期刊
PSYCHOLOGICAL MEDICINE
卷 49, 期 12, 页码 1937-1947出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S003329171900120X
关键词
Cognitive-behavioural therapy; depression; multimedia; network meta-analysis; systematic review
资金
- National Institute for Health Research [RP-PG-0514-20012]
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust
- University of Bristol
- MRC ConDuCT-II Hub for Trials Methodology Research
- Bristol Randomised Trials Collaboration (BRTC), a UKCRC Registered Clinical Trials Unit (CTU) of National Institute for Health Research CTU
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence
- British Heart Foundation [MR/KO232331/1]
- Cancer Research UK [MR/KO232331/1]
- Economic and Social Research Council [MR/KO232331/1]
- Medical Research Council [MR/KO232331/1]
- Welsh Government [MR/KO232331/1]
- Wellcome Trust, under UK Clinical Research Collaboration [MR/KO232331/1]
- National Institutes of Health Research (NIHR) [RP-PG-0514-20012] Funding Source: National Institutes of Health Research (NIHR)
- MRC [MR/K025643/1] Funding Source: UKRI
Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
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