Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis

Oud, Matthijs; de Winter, Lars; Vermeulen-Smit, Evelien; Bodden, Denise; Nauta, Maaike; Stone, Lisanne; van den Heuvel, Marieke; Taher, Reham Al; de Graaf, Ireen; Kendall, Tim; Engels, Rutger; Stikkelbroek, Yvonne

doi:10.1016/j.eurpsy.2018.12.008

Cited by 319Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis

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Oud, Matthijs, de Winter, Lars, Vermeulen-Smit, Evelien, Bodden, Denise, Nauta, Maaike, Stone, Lisanne, van den Heuvel, Marieke, Taher, Reham Al +4 more·2019·European Psychiatry

DOI 10.1016/j.eurpsy.2018.12.008

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Abstract

Background: Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects. Methods: A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT. Results: We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term. Conclusions: There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.

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CBT is effective for the treatment of depression and prevention of relapse in non-autistic children and adolescents.
“A recent systematic review and meta-analysis of 31 randomized controlled trials indicates that CBT is effective for the treatment of depression and prevention of relapse in non-autistic children and adolescents (Oud et al., 2019).”
From Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy (2024) · cites this paper as Oud et al., 2019
The Results (Table 2 and §3.5.2.2; page not available) report reductions in depressive symptoms with CBT, supporting the treatment claim. But the paper assesses follow-up symptoms and risk of a depressive disorder, not prevention of relapse after recovery. Its eligibility criteria (§2.1) also do not identify a specifically non-autistic population. (LLM, conf=0.85)
Experimental — accuracy not yet measured
There is a growing evidence base reporting that CBT is effective for the prevention and treatment of anxiety and depression symptoms in adolescents and young adults.
“There is a growing evidence base reporting on the effectiveness of CBT for the prevention and treatment of anxiety and depression symptoms in AYA [11, 12].”
From Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial (2022) · cites this paper as [11]
The Abstract reports that CBT reduced depressive symptoms in youth and that indicated prevention lowered the risk of depression at follow-up. The Eligibility criteria limit the review to children and adolescents with depressive symptoms or disorders; it does not establish effectiveness for anxiety symptoms or young adults. (LLM, conf=0.88)
Experimental — accuracy not yet measured
CBT is the most well-documented and researched type of treatment for child and adolescent populations.
“Although cognitive behavioural therapy (CBT) is the most well-documented and researched type of treatment for child and adolescent populations (Christ et al., 2020; James et al., 2013; Oud et al., 2019)”
From Investigating the potential of a novel internet-based cognitive behavioural intervention for Dari and Farsi speaking refugee youth: A feasibility study (2022) · cites this paper as Oud et al., 2019
The Introduction describes CBT as an evidence-based treatment for youth depression and notes several meta-analyses of its effects; the Abstract reports a review of 31 trials. These passages show that CBT is well researched for depression in children and adolescents, but they do not establish that it is the most researched treatment across child and adolescent populations. (LLM, conf=0.84)
Experimental — accuracy not yet measured
The efficacy of CBT, particularly its exposure techniques, behavioral activation, and cognitive restructuring components, has been well established.
“The efficacy of CBT, particularly its exposure techniques, behavioral acti vation, and cognitive restructuring components, has been well estab lished (Oud et al., 2019; Stiede et al., 2023).”
From Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials. (2025) · cites this paper as Oud et al., 2019
The Abstract reports evidence that CBT reduces depressive symptoms in youth, and §3.6 links the combination of behavioral activation and challenging thoughts (part of cognitive restructuring) to better follow-up outcomes. But §4.3 says a causal benefit from those components needs further evidence, and the cited passages do not establish the efficacy of exposure techniques. The claim therefore overstates what this review establishes about the components. (LLM, conf=0.90)
Experimental — accuracy not yet measured
CBT has been shown to be effective in adolescents, outperforming both no intervention and other talk-based therapies.
“CBT has been shown to be effective in adolescents, outperforming both no intervention and other talk-based therapies (61, 62).”
From Recent developments in bibliotherapy for adolescent depression (2025) · cites this paper as [61]
Section 3.5.2.1 reports that CBT reduced depressive symptoms compared with waitlist/no treatment, supporting that part of the claim for youth with depression. The Introduction says interpersonal psychotherapy has not been shown to be more effective than CBT, but that does not establish that CBT outperforms other talk-based therapies. Section 4.1 also notes evidence that a brief psychosocial intervention can be as effective as CBT. (LLM, conf=0.88)
Experimental — accuracy not yet measured

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Efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with depression: A systematic review and preliminary meta-analysis
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Depression in Youth-Onset Type 2 Diabetes
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Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial
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“A recent systematic review and meta-analysis of 31 randomized controlled trials indicates that CBT is effective for the treatment of depression and prevention of relapse in non-autistic children and adolescents (Oud et al., 2019).”
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Young People’s Digital Interactions from a Narrative Identity Perspective: Implications for Mental Health and Wellbeing
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Effectiveness of cognitive-behavioral therapy on resilience of adults: A systematic review and meta-analysis
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Psychological risk and protective factors associated with depressive symptoms among adolescents in secondary schools in China: A systematic review and meta-analysis
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Effectiveness of trauma-focused treatment for adolescents with major depressive disorder
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Effectiveness of Social Inclusion Interventions for Anxiety and Depression among Adolescents: A Systematic Review
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Effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer: A systematic review and meta-analysis.
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Factors Contributing to the Efficacy of Universal Mental Health and Wellbeing Programs in Secondary Schools: A Systematic Review
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The efficacy of personalized psychological interventions in adolescents: a scoping review and meta-analysis
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Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study
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Examining cognitive-behavioral therapy change mechanisms for decreasing depression, weight, and insulin resistance in adolescent girls at risk for type 2 diabetes
Gulley, L. D., Shomaker, L. B., Kelly, N. R., Chen, K. Y., Olsen, C. H., Tanofsky‐Kraff, M., & Yanovski, J. A. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.110781 · Cited by 17 · see citing works
Cognitive behavioural group therapy for adolescents with ADHD: a study of satisfaction and feasibility
Andersen, A., Sund, A. M., Thomsen, P., Lydersen, S., Young, S., & Nøvik, T. (2021) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2021.1965212 · Cited by 10 · see citing works
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The effective delivery of digital CBT: a service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020
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Effectiveness of family‐based therapy for depressive symptoms in children and adolescents: A systematic review and meta‐analysis
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Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial
van den Heuvel, M. W. H., Bodden, D. H. M., Moerbeek, M., Smit, F., & Engels, R. C. M. E. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2168-6 · Cited by 15 · see citing works
Self-citation
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Problem gambling during Covid-19
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Videoconferencing-based cognitive behavioral therapy for youth with anxiety and depression during COVID-19 pandemic
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Cognitive Behavioral Therapies for Individuals with Cerebral Palsy: A Scoping Review
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Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents
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Proactive and reactive aggression and substance use among detained youth
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Self-citation

Authors: Oud, M., de Winter, L., Vermeulen-Smit, E., Bodden, D., Nauta, M., Stone, L., van den Heuvel, M., Taher, R. A., de Graaf, I., Kendall, T., Engels, R., & Stikkelbroek, Y.
Affiliations: Trimbos Institute (NL)
Christian University of Applied Sciences (NL)
Utrecht University (NL)
University of Groningen (NL)
National Health Service (GB)
Erasmus University Rotterdam (NL)
Corresponding author: Oud, Matthijs
ORCID: Oud, Matthijs
Bodden, Denise
Nauta, Maaike
Taher, Reham Al
Kendall, Tim
Engels, Rutger
Stikkelbroek, Yvonne
Venue: European Psychiatry
Publisher: Cambridge University Press (CUP)
Published: 2019-01-16
Volume: 57
Pages: 33-45
ISSN: 0924-9338 (ISSN-L)
1778-3585
DOI: 10.1016/j.eurpsy.2018.12.008
OpenAlex: W2909121890
Cited by: 319
References: 74
Citations by year: 2026: 51 · 2025: 49 · 2024: 57 · 2023: 48 · 2022: 54 · 2021: 36 · 2020: 13 · 2019: 10
FWCI: 4.19
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified)
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: European Psychiatry (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Utrecht University Repository (Utrecht University) (submittedVersion)
Funders: ZonMw
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: cognitive behavioral therapy, adolescent depression, childhood depression, treatment efficacy, behavioral activation, cognitive restructuring, caregiver involvement, depression prevention, treatment moderators
MeSH terms: Adolescent, Depression, Depressive Disorder, Humans, Regression Analysis, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Young Adult

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Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis

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