Pim Cuijpers1, Hisashi Noma2, Eirini Karyotaki2, Andrea Cipriani3,4, Toshi A Furukawa5. 1. Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands. 2. Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan. 3. Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom. 4. Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom. 5. Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan.
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.
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.
Authors: Eirini Karyotaki; Heleen Riper; Jos Twisk; Adriaan Hoogendoorn; Annet Kleiboer; Adriana Mira; Andrew Mackinnon; Björn Meyer; Cristina Botella; Elizabeth Littlewood; Gerhard Andersson; Helen Christensen; Jan P Klein; Johanna Schröder; Juana Bretón-López; Justine Scheider; Kathy Griffiths; Louise Farrer; Marcus J H Huibers; Rachel Phillips; Simon Gilbody; Steffen Moritz; Thomas Berger; Victor Pop; Viola Spek; Pim Cuijpers Journal: JAMA Psychiatry Date: 2017-04-01 Impact factor: 21.596
Authors: Julian P T Higgins; Douglas G Altman; Peter C Gøtzsche; Peter Jüni; David Moher; Andrew D Oxman; Jelena Savovic; Kenneth F Schulz; Laura Weeks; Jonathan A C Sterne Journal: BMJ Date: 2011-10-18
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Authors: Eirini Karyotaki; Orestis Efthimiou; Clara Miguel; Frederic Maas Genannt Bermpohl; Toshi A Furukawa; Pim Cuijpers; Heleen Riper; Vikram Patel; Adriana Mira; Alan W Gemmil; Albert S Yeung; Alfred Lange; Alishia D Williams; Andrew Mackinnon; Anna Geraedts; Annemieke van Straten; Björn Meyer; Cecilia Björkelund; Christine Knaevelsrud; Christopher G Beevers; Cristina Botella; Daniel R Strunk; David C Mohr; David D Ebert; David Kessler; Derek Richards; Elizabeth Littlewood; Erik Forsell; Fan Feng; Fang Wang; Gerhard Andersson; Heather Hadjistavropoulos; Heleen Christensen; Iony D Ezawa; Isabella Choi; Isabelle M Rosso; Jan Philipp Klein; Jason Shumake; Javier Garcia-Campayo; Jeannette Milgrom; Jessica Smith; Jesus Montero-Marin; Jill M Newby; Juana Bretón-López; Justine Schneider; Kristofer Vernmark; Lara Bücker; Lisa B Sheeber; Lisanne Warmerdam; Louise Farrer; Manuel Heinrich; Marcus J H Huibers; Marie Kivi; Martin Kraepelien; Nicholas R Forand; Nicky Pugh; Nils Lindefors; Ove Lintvedt; Pavle Zagorscak; Per Carlbring; Rachel Phillips; Robert Johansson; Ronald C Kessler; Sally Brabyn; Sarah Perini; Scott L Rauch; Simon Gilbody; Steffen Moritz; Thomas Berger; Victor Pop; Viktor Kaldo; Viola Spek; Yvonne Forsell Journal: JAMA Psychiatry Date: 2021-04-01 Impact factor: 21.596