Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 1;76(7):700-707.
doi: 10.1001/jamapsychiatry.2019.0268.

Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults With Depression: A Network Meta-analysis

Pim Cuijpers  1 , Hisashi Noma  2 , Eirini Karyotaki  2 , Andrea Cipriani  3   4 , Toshi A Furukawa  5
Affiliations

Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults With Depression: A Network Meta-analysis

Pim Cuijpers et al. JAMA Psychiatry. .

Erratum in

  • Error in Figure 3.
    [No authors listed] [No authors listed] JAMA Psychiatry. 2019 Sep 1;76(9):986. doi: 10.1001/jamapsychiatry.2019.2040. JAMA Psychiatry. 2019. PMID: 31314064 Free PMC article. No abstract available.
  • Error in Results and in the Figure 3B Label and Plotted Values.
    [No authors listed] [No authors listed] JAMA Psychiatry. 2022 Feb 1;79(2):180. doi: 10.1001/jamapsychiatry.2021.3357. JAMA Psychiatry. 2022. PMID: 34817574 Free PMC article. No abstract available.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Noma reported personal fees from Boehringer Ingelheim, Kyowa Hakko Kirin, and ASKA Pharmaceutical outside of the submitted work. Dr Cipriani reported support from the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility, professorship grant RP-2017-08-ST2-006 from the NIHR Research, and grant BRC-1215-20005 from the NIHR Oxford Health Biomedical Research Centre. Dr Furukawa reported personal fees from Meiji Seika Pharma, grants and personal fees from Mitsubishi-Tanabe, personal fees from MSD, and personal fees from Pfizer outside of the submitted work and a pending patent to 2018-177688. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Network Plot of Meta-analysis
Figure 2.
Figure 2.. Network Meta-analyses of Cognitive Behavior Therapy (CBT) Delivery Formats
The diagonal gives the different nodes that were examined in the study; at the left of the diagonal, the data for the effect sizes are given as standardized mean difference (SMD) with 95% CIs and 95% prediction intervals, with every cell indicating the values for a specific contrast between the nodes. At the right of the diagonal, the values for acceptability are given as relative risk (RR) with 95% CIs and 95% prediction intervals. Data in bold are statistically significant. Pill placebo is not included because only 2 studies used a pill placebo condition and both compared placebo with individual CBT. The results including pill placebo are presented in eAppendix G in the Supplement.
Figure 3.
Figure 3.. Ranked Forest Plots of Effectiveness and Acceptability of Cognitive Behavior Therapy (CBT) Formats
Care-as-usual format is the reference group for both the effectiveness (A) and acceptability (B) plots. RR indicates relative risk; SMD, standardized mean difference.
See this image and copyright information in PMC

Comment in

References

    1. Barth J, Munder T, Gerger H, et al. . Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10(5):e1001454. doi:10.1371/journal.pmed.1001454 - DOI - PMC - PubMed
    1. Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry. 2013;58(7):376-385. doi:10.1177/070674371305800702 - DOI - PubMed
    1. Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008;76(6):909-922. doi:10.1037/a0013075 - DOI - PubMed
    1. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression. New York, NY: The Guilford Press; 1979.
    1. Feng C-Y, Chu H, Chen C-H, et al. . The effect of cognitive behavioral group therapy for depression: a meta-analysis 2000-2010. Worldviews Evid Based Nurs. 2012;9(1):2-17. doi:10.1111/j.1741-6787.2011.00229.x - DOI - PubMed

Publication types