Skip to main content Accessibility help
×
Home
Hostname: page-component-768ffcd9cc-7jw6s Total loading time: 0.411 Render date: 2022-12-03T21:53:36.389Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

A meta-analysis of randomized trials of behavioural treatment of depression

Published online by Cambridge University Press:  01 October 2007

D. Ekers*
Affiliation:
Tees Esk & Wear Valleys NHS Trust/University of York Department of Health Sciences, The Health Centre, Newcastle Road, Chester le Street, Co. Durham, UK
D. Richards
Affiliation:
Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
S. Gilbody
Affiliation:
Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK
*
*Address for correspondence: D. Ekers, Tees Esk & Wear Valleys NHS Trust/Department of Health Sciences, The Health Centre, Newcastle Road, Chester le Street, Co. Durham DH3 3UR, UK. (Email: David.Ekers@cddps.nhs.uk)

Abstract

Background

Depression is a common, disabling condition for which psychological treatments, in particular cognitive behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for depression, determine the effect of such interventions and examine any moderators of such effect.

Method

Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were extracted and analysed using meta-analysis and meta-regression respectively.

Results

Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls [standardized mean difference (SMD) −0.70, 95% CI −1.00 to −0.39, k=12, n=459], brief psychotherapy (SMD −0.56, 95% CI −1.0 to −0.12, k=3, n=166), supportive therapy (SMD −0.75, 95% CI −1.37 to −0.14, k=2, n=45) and equal to cognitive behavioural therapy (SMD 0.08, 95% CI −0.14 to 0.30, k=12, n=476).

Conclusions

The results in this study indicate behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues of parsimony of such interventions.

Type
Invited Review
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, A (1976). Cognitive Therapy and the Emotional Disorders. International Universities Press: New York.Google Scholar
Beck, A, Ward, C, Mendelson, M, Mock, J, Erdbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.CrossRefGoogle ScholarPubMed
Begg, C (1994). Publication bias. In: The Handbook of Research Synthesis (ed. Cooper, H. and Hedges, L. V.), pp. 399409. Russell Sage Foundation: New York, NY.Google Scholar
Centre for Economic Performance's Mental Health Policy Group (2006). The Depression Report. A New Deal for Depression and Anxiety Disorders. London School of Economics: London.Google Scholar
Churchill, R, Hunot, V, Corney, R, Knapp, M, McGuire, H, Tylee, A, Wessley, S (2001). A systematic review of controlled trials of the effectiveness and cost effectiveness of brief psychological treatments of depression. Health Technology Assessment 5 (35).Google Scholar
Cochrane Collaboration (2003). Review Manager (RevMan) [computer program]. Version 4.2 for Windows. The Nordic Cochrane Centre: Copenhagen.Google Scholar
Cole, M (1983). Behavioural treatment of chronic depression. Dissertation Abstracts International, vol. 45, no. 3. Univ Microfilms International, US.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L (2007). Behavioural activation treatments of depression: a meta analysis. Clinical Psychology Review 27, 318326.CrossRefGoogle Scholar
Cullen, J, Spates, R, Pagoto, S, Doran, N (2006). Behavioral activation treatment for major depressive disorder: a pilot investigation. Behavior Analyst Today 7, 151166.CrossRefGoogle Scholar
Dimidjian, S, Hollon, S, Dobson, K, Schmaling, K, Kohlenberg, R, Addis, M, Gallop, R, McGlinchey, J, Markley, D, Gollan, J, Atkins, D, Dunner, D, Jacobson, N (2006). Randomized trial of behavioural activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 74, 658670.CrossRefGoogle Scholar
Dobson, K (1989). A meta analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology 57, 414419.CrossRefGoogle Scholar
Egger, M, Davey-Smith, G, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.CrossRefGoogle ScholarPubMed
Ferster, C (1973). A functional analysis of depression. American Psychologist 28, 857870.CrossRefGoogle Scholar
Furukawa, T, Barbui, C, Cipriani, A, Brambilla, P, Watanabe, N (2006). Imputing missing standard deviations in meta-analyses can provide accurate results. Journal of Clinical Epidemiology 59, 710.CrossRefGoogle ScholarPubMed
Gallagher, D, Thompson, L (1982). Treatment of major depressive disorder in older adult outpatients with brief psychotherapies. Psychotherapy 19, 482490.CrossRefGoogle Scholar
Gardner, P, Oei, T (1981). Depression and self-esteem: an investigation that used behavioural and cognitive approaches to the treatment of clinically depressed clients. Journal of Clinical Psychology 37, 129135.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Gloaguen, V, Cottraux, J, Cucherat, M, Blackburn, I (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 49, 5972.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry 23, 5662.CrossRefGoogle Scholar
Higgins, J, Thompson, S (2004). Controlling the risk of spurious findings from meta-regression. Statistics in Medicine 23, 16631682.CrossRefGoogle ScholarPubMed
Higgins, J, Thompson, S, Deeks, J, Altman, D (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.CrossRefGoogle ScholarPubMed
Hirschfeld, R, Keller, M, Panico, S, Arons, B, Barlow, D, Davidoff, F, Endicott, J, Froom, J, Goldstein, M, Gorman, J, Guthrie, D, Marek, R, Maurer, T (1997). The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. Journal of the American Medical Association 277, 333340.CrossRefGoogle Scholar
Hollon, S, Thase, M, Markowitz, J (2002). Treatment and prevention of depression. Psychological Science in the Public Interest 3, 139.CrossRefGoogle ScholarPubMed
Hopko, D, Lejuez, C, Lepage, J, Hopko, S, McNeil, D (2003 a). A brief behavioral activation treatment for depression; a randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification 27, 458469.CrossRefGoogle ScholarPubMed
Hopko, D, Lejuez, C, Ruggiaro, K, Eifert, G (2003 b). Contemporary behavioural activation treatments for depression: procedures, principles and progress. Clinical Psychology Review 23, 699717.CrossRefGoogle ScholarPubMed
Jacobson, N, Dobson, K, Traux, P, Addis, M, Koerner, K, Gollan, J, Gortner, E, Prince, S (1996). A component analysis of cognitive-behavioural treatment of depression. Journal of Consulting and Clinical Psychology 64, 295304.CrossRefGoogle Scholar
Jacobson, N, Gortner, E (2000). Can depression be de-medicalised in the 21st century: scientific revolutions, counter revolutions and the magnetic field of normal science. Behaviour Research and Therapy 38, 103117.CrossRefGoogle Scholar
Jacobson, N, Martell, C, Dimijan, S (2001). Behavioural activation treatment for depression: returning to contextual roots. Clinical Psychology: Science & Practice 8, 255270.Google Scholar
Jadad, A, Moore, R, Carroll, D, Jenkinson, C, Reynolds, D, Cavaghan, D, McQuay, H (1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clinical Trials 17, 112.CrossRefGoogle ScholarPubMed
Khan, K, Kleijnen, J (2002). Phase 4: Selection of Studies. Undertaking systematic reviews of research on effectiveness CRD's guidance for those carrying out or commissioning reviews. In Report 4, 2nd edn (ed. Khan, K., ter Riet, G., Galanville, J., Sowden, A. and Kleijnen, J.). Centre for Reviews and Dissemination, University of York, UK.Google Scholar
Khan, K, ter Riet, G, Papay, J, Nixon, J, Kleijnen, J (2002). Phase 5: Study Quality Assesment. Undertaking systematic reviews of research on effectiveness CRD's guidance for those carrying out or commissioning reviews. In Report 4, 2nd edn (ed. Khan, K., ter Riet, G., Galanville, J., Sowden, A. and Kleijnen, J.). Centre for Reviews and Dissemination, University of York, UK.Google Scholar
Klerman, G, Weissman, M, Rounsaville, B, Chevron, E (1984). Interpersonal Psychotherapy of Depression. Basic Books: New York, NY.Google Scholar
Lewinsohn, P, Graf, M (1973). Pleasant activities and depression. Journal of Consulting and Clinical Psychology 41, 261295.CrossRefGoogle ScholarPubMed
Lipsey, M, Wilson, D (1993). The efficacy of psychological, educational and behavioural treatment. American Psychologist 48, 11811209.CrossRefGoogle Scholar
Luborsky, L, Mark, D, Hole, A (1995). Manual for supportive expressive dynamic therapy for depression: adaptation of the general SE manual. In Psychodynamic Psychotherapy for Axis 1 Disorders (ed. Barber, J. and Crits-Christoph, P.). Basic Books: New York.Google Scholar
Maldonado, Lopez A (1982). Behavioural therapy and depression. Revista dePsicología General y Aplicada 37, 3156.Google Scholar
Maldonado, Lopez A (1984). Behavioural therapy and depression: an experimental analysis of the interaction between cognitive and behavioural therapies and pharmacological therapy in depressed people. Revista de Psicología General y Aplicada 39, 517535.Google Scholar
Martell, C, Addis, M, Jacobson, N (2001). Depression in Context. Strategies for Guided Action. Norton: New York.Google Scholar
McKendree-Smith, N (1998). Cognitive and behavioural bibliotherapy for depression: an examination of efficacy and mediators and moderators of change (unpublished Ph.D. thesis). University of Alabama.Google Scholar
McLean, P, Hakstain, R (1979). Clinical depression: comparative efficacy of outpatient treatment. Journal of Consulting and Clinical Psychology 47, 818836.CrossRefGoogle Scholar
McNamara, K, Horan, J (1986). Experimental construct validity in the evaluation of cognitive and behavioral treatments for depression. Journal of Counselling Psychology 33, 2330.CrossRefGoogle Scholar
NICE (2004). Management of Depression in Primary and Secondary Care. National Institute for Clinical Excellence: London.Google Scholar
Padfield, M (1976). The comparative effects of two counseling approaches on the intensity of depression among rural women of low socioeconomicstatus. Journal of Counselling Psychology 23, 209214.CrossRefGoogle Scholar
Rogers, C (1961). On Becoming a Person. Houghton Mifflin: Boston, MA.Google Scholar
Schulz, K, Grimes, D (2002). Allocation concealment in randomised trials: defending against deciphering. Lancet 359, 614618.CrossRefGoogle ScholarPubMed
Scogin, F, Jamison, C, Gochneaur, K (1989). Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. Journal of Consulting and Clinical Psychology 57, 403407.CrossRefGoogle ScholarPubMed
Singleton, N, Bumpstead, R, O'Brien, M, Lee, A, Meltzer, Y (2001). Office of National Statistics: Psychiatric Morbidity Among Adults Living in Private Households, 2000. HMSO: London.Google Scholar
Skinner, D (1984). Self-control of depression: A comparison of behaviour therapy and cognitive behaviour therapy. Dissertation Abstracts International, vol. 45, no. 3. Univ Microfilms International, US.Google Scholar
Stata Corporation (2003). Version 8 [program]. Stata Corporation: Texas.Google Scholar
Sutton, A, Abrams, K, Jones, D (1998). Systematic reviews of trials and other studies. Health Technology Assessment 2 (19).Google ScholarPubMed
Taylor, F, Marshall, W (1977). Experimental analysis of a cognitive-behavioral therapy for depression. Cognitive Therapy and Research 1, 5972.CrossRefGoogle Scholar
Thompson, L, Gallagher, D, Breckenridge, J (1987). Comparative effectiveness of psychotherapies for depressed elders. Journal of Consulting and Clinical Psychology 55, 385390.CrossRefGoogle ScholarPubMed
Thompson, S, Higgins, J (2002). How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine 21, 15591573.CrossRefGoogle ScholarPubMed
WHO (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope. World Health Organisation: Geneva.Google Scholar
Wilson, P (1982). Combined pharmacological and behavioural treatment of depression. Behavior Research and Therapy 20, 173184.CrossRefGoogle ScholarPubMed
Wilson, P, Goldin, J, Charbonneau, P (1983). Comparative efficacy of behavioral and cognitive treatments of depression. Cognitive Therapy and Research 7, 111124.CrossRefGoogle Scholar
Zeiss, A, Lewinsohn, P, Munoz, R (1979). Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules or cognitive training. Journal of Consulting and Clinical Psychology 47, 427439.CrossRefGoogle ScholarPubMed
Supplementary material: File

Ekers Supplementary Material

Figure.doc

Download Ekers Supplementary Material(File)
File 28 KB
Supplementary material: File

Ekers Supplementary Material

Appendix.doc

Download Ekers Supplementary Material(File)
File 90 KB
248
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

A meta-analysis of randomized trials of behavioural treatment of depression
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

A meta-analysis of randomized trials of behavioural treatment of depression
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

A meta-analysis of randomized trials of behavioural treatment of depression
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *