Cited by 1,066Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments

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Cuijpers, Pim, Berking, Matthias, Andersson, Gerhard, Quigley, Leanne, Kleiboer, Annet, Dobson, Keith S·2013·The Canadian Journal of Psychiatry

Abstract

Objective: No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis. Methods: Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy. Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower ( g = 0.53) than for lower-quality studies ( g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone ( g = 0.49). Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.

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Crossref · 10.1177/070674371305800702

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  • Strategies such as distraction or reappraisal feature prominently in treating acute phase depression.

    “This inhibition is understandable given that strategies such as distraction or reappraisal feature prominently in treating acute phase depression (Cuijpers et al., 2013, Markowitz, 2008).”

    From Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial (2022) · cites this paper as Cuijpers et al., 2013

    In Identification and Selection of Studies (p. 4), the paper describes cognitive restructuring—evaluating and modifying dysfunctional beliefs—as a core or important component of CBT for adult depression. That supports the reappraisal part in substance, but the paper does not identify distraction as a prominent strategy or specifically characterize these strategies as treatments for acute-phase depression. (LLM, conf=0.84)

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  • The combination of CBT and an antidepressant is more effective than either alone.

    “the combination of CBT and an antidepressant is more effective than either alone.57,88,89”

    From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [57]

    The Clinical Implications (p. 3) and Discussion (p. 10) say that CBT combined with pharmacotherapy is more effective than pharmacotherapy alone. They do not establish that the combination is more effective than CBT alone, so the claim’s “either alone” wording goes beyond this source. (LLM, conf=0.90)

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  • A meta-analysis of 9 RCTs comparing CBT and pharmacotherapy concluded that after 1 year, those who received CBT in the acute phase of depressive illness had a lower rate of relapse than those who discontinued medication.

    “a meta-analysis of 9 RCTs comparing CBT and pharmacotherapy concluded that after 1 year, those who received CBT in the acute phase of depressive illness had a lower rate of relapse than those who discontinued medication.”

    From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [57]

    The Discussion (p. 10) reports that another meta-analysis found lower relapse rates after one- and two-year follow-up among people who received CBT than among those treated with pharmacotherapy. But this paper says its own meta-analysis examined only short-term outcomes; it does not establish the claimed nine RCTs or specify a comparison with people who discontinued medication. (LLM, conf=0.88)

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  • There was no difference between the CBT group and those who continued pharmacotherapy at 1-year follow-up.

    “There was no difference, however, between the CBT group and those who continued pharmacotherapy at 1-year follow-up.57”

    From Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder (2016) · cites this paper as [57]

    The “CBT, Compared With Pharmacotherapy” section (p. 8) reports no significant overall difference, but that finding concerns short-term outcomes. The Discussion (p. 10) says this meta-analysis did not examine long-term efficacy and reports lower relapse rates after one- and two-year follow-up for people who received CBT than for people treated with pharmacotherapy. It does not establish the claimed lack of difference at one year against continued pharmacotherapy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Evidence-based psychological treatments for anxiety and depression (eg, cognitive behavioral therapy) are highly effective in reducing symptoms and improving functioning.

    “Evidence-based psychological treatments for anxiety and depression (eg, cognitive behavioral therapy) are highly effective in reducing symptoms and improving functioning [1-3].”

    From Clinical Effects of Asynchronous Provider-Guided Practice Sessions During Blended Care Therapy for Anxiety and Depression: Pragmatic Retrospective Cohort Study (2024) · cites this paper as [2]

    The Results and Conclusions (p. 2) find CBT effective for adult depression, while noting that publication bias and study quality may have inflated the estimated effect. The paper does not establish effectiveness for anxiety, and its description of improving functioning (Identification and Selection of Studies, p. 4) is a treatment rationale rather than a reported outcome. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 2

  1. [16]16. Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando (FL): Academic Press; 1985.
  2. [21]21. Smit F, Ederveen A, Cuijpers P, et al. Opportunities for costeffective prevention of late-life depression: an epidemiological approach. Arch Gen Psychiatry. 2006;63:290-296.

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Authors
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S.
Affiliations
  • Leuphana University of Lüneburg (DE)
  • Linköping University (SE)
  • University of Calgary (CA)
  • Amsterdam Public Health (NL)
Corresponding author
Cuijpers, Pim
Venue
The Canadian Journal of Psychiatry
Published
2013-07
Volume
58
Issue
7
Pages
376-385
ISSN
  • 0706-7437 (ISSN-L)
  • 1497-0015
OpenAlex
W2142420226
Cited by
1,066
References
34
Citations by year
2026: 53 · 2025: 72 · 2024: 80 · 2023: 79 · 2022: 132 · 2021: 123 · 2020: 94 · 2019: 99 · 2018: 74 · 2017: 84 · 2016: 75 · 2015: 51 · 2014: 45 · 2013: 5
FWCI
8.66
Type
journal article
Language
en
Open access
Locations
  • The Canadian Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • Multilingual Matters (Channel View Publications) (submittedVersion, other-oa)
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, adult depression, psychotherapy efficacy, pharmacotherapy, combined psychotherapy and pharmacotherapy, publication bias, treatment effect size, number needed to treat, psychotherapy comparison
MeSH terms
Adult, Depression, Humans, Cognitive Behavioral Therapy

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