From the Journals

Most CBT delivery methods effective for depression


 

FROM JAMA PSYCHIATRY

Most modes of delivery for cognitive-behavioral therapy appear to be effective interventions for the acute symptoms of depression, with the exception of unguided self-help therapy, a study has found.

In the study, published in JAMA Psychiatry, researchers reported the results of a network meta-analysis of 155 trials involving 15,191 participants who were treated with one of five cognitive-behavioral therapy (CBT) delivery formats: individual, group, telephone, guided, and unguided self-help.

In general, CBT delivered individually, in a group, by guided self-help, or by telephone were all significantly more effective at improving the severity of depression than unguided, self-administered CBT, and significantly more effective than the controls of waiting list or usual care.

However, even unguided self-help CBT was more effective than the waiting list, although not more effective than care as usual.

“This study suggests that group, telephone, and guided self-help treatments are effective interventions that may be considered as alternatives to individual CBT,” wrote Pim Cuijpers, PhD, who is affiliated with the Amsterdam Public Health Research Institute at the Vrije Universiteit Amsterdam, and his coauthors. “Applying effective and acceptable CBT in a range of different formats will make CBT easier to implement, disseminate, and deliver across different settings and diverse patient populations.”

In terms of acceptability, individual-, group-, and telephone-delivered CBT were all equally acceptable. The analysis showed that guided self-help had lower acceptability than individual or group therapy, care as usual, and the waiting list, while unguided self-help therapy was less acceptable than being on a waiting list.

The authors said it was not clear why guided self-help CBT showed lower acceptability, compared with the other CBT formats.

“Maybe the absence of direct contact with a professional makes it easier to stop the treatment because there is less personal relationship pressure to continue with the treatment or the study,” they wrote.

The analysis also explored the long-term effectiveness of different delivery methods, although the authors cautioned that this was based on small numbers of comparisons. They found significantly greater long-term effectiveness associated with individual, group, guided self-help, and telephone CBT, compared with usual care, but telephone CBT was less effective than individual CBT.

Two authors reported receiving personal fees from private industry outside of the submitted work, and one reported receiving grants and support from the National Institute for Health Research.

SOURCE: Cuijpers P et al. JAMA Psychiatry. 2019 Apr 17. doi: 10.1001/jamapsychiatry.2019.0268.

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