How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study
Open accessAbstract
Background Depression and anxiety disorders are relapse-prone conditions, even after successful treatment with pharmacotherapy or psychotherapy. Cognitive behavioural therapy (CBT) is known to prevent relapse, but there is little evidence of the durability of remission after low intensity forms of CBT (LiCBT).Method This study aimed to examine relapse rates 12 months after completing routinely-delivered LiCBT. A cohort of 439 LiCBT completers with remission of symptoms provided monthly depression (PHQ-9) and anxiety (GAD-7) measures during 12 months after treatment. Survival analysis was conducted to model time-to-relapse while controlling for patient characteristics.Results Overall, 53% of cases relapsed within 1 year. Of these relapse events, the majority (79%) occurred within the first 6 months post-treatment. Cases reporting residual depression symptoms (PHQ-9 = 5 to 9) at the end of treatment had significantly higher risk of relapse (hazard ratio = 1.90, p < 0.001).Conclusions The high rate of relapse after LiCBT highlights the need for relapse prevention, particularly for those with residual depression symptoms.
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In major depressive disorder, 18-77% of patients experienced a relapse.
“Likewise, with regard to major depressive disorder (MDD), 18–77% of patients experienced a relapse [22–28].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [27]
The Time-to-event analysis reports that 52.8% of cases relapsed within 12 months, which falls within the claimed range. But the Sample characteristics and Outcome definitions describe a cohort with depression and/or anxiety, not an MDD-only relapse rate; the paper does not establish the 18–77% bounds. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA longitudinal study of low-intensity CBT using an RCI of ≤5 demonstrated a reliable change in 43.8% (181/439) of participants.
“A longitudinal study of low-intensity CBT using an RCI of ≤5 demonstrated a reliable change in 43.8% (181/439) of the participants [71]”
From Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial (2021) · cites this paper as [71]
The paper’s Table 1 reports 181 participants (43.8%) with an early response during low-intensity CBT, defined in its footnote as symptom reduction greater than the reliable change index between sessions 1 and 3. Section 2.2 specifies an RCI of ≥5 points, not ≤5; the table does not present 43.8% as the overall rate of reliable change. The stated fraction, 181/439, also does not equal 43.8%. (LLM, conf=0.90)
Experimental — accuracy not yet measuredResidual depression symptoms in the non-depressed range strongly predict time to relapse/recurrence, including over long-term follow-up.
“based on previous studies which show that residual symptoms in the non-depressed range are a strong predictor of time to relapse/recurrence, even over long-term follow-ups (Ali et al. 2017; Judd et al. 1997; Pintor et al. 2004).”
From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Ali et al. 2017
In the absence of long-term follow-up, a reduction in residual symptoms of depression can be regarded as an imperfect proxy for reduction in risk of relapse.
“In the absence of long-term follow-up of service users, a reduction in residual symptoms of depression can also be regarded an imperfect proxy for reduction in risk of relapse (Ali et al. 2017).”
From The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in Real-World Healthcare Services (2020) · cites this paper as Ali et al. 2017
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- Authors
- Ali, S., Rhodes, L., Moreea, O., McMillan, D., Gilbody, S., Leach, C., Lucock, M., Lutz, W., & Delgadillo, J.
- Affiliations
- University of York (GB)
- Leeds Community Healthcare NHS Trust (GB)
- National Institute for Health and Care Excellence (GB)
- University of Huddersfield (GB)
- Universität Trier (DE)
- University of Sheffield (GB)
- Corresponding author
- Delgadillo, Jaime
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 94
- Pages
- 1-8
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2605428381
- Cited by
- 139
- References
- 51
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 17 · 2023: 18 · 2022: 22 · 2021: 19 · 2020: 17 · 2019: 10 · 2018: 14 · 2017: 1
- FWCI
- 13.12
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.hud.ac.uk
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- University of Huddersfield Repository (University of Huddersfield) (submittedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Huddersfield Research Portal (University of Huddersfield) (submittedVersion, cc-by-nc-nd)
- Funders
- Leeds Community Healthcare NHS Trust, United Kingdom (FSF2010/11/08.11.2010)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- low-intensity cognitive behavioural therapy, depression, anxiety disorders, relapse, remission, relapse prevention, residual symptoms, treatment durability, post-treatment follow-up
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Depression, Female, Humans, Longitudinal Studies, Male, Middle Aged, Recurrence, Remission Induction, Time Factors, Cognitive Behavioral Therapy, Young Adult
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