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Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
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“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]
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“However, although CBT relapse rates are as low as 14 % (Levy et al., 2021), it is limited by the fact that not everyone fully benefits from this type of therapy (Heiervang et al., 2018), and the observed effect sizes are small to moderate (Oud et al., 2019).”
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
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Self-citationHow do children with intellectual disabilities regulate their emotions? The views of parents
Girgis, M., Paparo, J., & Kneebone, I. (2024) · Journal of Intellectual & Developmental Disability · doi:10.3109/13668250.2024.2372810 · Cited by 14
“This may act as a protective strategy against distortions and associated mental illnesses, as seen in neurotypical children and adolescents (Oud et al., 2019).”
Problem gambling during Covid-19
Frisone, F., Alibrandi, A., & Settineri, S. (2020) · Mediterranean Journal of Clinical Psychology · doi:10.6092/2282-1619/mjcp-2457 · Cited by 30
Uysal, B., Morgül, E., Taştekne, F., Sönmez, D., Tepedelen, M. S., Gülay, S., Aydın, İ., Evecek, H., & Görmez, V. (2022) · School Psychology International · doi:10.1177/01430343221097613 · Cited by 14
“…examining 31 studies for effectiveness of CBT for children and adolescents with depression, the individual/group CBT interventions for children and adolescence had a mean number of 10.6 sessions (range 5–16), a mean duration of 8.8 weeks and an average of 10.1 intervention hours (Oud et al., 2019).”
BackgroundInfluentialCognitive Behavioral Therapies for Individuals with Cerebral Palsy: A Scoping Review
Silberg, T., Kapil, N., Caven, I., Levac, D., & Fehlings, D. (2023) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.15507 · Cited by 13
Janssen, L. H. C., Verkuil, B., van Houtum, L. A. E. M., Wever, M. C. M., Wentholt, W. G. M., & Elzinga, B. M. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02447-1 · Cited by 16
“A recent meta-analysis has shown that the involvement of parents in treatment of adolescent depression can increase the efficacy of individual CBT [56].”
Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents
Smárason, O., Skarphéðinsson, G., & Storch, E. A. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.02.002 · Cited by 25
Proactive and reactive aggression and substance use among detained youth
Fite, P. J., Griffith, R., Robertson, S., & O’Dell, C. C. (2021) · Journal of Substance Use · doi:10.1080/14659891.2021.1941353 · Cited by 12
“Cognitive behavioral interventions for negative emotions can be effective for adolescents (e.g., Oud et al., 2019) and may be indicated for reactive aggressive youth.”
BackgroundThe kids are alright: adolescents’ experiences during COVID-19 disruption
Lopatovska, I., Garg, R., Turpin, O., Yoon, J. H., Vroom, L., & Brown, D. (2022) · Information and Learning Sciences · doi:10.1108/ils-11-2021-0096 · Cited by 14
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von Wirth, E., Meininger, L., Adam, J., Woitecki, K., Treier, A., & Döpfner, M. (2023) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x231157103 · Cited by 12
McGar, A. B., Kindler, C., & Marsac, M. (2019) · JMIR Pediatrics and Parenting · doi:10.2196/12427 · Cited by 9
“Results from this systematic review suggest that the intervention theory that guided intervention content might have influenced the outcomes: of the studies included in this systematic review, those that primarily utilized CBT (80”
InfluentialBlake, J. A., Thomas, H. J., Pelecanos, A. M., Najman, J. M., & Scott, J. G. (2024) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-024-02737-8 · Cited by 12
Advances in the prevalence and treatment of depression for adolescents: a review
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van den Heuvel, M. W. H., Bodden, D. H. M., Smit, F., Stikkelbroek, Y. A. J., Weisz, J. R., Moerbeek, M., & Engels, R. C. M. E. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1978296 · Cited by 10
“Some studies have investigated the association of specific components with the overall effect of CBT on adolescent depression (Kennard et al., 2009; Oud et al., 2019).”
BackgroundMethodInfluentialSelf-citationPsychological interventions for depression in children and adolescents: A bibliometric analysis
Wang, N., Kong, J.-Q., Bai, N., Zhang, H.-Y., & Yin, M. (2024) · World Journal of Psychiatry · doi:10.5498/wjp.v14.i3.467 · Cited by 12
Marić, M., Schumacher, L., Noortgate, W. V. D., Bettelli, L., Engelbertink, W., & Stikkelbroek, Y. A. J. (2023) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-023-00432-9 · Cited by 10
“Numerous empirically established interventions are available for treating these disorders (e.g., Crowe & McKay, 2017; Oud et al., 2019; Weems & Neill, 2020; Weisz et al., 2017).”
BackgroundSelf-citationGleason, M. M., Flom, M., Rapoport, S., Williams, A. A. A., Birch, A., Wells, N. K., Forman‐Hoffman, V. L., & Robinson, A. H. (2025) · JAACAP Open · doi:10.1016/j.jaacop.2025.02.002 · Cited by 10
“11 Despite the strength of evidence supporting CBT-based interventions for adolescents with depression and anxiety, effective delivery of CBT is limited by access to trained mental health professionals, the time and resources that traditional therapy attendance requires, a mismatch between…”
Designing Chatbots to Treat Depression in Youth: Qualitative Study
Kuhlmeier, F. O., Bauch, L., Gnewuch, U., & Lüttke, S. (2025) · JMIR Human Factors · doi:10.2196/66632 · Cited by 11
“Cady guides participants through a behavioral activation exercise, which is a core component of CBT to treat depression in youth [3].”
Shahrokhian, N., Hassanzadeh, S., Razini, H. H., & Ramshini, M. (2022) · International journal of Sport Studies for Health · doi:10.5812/intjssh.122504 · Cited by 18
Efficacy of the Triple P – Positive Parenting Program on 0–12 year-old Quebec children's behavior
Gagné, M., Piché, G., Brunson, L., Clément, M., Drapeau, S., & Jean, S.-M. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.106946 · Cited by 11
Berry, K. R., Gliske, K., Schmidt, C., Ballard, J., Killian, M., & Fenkel, C. (2023) · JMIR Formative Research · doi:10.2196/45305 · Cited by 10
“Past research suggests that increased treatment engagement is linked to downstream impacts, including the eventual improvement of clinical outcomes and other indicators of recovery important to both youths and young adults and their families [4-7].”
BackgroundPerceived causal symptom network of adolescent mental health issues
Bångstad, A., Fellman, J., Rosendahl, C., Bellander, M., Cervin, M., Bjureberg, J., & Klintwall, L. (2022) · Journal of Child and Adolescent Mental Health · doi:10.2989/17280583.2023.2283032 · Cited by 9
“Consequently, treatment outcomes have been described as of low clinical importance (Oud et al ., 2019) .”
BackgroundAndersson, R., Vigerland, S., Åhlén, J., Widström, H., Unger, I., Serlachius, E., & Engberg, H. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-023-02142-7 · Cited by 9
“Previous research suggests that parental involvement might improve long-term clinical outcomes in treat-ment for adolescent depression [26, 27] and Grist et al. found that internet-based interventions were more effective if parents were involved [28].”
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“Another meta-analysis concluded that CBT is effective for youth with subclinical depression (Oud et al., 2019).”
BackgroundKurzweil, S. (2023) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20220025 · Cited by 11
Bevilacqua, L., Fox‐Smith, L., Lampard, O., Rojas, N. K., Zavitsanou, G., Meiser‐Stedman, R., & Beazley, P. I. (2024) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045241259070 · Cited by 9
“There is a plethora of evidence that shows that group and individual CBT represents an effective psychological treatment for a range of dif fi culties, including anxiety disorders and depression in children and young people (Cartwright-Hatton et al., 2004; James et al., 2020; Oud et al., 2019).”
Luttinen, J., Watroba, A., Niemelä, M., Miettunen, J., & Ruotsalainen, H. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.002 · Cited by 13
Wang, X., Zhang, Z., Li, Y., Gao, Y., & Cao, Q.-J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120132 · Cited by 8
Changklang, P., & Ranteh, O. (2023) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1274_22 · Cited by 8
Metadata
- 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
- Venue
- European Psychiatry
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-01-16
- Volume
- 57
- Pages
- 33-45
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- 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
- 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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