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Predictors of depression relapse and recurrence after cognitive behavioural therapy: a systematic review and meta-analysis

Published online by Cambridge University Press:  21 March 2019

Caroline Wojnarowski*
Department of Psychology, University of Sheffield, Sheffield, UK
Nick Firth
School of Health and Related Research, University of Sheffield, Sheffield, UKxs
Megan Finegan
Department of Psychology, University of Sheffield, Sheffield, UK
Jaime Delgadillo
Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
*Corresponding author. Email:



Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.


This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.


We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.


Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p = .01) and prior episodes (r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [−0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.


Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.

© British Association for Behavioural and Cognitive Psychotherapies 2019 

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