Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression

Watts, Sarah E.; Turnell, Adrienne; Kladnitski, Natalie; Newby, Jill M.; Andrews, Gavin

doi:10.1016/j.jad.2014.12.025

Cited by 189Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health InterventionsPsychotherapy Techniques and Applications

Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression

Watts, Sarah E., Turnell, Adrienne, Kladnitski, Natalie, Newby, Jill M., Andrews, Gavin·2015·Journal of Affective Disorders

DOI 10.1016/j.jad.2014.12.025

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Abstract

Objectives There were three aims of this study, the first was to examine the efficacy of CBT versus treatment-as-usual (TAU) in the treatment of anxiety and depressive disorders, the second was to examine how TAU is defined in TAU control groups for those disorders, and the third was to explore whether the type of TAU condition influences the estimate of effects of CBT.Method A systematic search of Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL was conducted.Results 48 studies of CBT for depressive or anxiety disorders (n=6926) that specified that their control group received TAU were identified. Most (n=45/48) provided an explanation of the TAU group however there was significant heterogeneity amongst TAU conditions. The meta-analysis showed medium effects favoring CBT over TAU for both anxiety (g=0.69, 95% CI 0.47-0.92, p<0.001, n=1318) and depression (g=0.70, 95% CI 0.49-0.90, p<0.001, n=5054), with differential effects observed across TAU conditions.Conclusions CBT is superior to TAU and the size of the effect of CBT compared to TAU depends on the nature of the TAU condition. The term TAU is used in different ways and should be more precisely described. The four key details to be reported can be thought of as "who, what, how many, and any additional treatments?"

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TAU was found to be a very heterogeneous control condition and anything but usual or standard care.
“TAU, in addition, was also found to be a very heterogeneous control condition and anything but usual or standard care85,86.”
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Remission of depression in a mother has positive effects on her school aged and adolescent children for at least a year afterwards, including the children of mothers treated with medication or psychotherapy, and varying with the severity of maternal depression.
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Usually, the effect size of cognitive behavioral therapies is smaller when compared with TAU than with a wait-list condition.
“Usually, the effect size of cognitive behavioral therapies is smaller, for example, when compared with TAU than with a wait-list condition (56).”
From Computer-assisted avatar-based treatment for dysfunctional beliefs in depressive inpatients: A pilot study (2021) · cites this paper as [56]

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Effectiveness Of Group Cognitive Behaviour Therapy Augmentation In Reducing Negative Cognitions In The Treatment Of Depression In Malaysia
Mukhtar, F., Oei, T. P. S., & Yaacob, M. J. (2011) · ASEAN Journal of Psychiatry · Cited by 11 · see citing works
Efficacy of Ultrabrief Cognitive and Behavioural Therapy Performed by Psychiatric Residents on Depressed Inpatients
Rieu, J., Bui, É., Rouch, V., Faure, K., Birmes, P. J., & Schmitt, L. (2011) · Psychotherapy and Psychosomatics · doi:10.1159/000323406 · Cited by 9 · see citing works

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Sorted by citations

Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis
Andrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.01.001 · Cited by 922 · see citing works
Self-citation
Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018) · Depression and Anxiety · doi:10.1002/da.22728 · Cited by 846 · see citing works
“Such comparisons are suboptimal because waitlist control conditions do not control for the effect of patient expectations on treatment outcomes (e.g., Greenberg, Constantino, & Bruce, 2006), and TAU conditions are highly varied and not closely monitored (Watts et al., 2015).”
Background
Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.06.002 · Cited by 545 · see citing works
Self-citation
Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence
Kaczkurkin, A. N., & Foa, E. B. (2015) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2015.17.3/akaczkurkin · Cited by 523 · see citing works
The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses
Leichsenring, F., Steinert, C., Rabung, S., & Ioannidis, J. P. A. (2022) · World Psychiatry · doi:10.1002/wps.20941 · Cited by 485 · see citing works
Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis
Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., Welton, N. J., Baxter, H., Kessler, D., Churchill, R., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30069-4 · Cited by 407 · see citing works
“18,84,85 We obtained similar ﬁ ndings in the sensitivity analysis after exclusion of trials with high overall attrition to those from the main analysis after exclusion of waiting list controlled trials— ie, no diﬀ erence between psychotherapies.”
Technology delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis
Grist, R., Croker, A., Denne, M., & Stallard, P. (2019) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-018-0271-8 · Cited by 287 · see citing works
Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum
Kotov, R., Jonas, K. G., Carpenter, W. T., Dretsch, M. N., Eaton, N. R., Forbes, M. K., Forbush, K. T., Hobbs, K. A., Reininghaus, U., Slade, T. N., et al. (2020) · World Psychiatry · doi:10.1002/wps.20730 · Cited by 310 · see citing works
Dismantling, optimising and personalising internet cognitive-behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data
Furukawa, T. A., Suganuma, A., Ostinelli, E. G., Andersson, G., Beevers, C. G., Shumake, J., Berger, T., Boele, F. W., Buntrock, C., Carlbring, P., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00077-8 · Cited by 255 · see citing works
Self-citation
Internet Cognitive Behavioral Therapy for Women With Postnatal Depression: A Randomized Controlled Trial of MumMoodBooster
Milgrom, J., Danaher, B. G., Gemmill, A. W., Holt, C., Holt, C. J., Seeley, J. R., Tyler, M. S., Ross, J., & Ericksen, J. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4993 · Cited by 221 · see citing works
“It was not unexpected to see the considerable variation in treatments and supports accessed in TAU, as has been discussed in a recent review of what constitutes TAU in the context of RCTs of psychological interventions [67].”
On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: a systematic review and meta-analysis
Carlucci, L., Saggino, A., & Balsamo, M. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.101999 · Cited by 234 · see citing works
Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises
Purgato, M., Gastaldon, C., Papola, D., van Ommeren, M., Barbui, C., & Tol, W. A. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011849.pub2 · Cited by 215 · see citing works
“They are used to treat individuals with depression and somatoform disorders (Allen 2010), and they are used in children and adolescents as well as in adults (James 2015; Olthuis 2015; Watts 2015).”
Background
Control freaks: Towards optimal selection of control conditions for fMRI neurofeedback studies
Sorger, B., Scharnowski, F., Linden, D. E. J., Hampson, M., & Young, K. D. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2018.11.004 · Cited by 215 · see citing works
“This includes information about who provided the treatment, what the treatment consisted of, number and duration of sessions, and the country and standard of health care provided (17).”
Methodological Recommendations for Trials of Psychological Interventions
Guidi, J., Brakemeier, E.-L., Bockting, C. L. H., Cosci, F., Cuijpers, P., Jarrett, R. B., Linden, M., Marks, I., Peretti, C. S., Rafanelli, C., et al. (2018) · Psychotherapy and Psychosomatics · doi:10.1159/000490574 · Cited by 205 · see citing works
Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis
Fiest, K. M., Walker, J. R., Bernstein, C. N., Graff, L. A., Zarychanski, R., Abou-Setta, A. M., Patten, S. B., Sareen, J., Bolton, J. M., Marriott, J. J., et al. (2016) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2015.10.004 · Cited by 198 · see citing works
“It is important to consider the type of control group used in controlled trials (Mohr et al., 2014; Watts et al., 2015).”
Effectiveness of online and mobile telephone applications (‘apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis
Witt, K., Spittal, M. J., Carter, G., Pirkis, J., Hetrick, S., Currier, D., Robinson, J., & Milner, A. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1458-0 · Cited by 179 · see citing works
“Variability in the control condition has been found to be associated with the magnitude of the treatment effect in officebased psychosocial interventions for depression and anxiety [66, 67].”
Background
Effects of open-label placebos in clinical trials: a systematic review and meta-analysis
von Wernsdorff, M., Loef, M., Tuschen‐Caffier, B., & Schmidt, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-83148-6 · Cited by 177 · see citing works
The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability, Negative Beliefs, and Therapist Distress About Exposure-Based Interventions
Pittig, A., Kotter, R., & Hoyer, J. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.07.003 · Cited by 160 · see citing works
Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression
Hall, J., Kellett, S., Berrios, R., Bains, M. K., & Scott, S. (2016) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.06.006 · Cited by 157 · see citing works
World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders
Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N., Domschke, K., Eriksson, E., Fineberg, N. A., Hättenschwiler, J., et al. (2023) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2022.2086295 · Cited by 158 · see citing works
“This is a very heterogenous control condition, as TAU can mean anything between infrequent and short visits to a mental health service and standard quality psychological and/or pharmacological treatment (Watts et al. 2015).”
Background
A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders
Haller, H., Breilmann, P., Schröter, M., Dobos, G., & Cramer, H. (2021) · Scientific Reports · doi:10.1038/s41598-021-99882-w · Cited by 126 · see citing works
The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: a systematic review and meta-analysis
Massoudi, B., Holvast, F., Bockting, C. L. H., Burger, H., & Blanker, M. H. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.050 · Cited by 101 · see citing works
Cognitive behaviour therapy for depression in primary care: systematic review and meta-analysis
Santoft, F., Axelsson, E., Öst, L.-G., Hedman-Lagerlöf, M., Fust, J., & Hedman-Lagerlöf, E. (2019) · Psychological Medicine · doi:10.1017/s0033291718004208 · Cited by 105 · see citing works
“It has, for example, been demonstrated that the components of TAU, which was the most common comparator, tend to vary considerably from study to study (Watts et al., 2015).”
Background
Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients
Pittig, A., Heinig, I., Goerigk, S. A., Richter, J., Hollandt, M., Lueken, U., Pauli, P., Deckert, J., Kircher, T. T. J., Straube, B., et al. (2022) · Clinical Psychological Science · doi:10.1177/21677026221101379 · Cited by 105 · see citing works
A randomised controlled trial of ‘MUMentum postnatal’: Internet-delivered cognitive behavioural therapy for anxiety and depression in postpartum women
Loughnan, S. A., Butler, C., Sie, A. A., Grierson, A. B., Chen, A. Z., Hobbs, M. J., Joubert, A. E., Haskelberg, H., Mahoney, A., Holt, C., et al. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.03.001 · Cited by 102 · see citing works
Self-citation
The experiences of lay health workers trained in task-shifting psychological interventions: a qualitative systematic review
Shahmalak, U., Blakemore, A., Waheed, M. W., & Waheed, W. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-019-0320-9 · Cited by 97 · see citing works
Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-Analysis of Recent Literature
Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2023) · Current Psychiatry Reports · doi:10.1007/s11920-022-01402-8 · Cited by 82 · see citing works
The effect of treatment as usual on major depressive disorder: A meta-analysis
Kolovos, S., van Tulder, M. W., Cuijpers, P., Prigent, A., Chevreul, K., Riper, H., & Bosmans, J. E. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.12.013 · Cited by 79 · see citing works
“The problem of operationalization of TAU in clinical trials has been addressed before in the literature (Burns, 2009; Löfholm et al., 2013; Watts et al., 2015).”
MethodResult
Fear of falling: efficacy of virtual reality associated with serious games in elderly people
Levy, F., Rautureau, G., Komano, O., Millet, B., Jouvent, R., & Leboucher, P. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s97809 · Cited by 72 · see citing works
Open-label placebo clinical trials: is it the rationale, the interaction or the pill?
Blease, C., Bernstein, M. H., & Locher, C. (2019) · BMJ Evidence-Based Medicine · doi:10.1136/bmjebm-2019-111209 · Cited by 71 · see citing works
Cost effectiveness of guided internet-based interventions for depression in comparison with control conditions: an individual–participant data meta-analysis
Kolovos, S., van Dongen, J. M., Riper, H., Buntrock, C., Cuijpers, P., Ebert, D. D., Geraedts, A. S., Kenter, R. M., Nobis, S., Smith, A., et al. (2018) · Depression and Anxiety · doi:10.1002/da.22714 · Cited by 63 · see citing works
Different control conditions can produce different effect estimates in psychotherapy trials for depression
Michopoulos, I., Furukawa, T. A., Noma, H., Kishimoto, S., Onishi, A., Ostinelli, E. G., Ciharova, M., Miguel, C., Karyotaki, E., & Cuijpers, P. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.12.012 · Cited by 69 · see citing works
Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises
Purgato, M., Gastaldon, C., Papola, D., van Ommeren, M., Barbui, C., & Tol, W. A. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011849 · Cited by 68 · see citing works
Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis
Cuijpers, P., Quero, S., Papola, D., Cristea, I. A., & Karyotaki, E. (2021) · Psychological Medicine · doi:10.1017/s0033291719003581 · Cited by 62 · see citing works
Is the Automation of Digital Mental Health Ethical? Applying an Ethical Framework to Chatbots for Cognitive Behaviour Therapy
Vilaza, G. N., & McCashin, D. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.689736 · Cited by 60 · see citing works
Group psychotherapy for borderline personality disorder: A meta-analysis of randomized-controlled trials.
McLaughlin, S. P. B., Barkowski, S., Burlingame, G., Strauss, B., & Rosendahl, J. (2019) · Psychotherapy · doi:10.1037/pst0000211 · Cited by 43 · see citing works
Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial
Cano-Vindel, A., Muñoz-Navarro, R., Wood, C. M., Limonero, J. T., Medrano, L. A., Ruiz-Rodríguez, P., Gracia-Gracia, I., Dongil-Collado, E., Iruarrizaga, I., Chacón, F., et al. (2016) · JMIR Research Protocols · doi:10.2196/resprot.6351 · Cited by 56 · see citing works
“This treatment has been described in previous research as nontreatment, standard treatment, pharmacological treatment, and/or practical advice by the GP delivered in routine care [27], focused on reducing negative emotional symptomatology.”
Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings
Lange, K. W. (2021) · Global Health Journal · doi:10.1016/j.glohj.2021.07.001 · Cited by 59 · see citing works
Toward a paradigm shift in treatment and research of mental disorders
Leichsenring, F., Steinert, C., & Ioannidis, J. P. A. (2019) · Psychological Medicine · doi:10.1017/s0033291719002265 · Cited by 53 · see citing works
“In a meta-analysis testing different forms of TAU psychotherapy (cognitive–behavior therapy) achieved small effect sizes when compared with general practitioner management (0.20) and larger effect sizes (0.71) when compared with minimal contact (Watts et al., 2015).”
BackgroundResultInfluential
Cognitive–behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis
Fordham, B., Sugavanam, T., Edwards, K., Hemming, K., Howick, J., Copsey, B. J., Lee, H., Kaidesoja, M., Kirtley, S., Hopewell, S., et al. (2021) · Health Technology Assessment · doi:10.3310/hta25090 · Cited by 59 · see citing works
The Pursuit of Resilience: A Meta-Analysis and Systematic Review of Resilience-Promoting Interventions
Liu, J. J. W., Ein, N., Gervasio, J., Battaion, M., & Fung, K. P.-L. (2021) · Journal of Happiness Studies · doi:10.1007/s10902-021-00452-8 · Cited by 52 · see citing works
Dismantling, personalising and optimising internet cognitive–behavioural therapy for depression: a study protocol for individual participant data component network meta-analysis
Furukawa, T. A., Karyotaki, E., Suganuma, A. M., Pompoli, A., Ostinelli, E. G., Cipriani, A., Cuijpers, P. J., & Efthimiou, O. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-026137 · Cited by 46 · see citing works
“treatment Treatment as usual or care as usual can denote many different conditions in the literature.(21)”
BackgroundMethod
The roles of expectation, comparator, administration route, and population in open-label placebo effects: a network meta-analysis
Buergler, S., Sezer, D., Gaab, J., & Locher, C. (2023) · Scientific Reports · doi:10.1038/s41598-023-39123-4 · Cited by 46 · see citing works
Cultural influences on mental health symptoms in a primary care sample of Latinx patients
Escovar, E. L., Craske, M. G., Roy‐Byrne, P., Stein, M. B., Sullivan, G., Sherbourne, C. D., Bystritsky, A., & Chavira, D. A. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.03.005 · Cited by 45 · see citing works
Cognitive behavioral therapies for depression and anxiety in people with chronic disease: A systematic review and meta-analysis
Scott, A. J., Bisby, M. A., Heriseanu, A. I., Salameh, Y., Karin, E., Fogliati, R., Dudeney, J., Gandy, M., McLellan, L. F., Wootton, B., et al. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102353 · Cited by 45 · see citing works
A critical review of negative affect and the application of CBT for PTSD
Brown, W. J., Dewey, D., Bunnell, B. E., Boyd, S. J., Wilkerson, A. K., Mitchell, M. A., & Bruce, S. E. (2018) · Trauma, Violence, & Abuse · doi:10.1177/1524838016650188 · Cited by 43 · see citing works
How can neurobiology of fear extinction inform treatment?
Craske, M. G., Sandman, C. F., & Stein, M. B. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104923 · Cited by 43 · see citing works
Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten: Anwendung und systemische Barrieren
Pittig, A., & Hoyer, J. (2017) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000441 · Cited by 43 · see citing works
Group transdiagnostic cognitive-behavior therapy for anxiety disorders: a pragmatic randomized clinical trial
Roberge, P., Provencher, M. D., Gaboury, I., Gosselin, P., Vasiliadis, H., Benoît, A., Carrier, N., Antony, M. M., Chaillet, N., Houle, J., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720004316 · Cited by 43 · see citing works
Intensity of Treatment as Usual and Its Impact on the Effects of Face-to-Face and Internet-Based Psychotherapy for Depression: A Preregistered Meta-Analysis of Randomized Controlled Trials
Münder, T., Geisshüsler, A., Krieger, T., Zimmermann, J., Wolf, M., Berger, T., & Watzke, B. (2022) · Psychotherapy and Psychosomatics · doi:10.1159/000521951 · Cited by 43 · see citing works
The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta‐analysis
Clinkscales, N., Golds, L., Berlouis, K., & MacBeth, A. (2023) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/papt.12441 · Cited by 41 · see citing works
Control interventions in randomised trials among people with mental health disorders
Faltinsen, E., Todorovac, A., Staxen Bruun, L., Hróbjartsson, A., Gluud, C., Kongerslev, M. T., Simonsen, E., & Storebø, O. J. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000050.pub2 · Cited by 40 · see citing works
Cognitive behavioral therapy in adolescents with type 1 diabetes: an integrative review
Rechenberg, K., & Koerner, R. (2021) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2021.06.019 · Cited by 38 · see citing works
Effectiveness of a Transdiagnostic guided internet-delivered protocol for emotional disorders versus treatment as usual in specialized care: randomized controlled trial
González-Robles, A., Díaz-García, A., García-Palacios, A., Roca, P., Ramos-Quiroga, J. A., & Botella, C. (2020) · Journal of Medical Internet Research · doi:10.2196/18220 · Cited by 40 · see citing works
“Several studies were considered for the calculation of the expected sample size [23,69,70].”
Background
Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis
Staines, A. C., Broomfield, N., Pass, L., Orchard, F., & Bridges, J. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13451 · Cited by 37 · see citing works
“previous meta-analyses which have investigated the impact of a CBT intervention for anxiety, on anxiety symptoms, have found effect sizes ranging from small to large (Watts et al., 2015; Goncalves & Byrne, 2012; Carpenter et al., 2018).”
BackgroundMethodInfluential
Markers for context-responsiveness: Client baseline interpersonal problems moderate the efficacy of two psychotherapies for generalized anxiety disorder.
Penedo, J. M. G., Constantino, M. J., Coyne, A. E., Westra, H. A., & Antony, M. M. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000233 · Cited by 38 · see citing works
Efficacy of Dialectical Behavior Therapy for Adolescents in a Partial Hospitalization Program
Lenz, A., & Conte, G. S. D. (2018) · Journal of Counseling & Development · doi:10.1002/jcad.12174 · Cited by 24 · see citing works
Bridging the Gaps Between Basic Science and Cognitive-Behavioral Treatments for Anxiety Disorders in Routine Care
Richter, J., Pittig, A., Hollandt, M., & Lueken, U. (2017) · Zeitschrift für Psychologie · doi:10.1027/2151-2604/a000309 · Cited by 33 · see citing works
Pilot Intervention to Promote Tolerance for Uncertainty in Early Multiple Sclerosis.
Molton, I. R., Koelmel, E., Curran, M., von Geldern, G., Ordway, A., & Alschuler, K. N. (2019) · Rehabilitation Psychology · doi:10.1037/rep0000275 · Cited by 31 · see citing works
Treatment as usual (TAU) as a control condition in trials of cognitive behavioural-based psychotherapy for self-harm: Impact of content and quality on outcomes in a systematic review
Witt, K., de Moraes, D. P., Salisbury, T. T., Arensman, E., Gunnell, D., Hazell, P., Townsend, E., van Heeringen, K., & Hawton, K. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.04.025 · Cited by 31 · see citing works
Effectiveness of a transdiagnostic internet-based protocol for the treatment of emotional disorders versus treatment as usual in specialized care: study protocol for a randomized controlled trial
González‐Robles, A., García‐Palacios, A., Baños, R., Riera, A., Llorca, G., Traver, F., Haro, G., Palop, V., Calatayud, G. L., Romeu, J. E., et al. (2015) · Trials · doi:10.1186/s13063-015-1024-3 · Cited by 30 · see citing works
“As we aim to compare the intervention with a TAU group, the results of a meta-analysis comparing CBT transdiagnostic treatments versus TAU have also been considered in the estimation of the expected sample size [106].”
Result
Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial
Andersson, R., Åhlén, J., Mataix‐Cols, D., Lenhard, F., Henje, E., Månsson, C., Sahlin, H., Beckman, M., Serlachius, E., & Vigerland, S. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-066357 · Cited by 31 · see citing works
Reducing the rate and duration of Re-ADMISsions among patients with unipolar disorder and bipolar disorder using smartphone-based monitoring and treatment – the RADMIS trials: study protocol for two randomized controlled trials
Faurholt‐Jepsen, M., Frost, M. M., Martiny, K., Tuxen, N., Rosenberg, N., Busk, J., Winther, O., Bardram, J. E., & Kessing, L. V. (2017) · Trials · doi:10.1186/s13063-017-2015-3 · Cited by 28 · see citing works
“CBT has proven efficacious in the treatment and prevention of depressive episodes in unipolar disorder [16], but the effect in relation to bipolar disorder is controversial [17].”
Background
Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders
Watkins, L. E., Patton, S. C., Drexler, K. P. G., Rauch, S. A. M., & ROTHBAUM, B. O. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.05.005 · Cited by 25 · see citing works
Effectiveness of brief group transdiagnostic therapy for emotional disorders in primary care: A randomized controlled trial identifying predictors of outcome
Corpas, J., Moriana, J. A., Martínez, J. F. V., & Gálvez‐Lara, M. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1952331 · Cited by 26 · see citing works
Meta‐analysis of culturally adapted cognitive behavioral therapy for anxiety and depression
Silveus, S. A., Schmit, M. K., Oliveira, J. T., & Hughes, L. E. (2023) · Journal of Counseling & Development · doi:10.1002/jcad.12463 · Cited by 24 · see citing works
Only Small Effects of Mindfulness-Based Interventions on Biomarker Levels of Inflammation and Stress: A Preregistered Systematic Review and Two Three-Level Meta-Analyses
Grasmann, J., Almenräder, F., Voracek, M., & Tran, U. S. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24054445 · Cited by 24 · see citing works
“Treatment-asusual (TAU) conditions were coded as active, as previous meta-analyses indicated large heterogeneity in TAU conditions, with some of them qualifying as active interventions ([60]; but see [61]).”
Result
A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol
Roberge, P., Provencher, M. D., Gosselin, P., Vasiliadis, H., Gaboury, I., Benoît, A., Antony, M. M., Chaillet, N., Houle, J., Hudon, C., et al. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1898-1 · Cited by 25 · see citing works
Examining the description of the concept “treatment as usual” for patients with depression, anxiety and stress-related mental disorders in primary health care research – A systematic review
Petersson, E., Forsén, E., Björkelund, C., Hammarback, L., Hessman, E., Weineland, S., & Svenningsson, I. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.01.076 · Cited by 23 · see citing works
Motivational theory-based interventions on health of people with several mental illness: A systematic review and meta-analysis.
Romain, A., Bernard, P., Akrass, Z., St-Amour, S., Lachance, J.-P., Hains-Monfette, G., Atoui, S., Kingsbury, C., Dubois, E., Karelis, A., et al. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.05.049 · Cited by 19 · see citing works
Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT
Lynch, T. R., Hempel, R. J., Whalley, B., Byford, S., Chamba, R., Clarke, P., Clarke, S., Kingdon, D., O’Mahen, H., Remington, B., et al. (2018) · Efficacy and Mechanism Evaluation · doi:10.3310/eme05070 · Cited by 22 · see citing works
“Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. iii criteria for dramatic–erratic PD (cluster B), bipolar di…”
BackgroundMethodInfluential
The effectiveness of modified, group-based CBT for dementia worry among Chinese elders
An, Q., Wang, K., Sun, F., & Zhang, A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.054 · Cited by 22 · see citing works
Effect of Mindfulness on Psychological Distress and Well-being of Children and Adolescents: a Meta-analysis
Zhang, Y., Chen, S., Wu, H., & Guo, C. (2021) · Mindfulness · doi:10.1007/s12671-021-01775-6 · Cited by 25 · see citing works
“However, the classification of control groups in interventions is important and complex (Cuijpers et al., 2021; Watts et al., 2015).”
BackgroundMethodInfluential
Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial
Corpas, J., Moriana, J. A., Martínez, J. F. V., & Gálvez‐Lara, M. (2020) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2020.11.002 · Cited by 20 · see citing works
Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review
Li, S. H., Achilles, M. R., Werner‐Seidler, A., Beames, J. R., Subotic-Kerry, M., & O’Dea, B. (2022) · JMIR Mental Health · doi:10.2196/37640 · Cited by 20 · see citing works
“Clinicians also adapt various engagement strategies to promote adherence to CBT, including developing a therapeutic alliance through collaborative goal setting, communicating and enhancing treatment expectancies, and clarifying concepts to ensure that treatment processes and rationale are well understood [1,2,5-7,10,1…”
Background
Misunderstood Stoicism: The negative Association Between Stoic Ideology and well-Being
Karl, J. A., Verhaeghen, P., Aikman, S. N., Solem, S., Lassen, E. R., & Fischer, R. D. (2022) · Journal of Happiness Studies · doi:10.1007/s10902-022-00563-w · Cited by 19 · see citing works
“1 3 Stoic thought has profoundly influenced Cognitive Behavioral Therapy (Robertson, 2016, 2019) and plays an important role in the treatment of anxiety and depression (Watts et al., 2015).”
Background
Modular cognitive‐behavioral therapy for affective symptoms in young individuals at ultra‐high risk of first episode of psychosis: Randomized controlled trial
Pozza, A., & Dèttore, D. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22901 · Cited by 19 · see citing works
Cognitive Behavioral Therapy for Panic Disorder
(2012) · PsycEXTRA Dataset · doi:10.1037/e675472012-001 · Cited by 18 · see citing works
Does cognitive behavioral therapy for anxiety disorders improve threat reappraisal?: A meta-analysis
Draheim, A. A., & Anderson, P. L. (2021) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.12.004 · Cited by 18 · see citing works
Dealing with Anxious Patients: An Integrative Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures
Weisfeld, C. C., Turner, J. A., Bowen, J. I., Eissa, R., Roelk, B., Ko, A., Dunleavy, K., Robertson, K., & Benfield, E. (2021) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2020.0505 · Cited by 17 · see citing works
“CBT is generally effective in treating anxiety, 35,36 usually by providing a psychoeducational component that teaches the client how thoughts, feelings, and behaviors are interrelated.”
Brain Mechanisms Underlying Panic Attack and Panic Disorder
Guan, X., & Cao, P. (2023) · Neuroscience Bulletin · doi:10.1007/s12264-023-01088-9 · Cited by 17 · see citing works
“CBT is recognized as the gold standard for the psychological treatment of anxiety disorders, and a large number of published meta-analyses have verified its excellent effectiveness for PD and other anxiety disorders [131–133].”
Discovering Common Elements of Empirically Supported Self-Help Interventions for Depression in Primary Care: a Systematic Review
Kuroda, N., Burkey, M. D., & Wissow, L. (2021) · Journal of general internal medicine · doi:10.1007/s11606-020-06449-y · Cited by 7 · see citing works
Internet-delivered psychological treatment as an add-on to treatment as usual for common mental disorders: A systematic review with meta-analysis of randomized trials
Jonsson, U., Linton, S. J., Ybrandt, H., Ringborg, A., Leander, L., Moberg, K., Hultcrantz, M., & Arnberg, F. K. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.11.036 · Cited by 16 · see citing works
“There has been a longstanding discussion about insufficient reporting of TAU comparators in the field of psychiatry (Burns and Priebe, 1996; Watts et al., 2015), but it is evident that the level of details provided can still be improved.”
Background
Emotionally-focused therapy and treatment as usual comparison groups in decreasing depression: A clinical pilot study
Alder, M. C., Dyer, W. J., Sandberg, J. G., Davis, S. Y., & Holt‐Lunstad, J. (2018) · American Journal of Family Therapy · doi:10.1080/01926187.2019.1572478 · Cited by 16 · see citing works
Computer-assisted avatar-based treatment for dysfunctional beliefs in depressive inpatients: A pilot study
Kocur, M., Dechant, M., Wolff, C., Nothdurfter, C., Wetter, T. C., Rupprecht, R., & Shiban, Y. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.608997 · Cited by 15 · see citing works
“Usually, the eﬀect size of cognitive behavioral therapies is smaller, for example, when compared with TAU than with a wait-list condition (56).”
Background
Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): a multicentre randomized controlled trial protocol
Aguilera‐Martín, Á., Gálvez‐Lara, M., Cuadrado, F., Moreno, E. M., García‐Torres, F., Martínez, J. F. V., Corpas, J., Jurado-González, F. J., Muñoz‐Navarro, R., González‐Blanch, C., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03726-4 · Cited by 16 · see citing works
“TAU usually consists of pharmacological treatment, though it might also involve practical advice or even no treatment at all [51].”
Background
Improving Depression, and Quality of Life in Patients with Type 2 Diabetes: Using Group Cognitive Behavior Therapy.
Noroozi, Z., Hamidian, S., Khajeddin, N., Honarmand, M. M. Z., Zargar, Y., Rashidi, H., & Dolatshahi, B. (2017) · PubMed Central · Cited by 15 · see citing works
Operationalization of Cochrane’s Risk of Bias 2 Tool (RoB 2) in the Context of Psychotherapy TrialsPreprint
Miguel, C., Harrer, M., Karyotaki, E., Sakher, E., Sakata, M., Furukawa, T. A., & Cuijpers, P. J. (2025) · medRxiv · doi:10.1101/2025.06.26.25330349 · Cited by 14 · see citing works
A Gender-Responsive Treatment Facility in Correctional Services: The Development of Psychological Gymnasium for Women Offenders
Mak, V., Ho, S. M. Y., Kwong, R. W. Y., & Li, W. (2016) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x16667572 · Cited by 13 · see citing works
Pharmacological and Psychotherapeutic Interventions for Management of Obsessive-compulsive Disorder in Adults: A Systematic Review and Network Meta-analysis.
Skapinakis, P., Caldwell, D., Hollingworth, W., Bryden, P. A., Fineberg, N., Salkovskis, P., Welton, N. J., Baxter, H., Kessler, D., Churchill, R., et al. (2021) · Focus · doi:10.1176/appi.focus.19402 · Cited by 119 · see citing works
“18,84,85 We obtained similar ﬁ ndings in the sensitivity analysis after exclusion of trials with high overall attrition to those from the main analysis after exclusion of waiting list controlled trials— ie, no diﬀ erence between psychotherapies.”
Comparing watchful waiting with antidepressants for the management of subclinical depression symptoms to mild–moderate depression in primary care: a systematic review
Iglesias-González, M., Aznar‐Lou, I., Gil‐Girbau, M., Moreno-Peral, P., Peñarrubia‐María, M. T., Rubio-Valera, M., & Serrano‐Blanco, A. (2017) · Family Practice · doi:10.1093/fampra/cmx054 · Cited by 13 · see citing works
“The first is that most studies compared WW with TAU (21) and the results were very difficult to interpret as the nature of the TAU condition varied across studies (22).”
Result
Three Decades of Internet- and Computer-Based Interventions for the Treatment of Depression: Protocol for a Systematic Review and Meta-Analysis
Moshe, I., Terhorst, Y., Cuijpers, P. J., Cristea, I. A., Pulkki-Råbäck, L., & Sander, L. (2020) · JMIR Research Protocols · doi:10.2196/14860 · Cited by 13 · see citing works
A meta-analysis of internet-based cognitive behavioral therapy for military and veteran populations
Liu, J. J. W., Ein, N., Forchuk, C. A., Wanklyn, S. G., Ragu, S., Saroya, S., Nazarov, A., & Richardson, J. D. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04668-1 · Cited by 12 · see citing works
Tratamiento psicológico de los trastornos emocionales en atención primaria: fundamentos teóricos y empíricos del estudio PsicAP
Cordero‐Andrés, P., González‐Blanch, C., Umaran‐Alfageme, O., Muñoz‐Navarro, R., Ruiz‐Rodríguez, P., Medrano, L. A., Hernández-de-Hita, F., Pérez-Poo, T., & Vindel, A. C. (2017) · Ansiedad y Estrés · doi:10.1016/j.anyes.2017.10.004 · Cited by 12 · see citing works
Predictors of Homework Engagement in CBT Adapted for Traumatic Brain Injury: Pre/post-Injury and Therapy Process Factors
Zelencich, L. M., Kazantzis, N., Wong, D. K., McKenzie, D. P., Downing, M. G., & Ponsford, J. L. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10036-9 · Cited by 12 · see citing works
“Treatment effect sizes were comparable to findings from CBT efficacy meta-analytic research (Hofmann et al. 2012; Watts et al. 2015).”
Result
Emotion tracking (vs. reporting) increases the persistence of positive (vs. negative) emotions
Boghrati, R., Sharif, M. A., Yousefi, S., & Heydarian, A. (2023) · Journal of Experimental Social Psychology · doi:10.1016/j.jesp.2023.104556 · Cited by 11 · see citing works
The Monetary Benefits and Costs of Community Supervision
Drake, E. K. (2018) · Journal of Contemporary Criminal Justice · doi:10.1177/1043986217750425 · Cited by 11 · see citing works
“In the mental health field, for example, meta-analytic research has shown that there is significant heterogeneity in what consists of “treatment as usual” and further, the effect size depends upon the specific nature of the control condition (Watts et al., 2015).”
Background
Focusing on the self in context as an emotion regulatory strategy: an evaluation of the “self-as-context” component of ACT compared to cognitive reappraisal in managing stress
Godbee, M., & Kangas, M. (2022) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2021.1985472 · Cited by 10 · see citing works
“However, CBT has demonstrated moderate efficacy (Watts et al., 2015) and a therapy such as ACT needs to demonstrate similar treatment outcomes to be considered an evidence-based alternative.”
Background
The Effectiveness of Emotional Freedom Techniques for Depressive Symptoms: A Meta-Analysis
Seok, J., & Kim, J. U. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216481 · Cited by 11 · see citing works

Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons
Wampold, B. E., Budge, S. L., Laska, K. M., Del Re, A. C., Baardseth, T. P., Flűckiger, C., Minami, T., Kivlighan, D. M., & Gunn, W. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.07.012 · Cited by 134 · see citing works
Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: A systematic review and meta-analysis of published outcome studies
Reinholt, N., & Krogh, J. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.897367 · Cited by 146 · see citing works
Cognitive-behavioral therapy versus other therapies: Redux
Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., Lindemann, A. M., Kivlighan, D. M., Laska, K. M., Re, A. C. D., et al. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.01.004 · Cited by 138 · see citing works
Transdiagnostic CBT for anxiety and depression dismantling meta analysis
Jordan, V. (2018) · Data Archiving and Networked Services (DANS) · doi:10.17632/sg6d2vsjgz
Meta‐analysis of culturally adapted cognitive behavioral therapy for anxiety and depression
Silveus, S. A., Schmit, M. K., Oliveira, J. T., & Hughes, L. E. (2023) · Journal of Counseling & Development · doi:10.1002/jcad.12463 · Cited by 24 · see citing works

Authors: Watts, S. E., Turnell, A., Kladnitski, N., Newby, J. M., & Andrews, G.
Affiliations: St Vincent's Hospital Sydney (AU)
Corresponding author: Newby, Jill M.
ORCID: Watts, Sarah E.
Turnell, Adrienne
Newby, Jill M.
Andrews, Gavin
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2015-04
Volume: 175
Pages: 152-167
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2014.12.025
OpenAlex: W2083442609
Cited by: 188
References: 76
Citations by year: 2026: 6 · 2025: 18 · 2024: 12 · 2023: 17 · 2022: 25 · 2021: 25 · 2020: 15 · 2019: 17 · 2018: 23 · 2017: 12 · 2016: 11 · 2015: 7
FWCI: 1.35
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: cognitive behavioral therapy, usual care, anxiety disorders, depressive disorders, treatment efficacy, differential treatment effects
MeSH terms: Anxiety, Anxiety Disorders, Depression, Depressive Disorder, Humans, Thinking, Cognitive Behavioral Therapy

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Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression

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