How effective is cognitive behavioral therapy for depression and anxiety disorders?

Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry. 2016;15(3):245-258. doi:10.1002/wps.20346

Objective

This is a meta-analysis: a statistical pooling of many trials. It estimates how well cognitive behavioral therapy (CBT) works for major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and social anxiety disorder (SAD). It also checks how much the results are affected by publication bias, by the quality of the trials, and by the use of waiting-list control groups.

Main part

The authors pooled 144 randomized trials (184 comparisons) in which CBT was compared with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of people diagnosed with one of the four disorders by a structured interview.

Overall, the effects of CBT were large for all four disorders (effect size g): 0.75 for MDD, 0.80 for GAD, 0.81 for PD and 0.88 for SAD.

Three things made these numbers less certain:

Publication bias. Studies with weaker results tend to go unpublished. Adjusting for this lowered the effect for GAD (g = 0.59) and MDD (g = 0.65), but not for PD and SAD.
Trial quality. Only 17.4% of the trials were rated high quality. Looking only at those, the effects were lower for PD (g = 0.61) and SAD (g = 0.76). Quality has improved over time: 29.5% of trials published in 2010 or later were rated high quality, compared with 12% of earlier trials.
Control groups. More than 80% of the anxiety trials used a waiting-list control group. The few trials that used other control groups found much smaller effects for CBT.

Conclusion

The authors conclude that CBT is probably effective in treating MDD, GAD, PD and SAD. The effects are large when CBT is compared with a waiting list, but small to moderate when it is compared with care-as-usual or a pill placebo. Because few trials were of high quality, these effects are still uncertain and should be considered with caution.

Literature

Selected references:

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