Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression: A meta-analysis of nonrandomized effectiveness studies.
Abstract
Objective The primary aim of this study was to assess the overall effectiveness of and dropout from individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary diagnosis of unipolar depressive disorder in routine clinical practice. Method We conducted a random effects meta-analysis of 34 nonrandomized effectiveness studies on outpatient individual and group CBT for adult unipolar depressive disorder. Standardized mean gain effect sizes are reported for end-of-treatment and 6-month follow-up effects for depression severity, dysfunctional cognitions, general anxiety, psychological distress, and functional impairment. The mean dropout rate from CBT is reported. We benchmarked our results against high-quality randomized controlled trials (RCTs). Results Outpatient CBT was effective in reducing depressive severity in completer (d = 1.13) and intention-to-treat (ITT) samples (d = 1.06). Moderate to large posttreatment effect sizes (d = 0.67-0.88) were found for secondary outcomes. The weighted mean dropout rate was 24.63%. Posttreatment gains for depression were maintained at 6 months after completion of therapy. Effect sizes for depression were inferior to those of benchmark RCTs. Conclusions Although clinical practice patients show lesser improvements in depressive symptoms than RCT patients, individual and group outpatient CBT can be effectively transported to routine clinical practice. The considerable treatment dropout rate, especially in indiv…
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A recent meta-analysis found large depression effect sizes (1.06-1.13) and moderate-to-large secondary outcome effect sizes (0.7-0.9).
“Similar findings were reported in a recent meta-analysis (Hans & Hiller, 2013), which found large effect sizes for depression (1.06–1.13), and moderate-to-large effect sizes for secondary outcomes (0.7–0.9).”
From An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results (2014) · cites this paper as Hans & Hiller, 2013
Depression effect sizes were lower than some efficacy studies but within the range of 0.87-2.60 reported in CBT for depression studies.
“A similar pattern was found for depression outcomes, with effect sizes being lower than some efficacy studies (e.g., 2.0 in Elkin et al., 1989), but still within the range (0.87–2.60 across CBT for depression studies; see Hans & Hiller, 2013).”
From An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results (2014) · cites this paper as Hans & Hiller, 2013
Other effectiveness studies have found higher attrition than efficacy studies, averaging 25%-30% and reaching 68%.
“Other effectiveness studies also have found higher attrition rates relative to efficacy studies, with rates averaging 25% to 30% and reaching as high as 68% (Hans & Hiller 2013; Lincoln et al., 2005).”
From An Integrated, Acceptance-Based Behavioral Approach for Depression With Social Anxiety: Preliminary Results (2014) · cites this paper as Hans & Hiller 2013
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“Similar findings were reported in a recent metaanalysis (Hans & Hiller, 2013), which found large effect sizes for depression (1.06-1.13), and moderate-to-large effect sizes for secondary outcomes (0.7- 0.9).”
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- Authors
- Hans, E., & Hiller, W.
- Affiliations
- Johannes Gutenberg University Mainz (DE)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2013-02
- Volume
- 81
- Issue
- 1
- Pages
- 75-88
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2136406064
- Cited by
- 211
- References
- 34
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 18 · 2023: 12 · 2022: 50 · 2021: 15 · 2020: 12 · 2019: 14 · 2018: 10 · 2017: 19 · 2016: 15 · 2015: 18 · 2014: 11 · 2013: 5
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, major depressive disorder, outpatient psychotherapy, treatment discontinuation, individual psychotherapy, group therapy, depression severity, general anxiety, psychological distress, functional disability, dysfunctional cognitions, routine clinical practice
- MeSH terms
- Adult, Depressive Disorder, Humans, Outpatients, Patient Dropouts, Cognitive Behavioral Therapy, Treatment Outcome
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