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PUBLISHED DATE: - 28-12-2024
DOI: -
https://doi.org/10.37547/TAJMSPR/Volume06Issue12-11
PAGE NO.: - 113-126
SYSTEMATIC LITERATURE REVIEW OF
COGNITIVE-BEHAVIORAL THERAPY (CBT)
EFFECTIVENESS IN TREATING DEPRESSION
AMONG ADULT MENTAL HEALTH PATIENTS
Franklin E. Ibadin
Faculty - Health Sciences, Public Health in Epidemiology, Purdue University
Global, West Lafayette, Indiana, USA
Excel Onajite Ernest-Okonofua
California Institute of Behavioral Neuroscience and Psychology (CiBNP),
Fairfield, California, USA
Correspondence: Franklin E. Ibadin
INTRODUCTION
Depression, a serious mental condition, is defined
through a constant sad mood, lack of interest in
pleasing activities, followed by various symptoms
such as, fatigue, insomnia, low concentration, loss
of weight, morbid thoughts of death and inapt
RESEARCH ARTICLE
Open Access
Abstract
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guilt.1,2 Depression is linked with distinct socio-
economic morbidity, lack of productivity, and
functionality which in turn links with developing
substantial
workload
over
workers.3
Furthermore, depression is linked with a
substantially amplified risk of death.4 Around 20%
of people suffer from depressive disorders
eventually in their lives.5 The third major outcome
of burden of disease around the world is
depression. It is projected to rise over the
following 20 years.6,7 Globally, depression is
known as the biggest non-fatal burden of disease
including a 12% of disability-lived life.8 Previous
resea
rch has evaluated depression’s point
prevalence as 3.9% and dysthymia, a minor long-
term variant of depression, to be at 1.1%.9 Over
the last two decades, prescription of anti-
depressants has tremendously increased among
the Western world, primarily along the
development of inhibitors of selective serotonin
reuptake and anti-depressants for the primary
clinical treatments of depression. 3,10 Although
anti-depressants are an effective treatment for
severe depression,11-16 the degree of patient
adherence to medication stay lower due to the
apprehensions regarding potential addiction and
side effects of the medication.17,18 Psychological
therapies are an essential and common substitute
to pharmacotherapy such as anti-depressant
medications in treating depression. Preceding
meta-analyses found that psychological therapies
are as effective as pharmacotherapy, as a sole
treatment of alleviating mild to moderate
depression
symptoms.19,20
Psychological
therapies have been established over the past few
years including the cognitive-behavioral therapy.2
As recommended by clinical guidelines,
psychological and pharmacological treatments in
combination or as separate treatments are
required to treat moderate to severe depression.3
Poor response to clinical interventions such as
antidepressants among depressed patients, is
quite common.21-23 This poor pharmacotherapy
response is known to be treatment-resistant
depression.24 While researchers have examined
possibly the most adequate treatments for
treatment-resistant depression since years, 22,23
no usual treatment intervention has been
developed so far.25 Moreover, a substantial
amount of patients suffering from chronic
depression do not even follow a treatment.26 As a
result, new treatment approaches are required for
the chronically depressed patients.27
By a thorough review of existing literature, the
efficacy of cognitive-behavioral therapy (CBT)
shows a significant empirical evidence aiding its
practice in clinical settings. CBT is substantially
being recognized as an effectual psychological
therapy approach for treating depression among
adult mental health patients. CBT is an organized
intervention centering on the association between
emotions, thoughts and behaviors (cognitive
restructuring), while targeting to challenge and
alter cognitive distortions contributing to
symptoms of depression.28 In addition, it
enhances the functioning and behavioral change.
Therapists utilizing CBT, highlight outdoor
activities apart from the sessions and assignments
as homework by a collaborative empiricism
approach to precisely experience the significance
of anticipated changes within therapy sessions.29
Moreover, CBT can be provided in several
arrangements such as, class, individual, or guided
self-help. Few studies have shown that CBT is also
effective in various arrangements including self-
help guidance.30,31 Previous study has compared
the efficacy of CBT treatment and shown just as
effective as solely a treatment of anti-
depressant,29 even though merging both the
treatments improves the treatment efficacy32,33.
Although a study focusing on a CBT variant, the
cognitive
behavioral
analysis
system
of
psychotherapy (CBASP), to be effective if
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combined with the antidepressant treatment,34
few studies found that CBASP has no benefit as a
sole
treatment
of
depression
without
medications.35,36 Similarly, mindfulness-based
cognitive therapy for depression treatment
without adding the medication treatment was not
found beneficial.37 However, these research did
not
concentrate
on
treatment-resistant
depression. The improvement shown while the
duration of depression treatment is known as
response whereas, remission is the complete
normalization of symptoms.38 Relapse is the
return of symptoms linked to a treated episode.
Therefore, to diminish the relapse risk, the newly
remitted
patients
are
usually
given
pharmacotherapy for the next 6-12 months.
Furthermore, the patients that do not relapse for a
long period of time, with the presumption that the
primary episode has finished, are said to have
recovered.39 Although many research has proven
the efficacy of depression treatments, under 50%
of the patients attain a full remission following no
substantial
remaining
symptoms
post-
psychological therapy,40 few research over
follow-ups have shown that the incidence of
relapse stays high.41
This paper targets to examine the efficacy of CBT
for treating depression among adult mental health
patients through a thorough literature review of
existing studies to assess the effectiveness of CBT
in alleviating depression among adults, taking into
consideration factors such as treatment duration,
patient demographics, and the presence of
comorbid conditions. This study will evaluate the
effectiveness of CBT in reducing symptoms and
improving depression among adult mental health
patients. This study will also explore potential
moderators such as age, gender, therapy duration,
existing comorbidities and treatment resistance
that impact CBT effectiveness in treating
depression. By combining outcomes from various
research, this systematic review targets to deliver
a distinct concept of how CBT can be personalized
to augment therapeutic effects for adult patients
suffering from depression, eventually supporting
the enhancement of mental healthcare in clinical
settings.
RESEARCH QUESTIONS
How\why is CBT effective in the treatment of
depression in adults?
What are internal/external factors associated with
the effectiveness of CBT for depression?
METHODOLOGY
This systematic review is executed based on the
methodology permitting to the Preferred
Reporting Items for Systematic Reviews and Meta-
Analysis (PRISMA) statement.42
Inclusion and Exclusion Criteria
Inclusion Criteria
Studies were included if they met the following
criteria: (1) Randomized controlled trials, meta-
analyses, and other relevant studies. (2) Studies
evaluating the effectiveness of CBT. (3) Studies
comparing CBT with other treatments like
psychological, pharmacotherapy treatments or a
control condition. (4) Studies regarding diagnosed
depression established by diagnostic interviews,
self-report scale or depressive symptoms among
adults. (5) Studies published in the English
language only that were published from 2015 to
2024. (6) Analysis of short term (after test) and
long term outcomes (follow ups) even though a
few research outlined this information.
Exclusion Criteria
Studies were not included if they met the following
criteria: (1) Non-peer reviewed studies such as
website or blog posts. (2) Studies including
depression among adolescents or children (less
than 18 years of age). (3) Studies not focusing on
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CBT. (4) Studies without a control condition. (5)
Studies published in languages other than English.
(5) Relevant studies that were published before
2015.
Search Strategy
Several electronic databases like Google Scholar,
PubMed, and Cochrane Library were searched
from 2015 to 2024 for randomized controlled trial,
meta-analyses and other relevant papers
regarding the cognitive-behavioral thera
py’s
efficacy in depression treatment among adult
mental health patients which meets the inclusion
criteria. To additionally discover relevant studies,
and unpublished studies that were not discovered
through the search strategy, the included studies’
reference lists were searched manually. Studies
only published in the English language were
included. Varying on the database, different
combinations of free terms and MeSH terms were
employed. The search terms included “cognitive
behavioral therapy”, “CBT”, “efficacy”, “major
depression”, “depression”, “adults”, “mental
health”.
Data Extraction and Management
Screening of the abstracts and titles were
performed by a reviewer. The titles and abstracts
of the screened randomized controlled trials and
relevant studies were reviewed to check if the
studies complied with the inclusion criteria. Data
extraction
was
performed
independently
employing the general data extraction methods
comprising study attributes such as title, sample
size and detailed information. The comprehensive
information in the PICOS method includes the
participation, treatment method, comparison,
results, design of the study and other
characteristics.
Quality Assessment
In this review, the Cochrane Collaboration tool for
evaluating the risk of biasness to assess the
validity, quality and the potential bias of the
included studies in methodologies of the
randomized controlled trials.43 The Cochrane
Collaboration tool offers seven items for assessing
bias: allocation concealment (selection bias),
selective reporting (reporting bias), blinding of
outcome assessment (detection bias), random
sequence generation (selection bias), blinding of
participants and personnel (performance bias),
incomplete outcome data (attrition bias) and other
bias.43 As a result, each study was classified as low
risk of bias and unclear (vagueness over the
possibility for bias or missing information),
shadowing the instructions from the Cochrane
Guide. In addition, Robvis, Risk of bias
visualization, is a variant of Cochrane Bias tool, for
creating risk of bias plots and was therefore,
utilized in this review.44
RESULTS
Initially, 21 studies were overall identified and
screened through comprehensive database
searches. After implementing the inclusion and
exclusion criteria, 8 articles were chosen for a
thorough analysis, which included randomized
controlled trials, meta analyses and other relevant
studies available from 2015 to 2023. The
combined sample size of these studies was
approximately 10384 adult participants diagnosed
with depression. Figure 1 shows the identified
databases and screened studies included in this
systematic review, meeting the inclusion and
exclusion criteria. The PRISMA flow diagram was
created using PRISMA2020.45
The results revealed that CBT diminishes
depressive symptoms as compared to the control
groups that received alternative therapies.
Additionally, the results revealed that CBT and
several variations of CBT showed moderate
efficacy in treating depression among severely
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depressed patients. Studies with follow up post-
treatment, validated that the benefits of CBT were
sustained over time, with reduction in depressive
symptoms retained from 6 to 12 months after the
successful completion of treatment. Adverse
effects were minimal. These results highlight that
CBT may be an effective treatment solely or may be
highly effective if combined with other treatments
for depression in adult mental health patients
while underlining its prospective for long term
effects. Table 1 shows the summary of results of
CBT as an intervention compared with control
groups and their study designs, follow-up duration
and outcomes.
CBT with Pharmacotherapy
In a study, it was shown that patients administered
into CBT were 2.4 times possible to have treatment
effectiveness at 16 weeks and showed milder
depressive symptoms as compared to the usual
treatment group which consisted of anti-
depressive medications.24 Furthermore, the long-
term effects that benefited through CBT were
followed up for 12 months and confirmed the
effective outcomes at 3 months. However, there
was no treatment difference shown at 8 weeks.
Similarly, no difference was found in the overall
well-being in both treatment groups. Eventually, it
was found that combining pharmacotherapy with
CBT was effective in alleviating depressive
symptoms in patients with treatment-resistant
depression. A meta-analysis reported that
pharmacotherapy showed minor improvement in
depression as compared to CBT.46 In the same
study, the randomized controlled trial samples
may not be inclusive of patients with depression
being treated in healthcare centers.47 Another
systematic review and meta-analysis conducted,
with women being the majority of the participants,
comparing CBT with second generation anti-
depressants showed no difference in treatment
effects in both the treatment therapies, whether
solely or in combination. The risks of response and
remissions were almost similar to the comparisons
of monotherapy. However, this study had a low
evidence rate and its outcomes were moderated by
small numbers. 48
CBT with Other Psychological Interventions
In a clinical trial conducted only on depressed
female patients comparing CBT with Positive
Psychology Interventions (PPI), 71.8% of
participants in CBT group were no longer
applicable to the diagnostic criteria whereas,
67.6% of the participants in the PPI group were no
more applicable to the criteria of diagnosis.49
Moreover, in the same study, results found that
intention-to-treat analysis showed both treatment
forms effectively diminishing the clinical
depressive symptoms along with enhancing the
quality of life. However, the main outcomes such as
level of depressive symptoms and diagnosis and
secondary outcomes such as, quality of life and
positive and negative effects, in both the groups
had no substantial difference. In addition, no
difference between CBT and PPI was found even in
severely depressed patients.49 Another study
showed that CBT variations, Blended CBT and
Face-to-Face CBT were both found effective in
treating depression. The participants age range
included 18-76 years, with 74% of them being
females.50 At 6 months’ follow up, no significant
variation between both the treatment variations
was found, whereas, a slight but non-significant
difference was shown at 12 months follow up.
Similarly, research comparing internet-based CBT
(iCBT) with waiting list group found that internet-
based CBT group showed diminished depressive
and anxiety symptoms and enhanced quality of life.
The mean participant age was 30.82, with 74% of
females.51 Moreover, the ICBT group had higher
(55%) remission rates.51 In a network meta-
analysis comparing CBT, cognitive restructuring
(CR) and behavioral activation (BA) with care as
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usual and waiting list on depressed patients, no
difference was found in the efficacy of CBT, CR, BA.
Hence, the outcomes recommend that CR or BA
solely or in combination with CBT may be effective
treatments as compared to care as usual and
waiting list.52 Furthermore, in a study conducting
CBT as a treatment for depression among young
adults, ranging from 22.4-51.7 years, and older
adults, ranging from 66.4-77.5 years, showed that
no substantial difference among the age groups is
reported in context to CBT efficacy for depression
in comparison to other treatments, provided the
overall effect supporting CBT over other
treatments. Hence, CBT is efficacious in both
younger and older adults.53
Quality Assessment Findings
The quality of the studies was moderate. The
Cochrane risk of bias tool was utilized to assess the
biasness of the included randomized controlled
trials and is summarized and shown in Figure 2.
Two studies reported overall adequacy whereas,
the other did not. Two studies reported blinding of
outcome assessors. In one study, intention to treat
analysis was conducted. One study met all the
inclusion criteria. Whereas, the other three had
adequate quality, meeting four to five criteria.
DISCUSSION
After a comprehensive literature review, only eight
studies were included to improve the quality of the
systematic analysis rather than quantity. Results
combined from the eight studies showed CBT as
comparatively an effective psychological therapy
for depression.
The theory regarding CBT was developed in a
research as, “participating in approaches targeted
to modifying negatively biased beliefs and thinking
styles result in cognitive change, which is the
mechanism through which depressive symptoms
are lowered.”54 Across multiple studies, evidence
supports CBT as a successful treatment for
depression
in
lowering
the
depressive
symptoms.24,46,48-53 This supports the case for
incorporating CBT into standard psychological
therapeutic interventions for depressed adult
mental health patients. Moreover, the findings of
this research emphasize that although CBT is
usually effectively, several characteristics like age,
gender, the presence of comorbidities, and the
severity of depression may affect the results of the
treatment. Similar to findings of this review,
research has shown that depression is generally
more common amongst women compared to
men.55 However, in context to this review, the
results based on gender may not be relevant as
several studies focused only on women. This is
suggestive of developing personalized CBT
approaches to provide the requirements based on
the individual pa
tient’s requirements and different
demographics that may enhance the overall
efficacy of the treatment. In addition, the
significance of the duration of treatment in one
study is highlighted showing that longer CBT
interventions are linked to enhanced outcomes,24
indicating that sufficient time is critical for patients
to completely participate in the procedure and
achieve effective coping approaches. This outcome
suggests that mental healthcare professionals
should take application of longer treatment
duration plans into consideration, specifically
aimed at patients encountering more severe
depressive symptoms.
This review acknowledges some limitations within
the reviewed studies, such as the differences in
sample sizes and study designs which affects the
generalizability of the overall outcomes.
Furthermore, several studies reported drop-out
rates that may have tempered with the overall
primary and secondary outcomes. The inadequate
amount of recent studies consisting of randomized
controlled trials makes it challenging to draw
definitive conclusions, although several previous
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studies have proven the efficacy of CBT on its
own.56-59 As a result, further study is essential to
examine the efficacy of CBT in randomized-
controlled studies. In addition, few studies
included the follow-up approaches in their study
designs to monitor short-term and long-term
effectiveness of CBT for the treatment of
depression. Future research must aim on
conducting more rigorous randomized controlled
trials consisting of larger sample sizes, keeping in
view the drop-out rates and individual patient
demographics to explore the long-term effects of
CBT
and
its
adaptability
in
different
characteristics.
CONCLUSION
In conclusion, this systematic review accentuates
that CBT not only provides alleviation from
depressive symptoms but also provides patients
with coping strategies for mental health
improvement. Additional research is required to
moderate
characteristics
like
patient
demographics and larger sample sizes are
required for more definite conclusions. Moreover,
future research must include treatment follow-ups
after the completion of the treatment for achieving
evidence of long-term and short-term benefits.
Nevertheless, this study shows ample findings that
prove CBT as a promising depression treatment
whether as a monotherapy or combined with other
therapies.
ACKNOWLEDGEMENTS
None.
DISCLOSURE
The authors report no conflicts of interest or
disclosure of financial interest in this work.
REFERENCES
1.
Association AP. Diagnostic and statistical
manual of mental disorders. Text revision.
2000;
2.
Hunot V, Moore TH, Caldwell DM, et al.
'Third wave'cognitive and behavioural
therapies versus other psychological
therapies
for
depression.
Cochrane
Database of Systematic Reviews. 2013;(10)
3.
Pilling S, Anderson I, Goldberg D, Meader N,
Taylor C. Depression in adults, including
those with a chronic physical health
problem: summary of NICE guidance. Bmj.
2009;339
4.
Cuijpers P, Smit F. Excess mortality in
depression: a meta-analysis of community
studies. Journal of affective disorders.
2002;72(3):227-236.
5.
Wittchen H-U, Jacobi F, Rehm J, et al. The size
and burden of mental disorders and other
disorders of the brain in Europe 2010.
European
neuropsychopharmacology.
2011;21(9):655-679.
doi:10.1016/j.euroneuro.2011.07.018
6.
Organization WH. The global burden of
disease: 2004 update. Geneva: WHO; 2008.
2017.
7.
Van Lerberghe W. The world health report
2008: primary health care: now more than
ever. World Health Organization; 2008.
8.
Moussavi S, Chatterji S, Verdes E, Tandon A,
Patel V, Ustun B. Depression, chronic
diseases, and decrements in health: results
from the World Health Surveys. The Lancet.
2007;370(9590):851-858.
9.
Investigators EM, Alonso J, Angermeyer M,
et al. Prevalence of mental disorders in
Europe: results from the European Study of
the Epidemiology of Mental Disorders
(ESEMeD) project. Acta psychiatrica
scandinavica. 2004;109:21-27.
10.
Ellis P. Australian and New Zealand clinical
practice guidelines for the treatment of
THE USA JOURNALS
THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN
–
2689-1026)
VOLUME 06 ISSUE12
120
https://www.theamericanjournals.com/index.php/tajmspr
depression. Australian & New Zealand
Journal
of
Psychiatry.
2004;38(6)doi:10.1111/j.1440-
1614.2004.01377.x
11.
Cipriani A, Brambilla P, Furukawa TA, et al.
Fluoxetine
versus
other
types
of
pharmacotherapy for depression. Cochrane
Database
of
Systematic
Reviews.
2005;(4)doi:10.1002/14651858.CD004185
.pub2
12.
Guaiana G, Barbui C, Hotopf M. Amitriptyline
for depression. Cochrane database of
systematic
reviews.
2007;(3)doi:10.1002/14651858.CD004186
.pub2
13.
Arroll B, Elley CR, Fishman T, et al.
Antidepressants
versus
placebo
for
depression in primary care. Cochrane
Database
of
Systematic
Reviews.
1996;2014(4)doi:10.1002/
14651858.CD007954
14.
Cipriani A, La Ferla T, Furukawa TA, et al.
Cochrane Database of Systematic Reviews.
Cochrane Database of Systematic Reviews.
2009;(2):006117-006117.
doi:10.1002/
14651858.CD006117.pub2
15.
Cipriani A, Santilli C, Furukawa TA, et al.
Escitalopram versus other antidepressive
agents for depression. Cochrane Database of
Systematic Reviews. 2009;(2)doi:10.1002/
14651858.CD006532.pub2
16.
Cipriani A, Furukawa TA, Salanti G, et al.
Comparative efficacy and acceptability of 12
new-generation
antidepressants:
a
multiple-treatments meta-analysis. The
lancet.
2009;373(9665):746-758.
doi:10.1002/14651858.CD006532.pub2
17.
Hunot VM, Horne R, Leese MN, Churchill RC.
A cohort study of adherence to
antidepressants in primary care: the
influence of antidepressant concerns and
treatment preferences. Primary care
companion to the Journal of clinical
psychiatry.
2007;9(2):91.
doi:10.4088/pcc.v09n0202
18.
van Geffen EC, Gardarsdottir H, van Hulten
R, van Dijk L, Egberts AC, Heerdink ER.
Initiation of antidepressant therapy: do
patients follow the GP's prescription?
British Journal of General Practice.
2009;59(559):81-87.
doi:10.3399/bjgp09X395067
19.
Dobson KS. A meta-analysis of the efficacy of
cognitive therapy for depression. Journal of
consulting
and
clinical
psychology.
1989;57(3):414.
doi:10.1037/0022-
006X.57.3.414
20.
De Maat S, Dekker J, Schoevers R, De Jonghe
F. Relative efficacy of psychotherapy and
pharmacotherapy in the treatment of
depression: A meta-analysis. Psychotherapy
Research.
2006;16(5):566-578.
doi:10.1080/10503300600756402
21.
Souery D, Amsterdam J, De Montigny C, et al.
Treatment
resistant
depression:
methodological overview and operational
criteria.
European
Neuropsychopharmacology.
1999;9(1-
2):83-91.
22.
Rush AJ, Trivedi MH, Wisniewski SR, et al.
Bupropion-SR, sertraline, or venlafaxine-XR
after failure of SSRIs for depression. New
England
Journal
of
Medicine.
2006;354(12):1231-1242.
23.
Trivedi MH, Rush AJ, Wisniewski SR, et al.
Evaluation of outcomes with citalopram for
depression using measurement-based care
in STAR* D: implications for clinical practice.
THE USA JOURNALS
THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN
–
2689-1026)
VOLUME 06 ISSUE12
121
https://www.theamericanjournals.com/index.php/tajmspr
American
journal
of
Psychiatry.
2006;163(1):28-40.
24.
Nakagawa A, Mitsuda D, Sado M, et al.
Effectiveness of supplementary cognitive-
behavioral therapy for pharmacotherapy-
resistant
depression:
a
randomized
controlled trial. The Journal of clinical
psychiatry. 2017;78(8):2450.
25.
Connolly KR, Thase ME. If at first you don’t
succeed: a review of the evidence for
antidepressant augmentation, combination
and
switching
strategies.
Drugs.
2011;71:43-64.
26.
Torpey DC, Klein DN. Chronic depression:
update on classification and treatment.
Current
psychiatry
reports.
2008;10(6):458-464.
27.
Cuijpers P, Huibers MJ, Furukawa TA. The
need for research on treatments of chronic
depression.
JAMA
psychiatry.
2017;74(3):242-243.
28.
Cristea IA, Huibers MJ, David D, Hollon SD,
Andersson G, Cuijpers P. The effects of
cognitive behavior therapy for adult
depression on dysfunctional thinking: A
meta-analysis. Clinical psychology review.
2015;42:62-71.
doi:10.1016/j.cpr.2015.08.003
29.
Cuijpers P, Berking M, Andersson G, Quigley
L, Kleiboer A, Dobson KS. A meta-analysis of
cognitive-behavioural therapy for adult
depression, alone and in comparison with
other treatments. The Canadian Journal of
Psychiatry. 2013;58(7):376-385.
30.
Barth J, Munder T, Gerger H, et al.
Comparative
efficacy
of
seven
psychotherapeutic
interventions
for
patients with depression: a network meta-
analysis.
Focus.
2016;14(2):229-243.
doi:10.1176/appi.focus.140201
31.
Cuijpers P, Donker T, van Straten A, Li J,
Andersson G. Is guided self-help as effective
as
face-to-face
psychotherapy
for
depression and anxiety disorders? A
systematic review and meta-analysis of
comparative outcome studies. Psychological
medicine.
2010;40(12):1943-1957.
doi:10.1017/S0033291710000772
32.
Cuijpers P, Dekker J, Hollon SD, Andersson G.
Adding psychotherapy to pharmacotherapy
in the treatment of depressive disorders in
adults: a meta-analysis. Journal of clinical
psychiatry. 2009;70(9):1219-1229.
33.
Cuijpers P, Sijbrandij M, Koole SL, Andersson
G, Beekman AT, Reynolds III CF. Adding
psychotherapy
to
antidepressant
medication in depression and anxiety
disorders:
a
meta-analysis.
Focus.
2014;12(3):347-358.
34.
Keller MB, McCullough JP, Klein DN, et al. A
comparison of nefazodone, the cognitive
behavioral-analysis
system
of
psychotherapy, and their combination for
the treatment of chronic depression. New
England
journal
of
medicine.
2000;342(20):1462-1470.
35.
Kocsis JH, Gelenberg AJ, Rothbaum BO, et al.
Cognitive behavioral analysis system of
psychotherapy and brief supportive
psychotherapy
for
augmentation
of
antidepressant nonresponse in chronic
depression: the REVAMP Trial. Archives of
general psychiatry. 2009;66(11):1178-
1188.
doi:10.1001/archgenpsychiatry.2009.144
36.
Wiersma JE, Van Schaik DJ, Hoogendorn AW,
et al. The effectiveness of the cognitive
behavioral
analysis
system
of
THE USA JOURNALS
THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN
–
2689-1026)
VOLUME 06 ISSUE12
122
https://www.theamericanjournals.com/index.php/tajmspr
psychotherapy for chronic depression: a
randomized controlled trial. Psychotherapy
and psychosomatics. 2014;83(5):263-269.
doi: 10.1159/000360795
37.
Michalak J, Schultze M, Heidenreich T,
Schramm E. A randomized controlled trial
on the efficacy of mindfulness-based
cognitive therapy and a group version of
cognitive behavioral analysis system of
psychotherapy for chronically depressed
patients. Journal of consulting and clinical
psychology. 2015;83(5):951.
38.
Frank E, Prien RF, Jarrett RB, et al.
Conceptualization
and
rationale
for
consensus definitions of terms in major
depressive disorder: remission, recovery,
relapse, and recurrence. Archives of general
psychiatry.
1991;48(9):851-855.
doi:10.1001/archpsyc.1991.018103300750
11
39.
Cuijpers P, Hollon SD, van Straten A,
Bockting C, Berking M, Andersson G. Does
cognitive behaviour therapy have an
enduring effect that is superior to keeping
patients on continuation pharmacotherapy?
A
meta-analysis.
BMJ
open.
2013;3(4):e002542. doi:10.1136/bmjopen-
2012-002542
40.
Casacalenda N, Perry JC, Looper K.
Remission in major depressive disorder: a
comparison
of
pharmacotherapy,
psychotherapy, and control conditions.
American
Journal
of
Psychiatry.
2002;159(8):1354-1360.
doi:10.1176/appi.ajp.159.8.1354
41.
Vittengl JR, Clark LA, Dunn TW, Jarrett RB.
Reducing relapse and recurrence in unipolar
depression: a comparative meta-analysis of
cognitive-behavioral
therapy's
effects.
Journal
of
consulting
and
clinical
psychology.
2007;75(3):475.
doi:10.1037/0022-006X.75.3.475
42.
Moher D, Liberati A, Tetzlaff J, Altman DG,
PRISMA Group* t. Preferred reporting items
for systematic reviews and meta-analyses:
the PRISMA statement. Annals of internal
medicine.
2009;151(4):264-269.
doi:10.7326/0003-4819-151-4-
200908180-00135
43.
Higgins JP, Altman DG, Gøtzsche PC, et al.
The Cochrane Collaboration’s tool for
assessing risk of bias in randomised trials.
Bmj. 2011;343doi:10.1136/bmj.d5928
44.
McGuinness LA, Higgins JP. Risk‐of‐bias
VISualization (robvis): an R package and
Shiny web app for visualizing risk‐of‐bias
assessments. Research synthesis methods.
2021;12(1):55-61. doi:10.1002/jrsm.1411
45.
Haddaway NR, Page MJ, Pritchard CC,
McGuinness LA. PRISMA2020: An R package
and Shiny app for producing PRISMA 2020‐
compliant flow diagrams, with interactivity
for optimised digital transparency and Open
Synthesis. Campbell systematic reviews.
2022;18(2):e1230. doi:10.1002/cl2.1230
46.
Weitz ES, Hollon SD, Twisk J, et al. Baseline
depression severity as moderator of
depression outcomes between cognitive
behavioral therapy vs pharmacotherapy: an
individual patient data meta-analysis. JAMA
psychiatry.
2015;72(11):1102-1109.
doi:10.1001/jamapsychiatry.2015.1516
47.
Wisniewski SR, Rush AJ, Nierenberg AA, et
al. Can phase III trial results of
antidepressant medications be generalized
to clinical practice? A STAR* D report.
American
Journal
of
Psychiatry.
2009;166(5):599-607.
doi:10.1176/appi.ajp.2008.08071027
THE USA JOURNALS
THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH
(ISSN
–
2689-1026)
VOLUME 06 ISSUE12
123
https://www.theamericanjournals.com/index.php/tajmspr
48.
Amick HR, Gartlehner G, Gaynes BN, et al.
Comparative benefits and harms of second
generation antidepressants and cognitive
behavioral therapies in initial treatment of
major depressive disorder: systematic
review
and
meta-analysis.
Bmj.
2015;351doi:10.1136/bmj.h6019
49.
Chaves C, Lopez-Gomez I, Hervas G, Vazquez
C. A comparative study on the efficacy of a
positive psychology intervention and a
cognitive behavioral therapy for clinical
depression. Cognitive therapy and research.
2017;41:417-433.
doi:10.1007/s10608-
016-9778-9
50.
Mathiasen K, Andersen TE, Lichtenstein MB,
et al. The clinical effectiveness of blended
cognitive behavioral therapy compared with
face-to-face cognitive behavioral therapy for
adult depression: randomized controlled
noninferiority trial. Journal of medical
Internet research. 2022;24(9):e36577.
doi:10.2196/36577
51.
Lin Z, Cheng L, Han X, et al. The effect of
internet-based cognitive behavioral therapy
on major depressive disorder: Randomized
controlled trial. Journal of Medical Internet
Research.
2023;25:e42786.
doi:10.2196/42786
52.
Ciharova M, Furukawa TA, Efthimiou O, et al.
Cognitive
restructuring,
behavioral
activation and cognitive-behavioral therapy
in the treatment of adult depression: A
network
meta-analysis.
Journal
of
Consulting
and
Clinical
Psychology.
2021;89(6):563. doi:10.1037/ccp0000654
53.
Werson AD, Meiser-Stedman R, Laidlaw K. A
meta-analysis of CBT efficacy for depression
comparing adults and older adults. Journal
of Affective Disorders. 2022;319:189-201.
doi:10.1016/j.jad.2022.09.020
54.
Lorenzo-Luaces L, German RE, DeRubeis RJ.
It's complicated: The relation between
cognitive change procedures, cognitive
change, and symptom change in cognitive
therapy for depression. Clinical psychology
review.
2015;41:3-15.
doi:10.1016/j.cpr.2014.12.003
55.
Albert PR. Why is depression more
prevalent in women? : Journal of Psychiatry
and Neuroscience; 2015. p. 219-221.
56.
Sudak DM. Cognitive behavioral therapy for
depression.
Psychiatric
Clinics.
2012;35(1):99-110.
doi:10.1016/j.psc.2011.10.001
57.
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT,
Fang A. The efficacy of cognitive behavioral
therapy: A review of meta-analyses.
Cognitive
therapy
and
research.
2012;36:427-440.
doi:10.1007/s10608-
012-9476-1v
58.
Powell VB, Abreu N, Oliveira IRd, Sudak D.
Cognitive-behavioral
therapy
for
depression. Brazilian Journal of Psychiatry.
2008;30:s73-s80.
doi:10.1590/S1516-
44462008000600004
59.
Li J-M, Zhang Y, Su W-J, et al. Cognitive
behavioral therapy for treatment-resistant
depression: A systematic review and meta-
analysis.
Psychiatry
research.
2018;268:243-250.
doi:10.1016/j.psychres.2018.07.020
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Figure 1. PRISMA Flow Diagram detailing the process of study selection
Figure 2. Summary of the risk of bias: review of authors’ judgements about each risk of bias item
for included RCTs
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Table 1. Summary of the results of the Efficacy of CBT in treating depression among adults
Author
(s)
Ye
ar
Samp
le
Size
Study
Design
Comparison
Group
Follow
-up
Durati
on
Key Findings
Nakaga
wa
et
al.
24
201
7
80
Randomiz
ed
Controlled
Trial
Treatment
with
anti-
depressants
12
months
Significant
reduction
in
depressive
symptoms
through CBT
Weitz et
al.
46
201
5
1700
Meta-
analysis
Pharmacother
apy
-
Minor
improvement
in depression
through
pharmacother
apy
Chavez
et al.
49
201
7
96
Controlled
clinical
trial
Positive
Psychology
Interventions
3-6
months
Both
treatments
reduced
depressive
symptoms
Amick
et al.
48
201
5
1511
Systematic
review/Me
ta-analysis
Second
generation
antidepressant
s
12-32
months
No difference
in depressive
effects in both
groups
Ciharov
a et al.
52
202
1
3,382
Network
meta-
analysis
Waiting
list
and care as
usual
-
Significant
difference in
treatment
effectiveness
through CBT,
combined
with cognitive
restructuring
and
behavioral
activation
Werson
et al.
53
202
2
3499
Meta-
analysis
CBT
effectiveness
in young and
old adults
-
CBT effective
in both young
and old adults
Mathias
en
et
al.
50
202
2
76
Randomiz
ed
controlled
trial
Blended CBT
and Face-to-
Face CBT
6-12
months
Both
CBT
variations
produced
treatment
effects
Lin
et
al.
51
202
3
40
Randomiz
ed
Waiting list
-
Lowered
depressive
symptoms
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controlled
trial
This table summarizes the key information from the included studies, such as authors, year of publication,
sample size, study design, comparison groups, follow-up durations, and key findings, adhering to PRISMA
guidelines.
Abbreviations:
CBT, Cognitive-Behavioral Therapy; CBASP, Cognitive Behavioral Analysis System of
Psychotherapy; PPI, Positive Psychology Interventions; CR, cognitive restructuring; BA, behavioral
activation; iCBT, Internet-based Cognitive-behavioral Therapy
