Comparing the effectiveness of cognitive behaviour therapy using individual or group therapy in the treatment of depression.

Abstract

The objective of this review was to present the best available information on the use of cognitive behaviour therapy using either group cognitive therapy (GCT) or individual cognitive therapy (ICT) in the treatment of depression. The primary question to be addressed in this review was: For the treatment of long-term depression, using a cognitive behavioural approach, is group therapy or individual therapy the most effective? Studies that included adolescents or adults with long-term depression and a measured Beck Depression Inventory (BDI) value of ≥12 or Hamilton Rating Scale for Depression (HRSD) of ≥14 were included. Interventions of interest were forms of cognitive behaviour therapy utilising either an individual or group approach. For the purpose of this review individual therapy was regarded as a one-to-one interaction between the patient and the therapist. Group therapy excluded family therapy. This review excluded studies that involved pharmacotherapy alone as the only intervention and studies that involved combined group and individual treatment. Outcome measures of interest were reduction in depression inventory scores, specifically the BDI and/or the HRSD. This study considered any randomised or pseudo-randomised controlled trials that addressed the use or comparison of GCT or ICT. Individual and group cognitive behavioural therapies for moderately or severely depressed adults (BDI ≥ 14) were comparable with each other in effectiveness and both were superior to providing no treatment at all. Individual cognitive therapy was equal to or better than tricyclic antidepressant drugs given at recommended therapeutic dosages for depressed people with a mean BDI of 30. This information was based on level II evidence. The following recommendations were made for adults:1 Either GCT or ICT can be used to treat moderate to severe depression. The choice of therapy should be dependent upon the clinician's perceived receptiveness of the particular patient to group or individual treatment.2 The use of computer-assisted therapy is a useful adjunct to GCT in moderate to severely depressed patients.3 ICT can effectively replace pharmacotherapy in moderate to severely depressed patients if the patient is opposed to being treated with drug therapy.4 GCT has not been compared to pharmacotherapy so no direct recommendation can be given as to its effectiveness as a replacement therapy.The following recommendations were made for adolescents:1 Either GCT or ICT can be used to treat moderately depressed adolescents (BDI ≥ 14).2 More research is needed to determine the effectiveness of GCT or ICT in severely depressed adolescents (BDI ≥ 20).