Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients
Abstract
Cognitive behavior therapy (CBT) is by far the most examined type of psychological treatment for depression and is recommended in most treatment guidelines. However, no recent meta‐analysis has integrated the results of randomized trials examining its effects, and its efficacy in comparison with other psychotherapies, pharmacotherapies and combined treatment for depression remains uncertain. We searched PubMed, PsycINFO, Embase and the Cochrane Library to identify studies on CBT, and separated included trials into several subsets to conduct random‐effects meta‐analyses. We included 409 trials (518 comparisons) with 52,702 patients, thus conducting the largest meta‐analysis ever of a specific type of psychotherapy for a mental disorder. The quality of the trials was found to have increased significantly over time (with increasing numbers of trials with low risk of bias, less waitlist control groups, and larger sample sizes). CBT had moderate to large effects compared to control conditions such as care as usual and waitlist (g=0.79; 95% CI: 0.70‐0.89), which remained similar in sensitivity analyses and were still significant at 6‐12 month follow‐up. There was no reduction of the effect size of CBT according to the publication year (2011). CBT was significantly more effective than other psychotherapies, but the difference was small (g=0.06; 95% CI: 0‐0.12) and became non‐significant in most sensitivity analyses. The effects of CBT did not differ significantly from those of…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 52,702 participants or records.
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