Effectiveness Of Cognitive Behavioral Therapy For Depression Research Articles

Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice

BackgroundIndividuals with depressive disorders often present to and seek treatment in primary care. Integrated behavioral health services within this setting can improve access to evidence-based cognitive behavioral therapy (CBT). However, limited information exists on the effectiveness of CBT for depression in primary care. MethodsOf the 1,302 participants with a primary depressive disorder referred by their primary care provider, 435 endorsed moderate to severe depression at baseline and engaged in at least one CBT session. A psychotherapy tracking database was used to collect relevant data, which included demographics, clinical characteristics, treatment outcomes, and CBT intervention use. ResultsParticipants with moderate to severe depression who participated in CBT reported a significant decrease in depression and anxiety symptoms at the end of treatment (p ≤ .001, d = 0.52–0.78). Rates of reliable change, response, and remission and types of CBT interventions used differed between major and persistent depressive disorders. LimitationsMultiple limitations must be noted, which are related to the naturalistic study design, inclusion and exclusion criteria, sample operationalization, symptomatic measurement, time-limited and focused assessment, data collection strategies, and psychological services. Together, these temper the conclusions that can be drawn. ConclusionSignificant reductions in depression and anxiety symptoms were reported by participants with depressive disorders who engaged in short-term CBT within primary care. This study indicates that CBT can be implemented within primary care and suggests that primary care patients with depression can benefit from integrated psychological services, supporting population-based models of care.

The effects of cognitive-behavioral therapy for depression are not falling: A re-analysis of Johnsen and Friborg (2015).

Cognitive-behavioral therapy (CBT) has a solid evidence base as an effective treatment for depression. However, a recent meta-analysis (Johnsen & Friborg, 2015) including 70 studies, showed that the effect sizes of CBT for depression have been falling between 1977 and 2014. A possible important limitation in the Johnsen and Friborg (2015) study was that they did not investigate a leveling off in the decline over time of the effectiveness of CBT for depression. We therefore reanalyzed the data reported by Johnsen and Friborg (2015) using meta-analytic regression models that allowed for a curvilinear effect of publication year and also modeled separate estimates of the decline of treatment effect before and after 1995. Our analyses showed that adding a quadratic effect of time to a linear effect of time significantly improved the meta-analytic regression models (p = .017-.027). Furthermore, significant declines were only observed between 1977 and 1995 (p = .001-.009) and not between 1995 to 2014 (p = .987-.785). We conclude that the declining effect of CBT for depression observed by Johnsen and Friborg (2015) was highly influenced by 22 studies published before 1995 and that the 48 studies published after 1995 did not demonstrate such a decline. Thus, there are no indications that CBT for depression is gradually losing its value. (PsycINFO Database Record

The effects of cognitive behavioral therapy are not systematically falling: A revision of Johnsen and Friborg (2015).

In a meta-analysis, Johnsen and Friborg (2015) reported a significant negative relationship between publication year and the effect sizes (ESs) of cognitive-behavioral therapy (CBT) for depressive disorders, suggesting its effectiveness was falling. We identified a series of methodological and conceptual caveats and consequently redid the meta-analysis. We used the same inclusion criteria, but only included randomized controlled trials and searched for additional eligible trials. We computed both within-group and between-group ESs for the CBT arm for the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). We assessed risk of bias, sample size, type of control group, and the study's country of origin and conducted subgroup, single, and multiple meta-regression analyses including publication year and other moderators. We identified 30 additional eligible trials. Within-group ESs presented huge heterogeneity estimates (I2 around 90%). Year of publication was significant in some single meta-regression analyses on the BDI, but not significant in others, in most analyses on the HRSD, and in any of the analyses on between-group ESs. Multiple regression models indicated that either year was not significantly related or that both year and country were significantly related to outcomes, with a temporal trend present solely in US studies. Year of publication does not appear to be a reliable and independent moderator of the effectiveness of CBT for depression. The linear "fall" reported by Johnsen and Friborg (2015) is most likely a spurious finding. (PsycINFO Database Record

Cognitive behavioral therapy for depression improves pain and perceived control in cardiac surgery patients.

Depression after cardiac surgery (CS) is associated with increased pain and decreased sleep quality. While cognitive behavioral therapy (CBT) aimed at depression is effective in relieving depressive symptoms after cardiac surgery, little is known about its ability to ameliorate other common postoperative problems that affect recovery and quality of life. The purpose of this study was to evaluate the effects of CBT for depression on pain severity, pain interference, sleep, and perceived control in patients recovering from CS. Depressed patients recovering from CS were randomized to receive either eight weeks of CBT or usual care. At baseline and post-intervention, patients completed questionnaires for depressive symptoms, pain, sleep, and perceived control. Group comparisons were conducted using t-tests or chi square analysis. Repeated measures analysis was used to assess the effect of the intervention in changes over time. The sample (n=53) included 16.9% women and had a mean age of 67.8±9.2 years. CBT for depression increased perceived control (p<0.001) and decreased pain interference (p=0.02) and pain severity (p=0.03). Group effects remained significant (p<0.05) for perceived control and pain interference and a trend was observed for pain severity (p<0.10) after controlling for variables that differed at baseline. There were no group differences in sleep disturbance over time. A depression-focused CBT intervention yields benefits in other common postoperative problems, specifically improved perceived control and decreased pain in depressed cardiac surgery patients.

The use of cognitive behaviour therapy to treat depression in people with learning disabilities: a systematic review

Purpose – Cognitive behaviour therapy (CBT) is currently one of the recommended treatments for depression for the general population and guidance recommends that people with a learning disability should have access to the same treatments as people without a learning disability. The purpose of this paper is to identify, outline and evaluate current research on the effectiveness of CBT for depression for people with a learning disability. The clinical, service and research implications are considered. Design/methodology/approach – A systematic search was conducted and five relevant articles were identified for critical review. Findings – There is a limited but promising evidence base for the use of CBT for depression with people with learning disabilities. Research limitations/implications – The current review identified a number of methodological issues and future research should attempt to overcome these (e.g. small sample sizes and lack of controls). In particular, research should focus on determining the relative contribution of cognitive and behavioural techniques in producing a change in depressive symptoms. Practical implications – Services (including those provided as part of Improving Access to Psychological Therapies) should be offering CBT-based interventions for people with learning disabilities who are experiencing depression. Originality/value – This paper provides a comprehensive and up to date review of the current literature regarding the use of CBT for depression for people with a learning disability. This will be of value to clinicians working with people with a learning disability as well as those commissioning services.