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

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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, de Graaf, Ireen, Kendall, Tim, Engels, Rutger, Stikkelbroek, Yvonne·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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“Studies on cognitive behavioral therapy (CBT) for adolescents with a depressive disorder show that treatment proves effective (Oud et al., 2019), though the outcomes are relatively modest (Zhou et al., 2015) with 60 % of the adolescents not responding to psychotherapy (Cuijpers et al., 2023) and a…”
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“…depression literature, reviews have identified behavioral activation (BA) as a key therapeutic strategy for adolescents (e.g., Malik et al., 2021; Martin & Oliver, 2019; Oud et al., 2019; Weersing et al., 2009), although additional, larger trials are needed with children (Weersing et al., 2024).”
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“Fortunately, evidence-based treatments exist for improving mental health in children and adolescents (e.g., Lee et al., 2012; Michelson et al., 2013; Oud et al., 2019; Ung et al., 2015).”
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“The CBT was also effective in the treatment of depression and anxiety disorders in children and adolescents according to Warwick et al. (2017) and Oud et al. (2019).”
Background
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“7 Research also indicates that a range of social–emotional learning curricula, when implemented with care, can result in positive outcomes.”
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“There is evidence that effects may be enhanced when psychotherapy contains components of activating challenging behaviors and thoughts and also when caregivers are involved[11].”
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Background
Internalising Problems
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“In a review examining CBT for depressive disorders, Oud et al. (2019) found that children and adolescents experienced small reductions in depressive symptoms at the end of treatment and these effects extend as far as 39 weeks after treatment termination.”
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“[15] examined the effectiveness of CBT for children and adolescents with depression.”
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“Although evidence-based therapies such as cognitive behavioural therapy (CBT) seem to be effective for children and adolescents with depression (Oud et al., 2019), a substantial proportion of patients do not respond satisfactorily.”
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Sweeny, K., Reavley, N. J., Rasmussen, B., Nenzhelele, H. Q., Jong, R. D., Ruiz, M. J. R., Okech, B. N., September, R., Mohan, A., & Kline, S. (2026) · Health Policy and Planning · doi:10.1093/heapol/czag075 · Cited by 1
“Clinician-delivered CBT and interpersonal psychotherapy can be effective in reducing symptoms of both depression and anxiety across a range of settings, including schools, community clinics, and specialist services (Oud et al. 2019, Baker et al. 2021).”

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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