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A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments
Open accessAbstract
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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“This is unexpected because the majority of mental health technologies is based on (principles of) CBT, which is the most studied treatment for depression and has proven effective in many studies [79].”
From Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence (2017) · cites this paper as [79]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In a meta-analysis of 46 outcome trials comparing CBT for depression with another therapy, we found that the mean number of patients included was 52, and the range was 13 to 178 (Cuijpers et al. 2013).”
From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Cuijpers et al. 2013
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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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.”
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]
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Fortunately, numerous studies have shown that the aforementioned mental disorders can be effectively treated with cognitive behavior therapy (CBT) (Cuijpers et al., 2013; Öst, 2008).”
From The effect of internet-delivered cognitive behavioral therapy for depression and anxiety on quality of life: A meta-analysis of randomized controlled trials (2023) · cites this paper as Cuijpers et al., 2013
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“Among responders, the benefits are often modest as indicated by medium effect sizes (Cuijpers et al., 2013).”
From A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial (2020) · cites this paper as Cuijpers et al., 2013
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“rates of response to the intervention (Cuijpers et al., 2013; Preskorn, 2013; Spijker et al., 2002)”
From A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial (2020) · cites this paper as Cuijpers et al., 2013
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“CBT has been shown to be particularly effective in the management of the psychiatric symptoms frequently observed in cervical dystonia [10, 11]”
From Internet-based cognitive behavioural therapy programme as an intervention for people diagnosed with adult-onset, focal, isolated, idiopathic cervical dystonia: A feasibility study protocol (2020) · cites this paper as [10]
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In the citing paper
“Despite the large body of evidence supporting the overall efficacy of CBT in alleviating depressive symptoms (Cuijpers et al., 2013a)”
From Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement (2016) · cites this paper as Cuijpers et al., 2013a
The cited source says what the claim attributes to it.
In the citing paper
“For example, cognitive behavioral therapy (CBT) versus supportive therapy for depression has a small, nonsignificant effect size (SMD = 0.10) and low heterogeneity (I 2 = 27%) (Cuijpers et al. 2013).”
From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Cuijpers et al. 2013
The cited source says what the claim attributes to it.
In the citing paper
“However, this was a relatively small drop compared to that reported in other studies on publication bias in psychotherapies for MDD 15,18,184 .”
From How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence (2016) · cites this paper as [184]
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In the citing paper
“Some meta-analytic comparisons between specific models of psychological treatment have shown no significant differences in efficacy, 57 with others showing modest differences.58”
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]
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In the citing paper
“Despite the efficacy of current first‐line MDD interventions (Cuijpers et al., 2013)”
From A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial (2020) · cites this paper as Cuijpers et al., 2013
The cited source says what the claim attributes to it.
In the citing paper
“Thus, we have evidence-based interventions for depression, including cognitive behavior therapy (CBT) [5, 6] and behavioral activation (BA) [7, 8], as well as interpersonal [3, 9] or problem-solving therapy [10].”
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In the citing paper
“The effects on antenatal depression are highly comparable to those found for ICBT-programs as well as traditional CBT for depression (Hedman et al., 2012;Hofmann et al., 2012;Cuijpers et al., 2013).”
From Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial (2017) · cites this paper as Cuijpers et al., 2013
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In the citing paper
“A recent meta-analysis found evidence for frontoparietal hypo-connectivity in MDD, especially of the dorsolateral prefrontal cortex, implicating it in goal-directed attention deficits in MDD 119 .”
From Major depressive disorder (2016) · cites this paper as [119]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“amelioration of depressive symptoms from first-line pharmacological or psychotherapy treatments occurs in less than 50 % of individuals with MDD (Cuijpers et al., 2013;Kolovos et al., 2017;Trivedi et al., 2006)”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Cuijpers et al., 2013
Experimental — accuracy not yet measuredIn the citing paper
“The low level of heterogeneity is in contrast with other meta-analyses examining the effects of psychotherapies on depressive symptoms (e.g., Cuijpers et al., 2013;Cuijpers et al., 2016a).”
From Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates (2018) · cites this paper as Cuijpers et al., 2013
In the citing paper
“Existing interventions for anxiety and depression emphasize negative affect reduction as the central treatment goal.”
From Upregulating the positive affect system in anxiety and depression: Outcomes of a positive activity intervention: Taylor et al. (2017) · cites this paper as [18]
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Metadata
- 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
- Publisher
- SAGE Publications
- 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
- bronze
- doi.org
- 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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