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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
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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
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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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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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