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Medical Science OPEN ACCESS

SYSTEMATIC LITERATURE REVIEW OF COGNITIVE-BEHAVIORAL THERAPY (CBT) EFFECTIVENESS IN TREATING DEPRESSION AMONG ADULT MENTAL HEALTH PATIENTS

Franklin E. Ibadin
Faculty - Health Sciences, Public Health in Epidemiology, Purdue University Global, West Lafayette, Indiana, USA
Excel Onajite Ernest-Okonofua
California Institute of Behavioral Neuroscience and Psychology (CiBNP), Fairfield, California, USA
tajmspr 2024
VOL. 6 / NO. 12 DECEMBER
VOLUME 6
ISSUE 12
YEAR 2024
PAGES 113-126

Abstract

A mental disorder that is common amongst adults is depression. Cognitive-behavioral therapy (CBT) is an intervention that has proved its efficacy in treating depressed adults. CBT approaches are multifaceted, as they include several mechanisms and can be delivered in different ways. This systematic review investigates the effectiveness of CBT in depression treatment among adult mental health patients, following PRISMA guidelines. The methodology is based on PRISMA guidelines. A thorough literature search was performed across several databases, including Google Scholar, PubMed and Cochrane Library to identify relevant studies published from 2015 to 2024. Overall, 8 studies complied with the inclusion criteria, including 10384 participants. The Inclusion criteria focused on studies comparing CBT with control conditions, pharmacotherapy or other psychological therapy, in adult mental health patients diagnosed with depression through a clinical diagnosis, self-report scale or depressive symptoms. Data extraction was performed, assessing potential factors that affect the outcomes such as, patient demographics, duration of therapy and existing comorbid conditions. Results direct that CBT considerably reduces depressive symptoms compared to control groups, with effective sizes ranging from small to large. In addition, this review also underscores that treatment duration plays an essential role in enhancing CBT outcomes. Limitations of the studies, including demographics of the participant and other characteristics such as, fewer follow-ups post-study and drop-out rates, are addressed. In conclusion, the review supports that CBT is, potentially, an effective intervention for alleviating depression among adults in combination with other treatment methods and personalized care, highlighting its implications for clinical practice and future possibilities.

Keywords

Cognitive Behavioral Therapy Efficacy Major Depression

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References

  1. Association AP. Diagnostic and statistical manual of mental disorders. Text revision. 2000;
  2. Hunot V, Moore TH, Caldwell DM, et al. 'Third wave'cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database of Systematic Reviews. 2013;(10)
  3. Pilling S, Anderson I, Goldberg D, Meader N, Taylor C. Depression in adults, including those with a chronic physical health problem: summary of NICE guidance. Bmj. 2009;339
  4. Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. Journal of affective disorders. 2002;72(3):227-236.
  5. Wittchen H-U, Jacobi F, Rehm J, et al. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European neuropsychopharmacology. 2011;21(9):655-679. doi:10.1016/j.euroneuro.2011.07.018
  6. Organization WH. The global burden of disease: 2004 update. Geneva: WHO; 2008. 2017.
  7. Van Lerberghe W. The world health report 2008: primary health care: now more than ever. World Health Organization; 2008.
  8. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet. 2007;370(9590):851-858.
  9. Investigators EM, Alonso J, Angermeyer M, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta psychiatrica scandinavica. 2004;109:21-27.
  10. Ellis P. Australian and New Zealand clinical practice guidelines for the treatment of depression. Australian & New Zealand Journal of Psychiatry. 2004;38(6)doi:10.1111/j.1440-1614.2004.01377.x
  11. Cipriani A, Brambilla P, Furukawa TA, et al. Fluoxetine versus other types of pharmacotherapy for depression. Cochrane Database of Systematic Reviews. 2005;(4)doi:10.1002/14651858.CD004185.pub2
  12. Guaiana G, Barbui C, Hotopf M. Amitriptyline for depression. Cochrane database of systematic reviews. 2007;(3)doi:10.1002/14651858.CD004186.pub2
  13. Arroll B, Elley CR, Fishman T, et al. Antidepressants versus placebo for depression in primary care. Cochrane Database of Systematic Reviews. 1996;2014(4)doi:10.1002/ 14651858.CD007954
  14. Cipriani A, La Ferla T, Furukawa TA, et al. Cochrane Database of Systematic Reviews. Cochrane Database of Systematic Reviews. 2009;(2):006117-006117. doi:10.1002/ 14651858.CD006117.pub2
  15. Cipriani A, Santilli C, Furukawa TA, et al. Escitalopram versus other antidepressive agents for depression. Cochrane Database of Systematic Reviews. 2009;(2)doi:10.1002/ 14651858.CD006532.pub2
  16. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. The lancet. 2009;373(9665):746-758. doi:10.1002/14651858.CD006532.pub2
  17. Hunot VM, Horne R, Leese MN, Churchill RC. A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences. Primary care companion to the Journal of clinical psychiatry. 2007;9(2):91. doi:10.4088/pcc.v09n0202
  18. van Geffen EC, Gardarsdottir H, van Hulten R, van Dijk L, Egberts AC, Heerdink ER. Initiation of antidepressant therapy: do patients follow the GP's prescription? British Journal of General Practice. 2009;59(559):81-87. doi:10.3399/bjgp09X395067
  19. Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. Journal of consulting and clinical psychology. 1989;57(3):414. doi:10.1037/0022-006X.57.3.414
  20. De Maat S, Dekker J, Schoevers R, De Jonghe F. Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression: A meta-analysis. Psychotherapy Research. 2006;16(5):566-578. doi:10.1080/10503300600756402
  21. Souery D, Amsterdam J, De Montigny C, et al. Treatment resistant depression: methodological overview and operational criteria. European Neuropsychopharmacology. 1999;9(1-2):83-91.
  22. Rush AJ, Trivedi MH, Wisniewski SR, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine. 2006;354(12):1231-1242.
  23. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR* D: implications for clinical practice. American journal of Psychiatry. 2006;163(1):28-40.
  24. Nakagawa A, Mitsuda D, Sado M, et al. Effectiveness of supplementary cognitive-behavioral therapy for pharmacotherapy-resistant depression: a randomized controlled trial. The Journal of clinical psychiatry. 2017;78(8):2450.
  25. Connolly KR, Thase ME. If at first you don’t succeed: a review of the evidence for antidepressant augmentation, combination and switching strategies. Drugs. 2011;71:43-64.
  26. Torpey DC, Klein DN. Chronic depression: update on classification and treatment. Current psychiatry reports. 2008;10(6):458-464.
  27. Cuijpers P, Huibers MJ, Furukawa TA. The need for research on treatments of chronic depression. JAMA psychiatry. 2017;74(3):242-243.
  28. Cristea IA, Huibers MJ, David D, Hollon SD, Andersson G, Cuijpers P. The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis. Clinical psychology review. 2015;42:62-71. doi:10.1016/j.cpr.2015.08.003
  29. Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry. 2013;58(7):376-385.
  30. Barth J, Munder T, Gerger H, et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus. 2016;14(2):229-243. doi:10.1176/appi.focus.140201
  31. Cuijpers P, Donker T, van Straten A, Li J, Andersson G. Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological medicine. 2010;40(12):1943-1957. doi:10.1017/S0033291710000772
  32. Cuijpers P, Dekker J, Hollon SD, Andersson G. Adding psychotherapy to pharmacotherapy in the treatment of depressive disorders in adults: a meta-analysis. Journal of clinical psychiatry. 2009;70(9):1219-1229.
  33. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds III CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. Focus. 2014;12(3):347-358.
  34. Keller MB, McCullough JP, Klein DN, et al. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England journal of medicine. 2000;342(20):1462-1470.
  35. Kocsis JH, Gelenberg AJ, Rothbaum BO, et al. Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Archives of general psychiatry. 2009;66(11):1178-1188. doi:10.1001/archgenpsychiatry.2009.144
  36. Wiersma JE, Van Schaik DJ, Hoogendorn AW, et al. The effectiveness of the cognitive behavioral analysis system of psychotherapy for chronic depression: a randomized controlled trial. Psychotherapy and psychosomatics. 2014;83(5):263-269. doi: 10.1159/000360795
  37. Michalak J, Schultze M, Heidenreich T, Schramm E. A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. Journal of consulting and clinical psychology. 2015;83(5):951.
  38. Frank E, Prien RF, Jarrett RB, et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence. Archives of general psychiatry. 1991;48(9):851-855. doi:10.1001/archpsyc.1991.01810330075011
  39. Cuijpers P, Hollon SD, van Straten A, Bockting C, Berking M, Andersson G. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ open. 2013;3(4):e002542. doi:10.1136/bmjopen-2012-002542
  40. Casacalenda N, Perry JC, Looper K. Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. American Journal of Psychiatry. 2002;159(8):1354-1360. doi:10.1176/appi.ajp.159.8.1354
  41. Vittengl JR, Clark LA, Dunn TW, Jarrett RB. Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of consulting and clinical psychology. 2007;75(3):475. doi:10.1037/0022-006X.75.3.475
  42. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group* t. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009;151(4):264-269. doi:10.7326/0003-4819-151-4-200908180-00135
  43. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343doi:10.1136/bmj.d5928
  44. McGuinness LA, Higgins JP. Risk‐of‐bias VISualization (robvis): an R package and Shiny web app for visualizing risk‐of‐bias assessments. Research synthesis methods. 2021;12(1):55-61. doi:10.1002/jrsm.1411
  45. Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020‐compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell systematic reviews. 2022;18(2):e1230. doi:10.1002/cl2.1230
  46. Weitz ES, Hollon SD, Twisk J, et al. Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: an individual patient data meta-analysis. JAMA psychiatry. 2015;72(11):1102-1109. doi:10.1001/jamapsychiatry.2015.1516
  47. Wisniewski SR, Rush AJ, Nierenberg AA, et al. Can phase III trial results of antidepressant medications be generalized to clinical practice? A STAR* D report. American Journal of Psychiatry. 2009;166(5):599-607. doi:10.1176/appi.ajp.2008.08071027
  48. Amick HR, Gartlehner G, Gaynes BN, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. Bmj. 2015;351doi:10.1136/bmj.h6019
  49. Chaves C, Lopez-Gomez I, Hervas G, Vazquez C. A comparative study on the efficacy of a positive psychology intervention and a cognitive behavioral therapy for clinical depression. Cognitive therapy and research. 2017;41:417-433. doi:10.1007/s10608-016-9778-9
  50. Mathiasen K, Andersen TE, Lichtenstein MB, et al. The clinical effectiveness of blended cognitive behavioral therapy compared with face-to-face cognitive behavioral therapy for adult depression: randomized controlled noninferiority trial. Journal of medical Internet research. 2022;24(9):e36577. doi:10.2196/36577
  51. Lin Z, Cheng L, Han X, et al. The effect of internet-based cognitive behavioral therapy on major depressive disorder: Randomized controlled trial. Journal of Medical Internet Research. 2023;25:e42786. doi:10.2196/42786
  52. Ciharova M, Furukawa TA, Efthimiou O, et al. Cognitive restructuring, behavioral activation and cognitive-behavioral therapy in the treatment of adult depression: A network meta-analysis. Journal of Consulting and Clinical Psychology. 2021;89(6):563. doi:10.1037/ccp0000654
  53. Werson AD, Meiser-Stedman R, Laidlaw K. A meta-analysis of CBT efficacy for depression comparing adults and older adults. Journal of Affective Disorders. 2022;319:189-201. doi:10.1016/j.jad.2022.09.020
  54. Lorenzo-Luaces L, German RE, DeRubeis RJ. It's complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical psychology review. 2015;41:3-15. doi:10.1016/j.cpr.2014.12.003
  55. Albert PR. Why is depression more prevalent in women? : Journal of Psychiatry and Neuroscience; 2015. p. 219-221.
  56. Sudak DM. Cognitive behavioral therapy for depression. Psychiatric Clinics. 2012;35(1):99-110. doi:10.1016/j.psc.2011.10.001
  57. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research. 2012;36:427-440. doi:10.1007/s10608-012-9476-1v
  58. Powell VB, Abreu N, Oliveira IRd, Sudak D. Cognitive-behavioral therapy for depression. Brazilian Journal of Psychiatry. 2008;30:s73-s80. doi:10.1590/S1516-44462008000600004
  59. Li J-M, Zhang Y, Su W-J, et al. Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis. Psychiatry research. 2018;268:243-250. doi:10.1016/j.psychres.2018.07.020