Cognitive behavior therapy for adult depressive disorders in routine clinical care: A systematic review and meta-analysis

Lars-Göran Öst; Pia Enebrink; Anna Finnes; Ata Ghaderi; Audun Havnen; Gerd Kvale; Sigrid Salomonsson; Gro Janne Wergeland

doi:10.1016/j.jad.2023.03.002

Cognitive behavior therapy for adult depressive disorders in routine clinical care: A systematic review and meta-analysis

J Affect Disord. 2023 Jun 15:331:322-333. doi: 10.1016/j.jad.2023.03.002. Epub 2023 Mar 8.

Authors

Lars-Göran Öst¹, Pia Enebrink², Anna Finnes³, Ata Ghaderi², Audun Havnen⁴, Gerd Kvale⁵, Sigrid Salomonsson⁶, Gro Janne Wergeland⁷

Affiliations

¹ Department of Psychology, Stockholm University, Sweden; Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: ost@psychology.su.se.
² Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
³ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Center, Region Stockholm, Sweden.
⁴ Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway.
⁵ Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway.
⁶ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁷ Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.

PMID: 36894029
DOI: 10.1016/j.jad.2023.03.002

Abstract

Background: Different cognitive behavioral therapies (CBT) have strong research support for treatment of adult depressive disorders (DD). Given the scarcity of knowledge about the performance of CBT in routine clinical care, a systematic review and meta-analysis of CBT for adults with DD treated in this context was conducted.

Methods: Published studies until the end of September 2022, were systematically searched in Ovid MEDLINE, Embase OVID, and PsycINFO. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for DD.

Results: Twenty-eight studies, comprising 3734 participants, were included. Large within-group effect sizes (ES) were obtained for DD-severity at post-treatment, and follow-up, on average 8 months post-treatment. Benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.51 vs. 1.71) and follow-up (1.71 vs. 1.85). Remission rates were also very similar; effectiveness studies 44 % and 46 %, efficacy studies 45 % and 46 %, at post-treatment and follow-up, respectively.

Limitations: Only studies published in English-language peer-reviewed journals were included and the use of pre-post ES in the meta-analyses could contribute to biased outcomes.

Conclusions: CBT for DD is an effective treatment when delivered in routine clinical care and the outcomes of effectiveness studies for DD are comparable to the effects obtained in efficacy studies.

Prospero registration: CRD42022285615.

Keywords: Adults; Cognitive behavior therapy; Depressive disorders; Effectiveness; Meta-analysis.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Cognitive Behavioral Therapy*
Depressive Disorder* / therapy
Humans
Treatment Outcome