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

Pim Cuijpers, Hisashi Noma, Eirini Karyotaki, Andrea Cipriani, Toshi A. Furukawa

Research output: Contribution to JournalArticleAcademicpeer-review

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 15191 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.

Original languageEnglish
Pages (from-to)700-707
Number of pages8
JournalJAMA Psychiatry
Volume76
Issue number7
Early online date17 Apr 2019
DOIs
Publication statusPublished - Jul 2019

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Cognitive Therapy
Depression
Telephone
Waiting Lists
Network Meta-Analysis
Information Storage and Retrieval
Therapeutics
Depressive Disorder
PubMed
Self Report
Libraries
Randomized Controlled Trials
Placebos
Outcome Assessment (Health Care)
Databases
Guidelines

Cite this

@article{94fcd30f4823407985e8550fc3011ef6,
title = "Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults with Depression: A Network Meta-analysis",
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 15191 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.",
author = "Pim Cuijpers and Hisashi Noma and Eirini Karyotaki and Andrea Cipriani and Furukawa, {Toshi A.}",
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Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults with Depression : A Network Meta-analysis. / Cuijpers, Pim; Noma, Hisashi; Karyotaki, Eirini; Cipriani, Andrea; Furukawa, Toshi A.

In: JAMA Psychiatry, Vol. 76, No. 7, 07.2019, p. 700-707.

Research output: Contribution to JournalArticleAcademicpeer-review

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AU - Cuijpers, Pim

AU - Noma, Hisashi

AU - Karyotaki, Eirini

AU - Cipriani, Andrea

AU - Furukawa, Toshi A.

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N2 - 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 15191 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.

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