Outcome 1 Response.
12.2
12.2. Analysis
Comparison 12 Sensitivity analysis: BT vs all other psychological therapies (fewer than 13 sessions), Outcome 2 Depression severity.
12.3
12.3. Analysis
Comparison 12 Sensitivity analysis: BT vs all other psychological therapies (fewer than 13 sessions), Outcome 3 Dropouts for any reason.
13.1
13.1. Analysis
Comparison 13 Sensitivity analysis: BT vs all other psychological therapies (excluding studies that replaced dropouts), Outcome 1 Response.
13.2
13.2. Analysis
Comparison 13 Sensitivity analysis: BT vs all other psychological therapies (excluding studies that replaced dropouts), Outcome 2 Depression severity.
13.3
13.3. Analysis
Comparison 13 Sensitivity analysis: BT vs all other psychological therapies (excluding studies that replaced dropouts), Outcome 3 Dropouts for any reason.
14.1
14.1. Analysis
Comparison 14 BT vs all other psychological therapies (follow‐up within 6 months), Outcome 1 Response.
14.2
14.2. Analysis
Comparison 14 BT vs all other psychological therapies (follow‐up within 6 months), Outcome 2 Remission.
14.3
14.3. Analysis
Comparison 14 BT vs all other psychological therapies (follow‐up within 6 months), Outcome 3 Depression severity.
15.1
15.1. Analysis
Comparison 15 BT‐Lewinsohn vs CBT‐Cognitive therapy, Outcome 1 Response.
15.2
15.2. Analysis
Comparison 15 BT‐Lewinsohn vs CBT‐Cognitive therapy, Outcome 2 Depression severity.
15.3
15.3. Analysis
Comparison 15 BT‐Lewinsohn vs CBT‐Cognitive therapy, Outcome 3 Dropouts for any reason.
16.1
16.1. Analysis
Comparison 16 BT‐SST/assertiveness vs CBT‐Self‐Control, Outcome 1 Response.
16.2
16.2. Analysis
Comparison 16 BT‐SST/assertiveness vs CBT‐Self‐Control, Outcome 2 Depression severity.
16.3
16.3. Analysis
Comparison 16 BT‐SST/assertiveness vs CBT‐Self‐Control, Outcome 3 Dropouts for any reason.
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