Comparison of cognitive behavioral therapy and third-wave-mindfulness-based therapies for patients suffering from depression measured using the Beck-Depression-Inventory (BDI): A systematic literature review and network-meta-analysis

Abstract

Background: Mindfulness-based therapies (MBT) are proposed as a "third wave" of cognitive-behavioral therapy (CBT). This network meta-analysis investigated this hypothesis by comparing the effectiveness of MBT and CBT for treating depression, measured by the Beck Depression Inventory-II (BDI-II).

Methods: An indirect comparison was made. Relevant databases were searched for studies comparing either CBT or MBT with treatment as usual (TAU). Mean differences (MD) between intervention and TAU were calculated using changes from baseline from both intervention (Me) and TAU-group (Mc). MDs of CBT and MBT were compared in a network meta-analysis. Results were reported for both the common-effects-model (CEM) and the random-effects-model (REM). Risk of Bias (RoB) was measured using the RoB-2-tool. Quality of evidence was investigated based on GRADE.

Results: Eight MBT and ten CBT studies, meeting eligibility since 2006, were included. MBT studies included behavioral activation with mindfulness, mindfulness-based cognitive therapy, person-based cognitive therapy, and a newly developed meditation-based lifestyle modification program. Both CBT and MBT differed significantly from TAU. In the unweighted CEM network meta-analysis, MBT showed significantly better treatment effect, but this was below the clinically relevant threshold (MD:-1.81). For REM and weighted analysis, there were no significant differences between CBT and MBT.

Limitations: Heterogeneity, high RoB, and low evidence quality were notable, with indirectness limiting this analysis.

Conclusions: CBT and MBT both showed significant and clinically important treatment effects for depression. However, an outstanding benefit of MBT in comparison to CBT could not be found in this analysis. Further research could include a direct comparison.

Keywords: Cognitive behavioral therapy; Depression; Meta-analysis; Mindfulness; Mindfulness-based-cognitive-therapy; Systematic literature review; Third-wave therapies.