Article

Psychological treatment of depression: Results of a series of meta-analyses

Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, The Netherlands.
Nordic journal of psychiatry (Impact Factor: 1.5). 07/2011; 65(6):354-64. DOI: 10.3109/08039488.2011.596570
Source: PubMed

ABSTRACT In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression.
We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression.
We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression.
We found no evidence showing that psychotherapy is less efficacious in severe depression (with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.

Download full-text

Full-text

Available from: Annemieke van Straten, Oct 29, 2014
5 Followers
 · 
378 Views
  • Source
    • "One challenge for the field will be who, or what agency, should take responsibility for such an effort. Although there do exist some notable efforts to bring together psychotherapy research results for the purposes of meta-analyses (Cuijpers, Anderson, Donker, & van Straten, 2011; Cuijpers et al., 2011), it is likely the case that no single research group, professional organization, or even a nationlevel system can take on the responsibility to accumulate such data-bases, since the efforts must be interprofessional and international in scope. It may be possible that web-based technology can be developed, perhaps sponsored by an international health organization, such as the World Health Organization or a consortium of international research agencies, to form a repository of evidencebased psychotherapies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper examines the issues related to the gap between theory and practice in the area of cognitive-behavioral therapy. The article begins with a review of the evidence for such a gap, and having demonstrated that the gap exists, provides a discussion of some of the factors that are likely important in its genesis and maintenance. The article then focuses on potential strategies to reduce the theory-practice gap that go beyond the common recommendation for both efficacy and effectiveness research. In particular, we provide recommendations for protocol planning and design, training and competency maintenance, dissemination research, and implementation and policy change. We conclude with the proposition that theory and research should not only inform practice, but that practice should have a reciprocal benefit on theory and research.
    Behavior therapy 12/2013; 44(4):559-567. DOI:10.1016/j.beth.2013.03.002 · 2.85 Impact Factor
  • Source
    • "been well established (Cuijpers et al., 2011a, 2011b). Both have been found to be similarly effective in reducing depressive symptoms (Cuijpers et al., 2011a). However, less is known about who will benefit from therapy, and who will not. "
    [Show abstract] [Hide abstract]
    ABSTRACT: By identifying which predictors and moderators lead to beneficial outcomes, accurate selection of the best initial treatment will have significant benefits for depressed individuals. An automated, fully self-guided randomized controlled internet-delivered noninferiority trial was conducted comparing two new interventions (Interpersonal Psychotherapy [IPT; n=620] and Cognitive Behavioral Therapy [CBT; n=610]) to an active control intervention (MoodGYM; n=613) over a period of 4 weeks to spontaneous visitors of an internet-delivered therapy website (e-couch). A range of putative predictors and moderators (socio-demographic characteristics [age, gender, marital status, education level], clinical characteristics [depression/anxiety symptoms, disability, quality of life, medication use], skills [mastery and dysfunctional attitudes] and treatment preference) were assessed using internet-delivered self-report measures at baseline and immediately following treatment and at six months follow-up. Analyses were conducted using Mixed Model Repeated Measures (MMRM). Female gender, lower mastery and lower dysfunctional attitudes predicted better outcome at post-test and/or follow-up regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered IPT may be the preferred treatment choice, whereas older participants derive more benefits from internet-delivered CBT programs. Although the sample of participants was large, power to detect moderator effects was still lacking. Different e-mental health programs may be more beneficial for specific age groups. The findings raise important possibilities for increasing depression treatment effectiveness and improving clinical practice guidelines for depression treatment of different age groups.
    Journal of Affective Disorders 08/2013; 151(1). DOI:10.1016/j.jad.2013.06.020 · 3.71 Impact Factor
  • Source
    • "Cognitive behavioural therapy (CBT) interventions have been shown in a multitude of studies to be an effective treatment for depression in adults and adolescents (Weisz et al. 2006; Calear & Christensen, 2010; Cuijpers et al. 2011). However, our knowledge of mechanisms that could explain this recovery is still limited (Kazdin, 2007; Lemmens et al. 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigates possible circularity in mechanisms of change in participants of Master Your Mood (MYM), a cognitive-based, online intervention for young adults with depressive symptoms. A previous study showed that MYM effectively reduced depression and anxiety and strengthened mastery. Method We randomized 244 participants with depressive symptoms into MYM or a wait-list control condition. We explored the circularity hypothesis by several analyses. Correlations were computed to determine the association between (change in) depression and anxiety. Path analysis mediation models were used to explore whether change in anxiety and mastery mediated the intervention effect on depression, whether depression and mastery mediated the effect on anxiety and whether depression and anxiety mediated the effect on mastery. We used linear regression to explore whether early changes in anxiety predicted later changes in depression, and whether early changes in depression predicted later changes in anxiety. Co-morbidity between depression and anxiety was high (69.2%) and the association between depression and anxiety change was strong (r = 0.677, p < 0.01). Changes in anxiety and mastery mediated change in depression (mediation proportion 44%); changes in depression mediated change in anxiety (79%) and mastery (75%). We did not find an early change in anxiety predictive for a late change in depression, and vice versa. This study appears to confirm the hypothesized circularity in the recovery process. We found high co-morbidity and strong correlation between depression and anxiety levels and bi-directional relationships between potential mediators and outcomes. Early anxiety change scores were not predictive of late depression change scores, and vice versa.
    Psychological Medicine 07/2013; 44(06):1-12. DOI:10.1017/S003329171300175X · 5.43 Impact Factor
Show more