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Clinical relevance of findings in trials of CBT for depression

Published online by Cambridge University Press:  23 March 2020

P. Lepping*
Affiliation:
Betsi Cadwaladr University Health Board, Centre for Mental Health and Society, Bangor University, North Wales, UK Mysore Medical College and Research Institute, Mysuru, India Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK
R. Whittington
Affiliation:
Department of Health Services Research, University of Liverpool, Liverpool, UK
R.S. Sambhi
Affiliation:
Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK
S. Lane
Affiliation:
Department of Health Services Research, University of Liverpool, Liverpool, UK
R. Poole
Affiliation:
Betsi Cadwaladr University Health Board, Centre for Mental Health and Society, Bangor University, North Wales, UK
S. Leucht
Affiliation:
Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
P. Cuijpers
Affiliation:
Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
R. McCabe
Affiliation:
Mersey Care NHS Trust, Liverpool, UK
W. Waheed
Affiliation:
Lancashirecare NHS Trust, Preston and the University of Manchester, Manchester, UK Centre for Primary care, The University of Manchester, Manchester, UK
*
*Corresponding author. Wrexham Academic Unit, Centre for Mental Health and Society, Technology Park, Wrexham, Wales LL13 7TP, United Kingdom. Fax: +44 1978 726 600. E-mail address:peter.lepping@wales.nhs.uk (P. Lepping).
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Abstract

Cognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression – Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD.

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Original article
Copyright
Copyright © European Psychiatric Association 2017

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