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Cited by 17Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsDigital Mental Health Interventions

Effectiveness of cognitive-behavioural therapies of varying complexity in reducing depression in adults: systematic review and network meta-analysis

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Angelakis, Ioannis, Huggett, Charlotte, Gooding, Patricia, Panagioti, Maria, Hodkinson, Alexander·2022·The British Journal of Psychiatry
DOI 10.1192/bjp.2022.35
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Abstract

BACKGROUND: Cognitive-behavioural therapy (CBT) is frequently used as an umbrella term to include a variety of psychological interventions. It remains unclear whether more complex CBT contributes to greater depression reduction. AIMS: To (a) compare the effectiveness of core, complex and ultra-complex CBT against other psychological intervention, medication, treatment-as-usual and no treatment in reducing depression at post-treatment and in the long term and (b) explore important factors that could moderate the effectiveness of these interventions. METHOD: MEDLINE, PsycInfo, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched to November 2021. Only randomised controlled trials were eligible for the subsequent network meta-analysis. RESULTS: We included 107 studies based on 15 248 participants. Core (s.m.d. = -1.14, 95% credible interval (CrI) -1.72 to -0.55 [m.d. = -8.44]), complex (s.m.d. = -1.24, 95% CrI -1.85 to -0.64 [m.d. = -9.18]) and ultra-complex CBT (s.m.d. = -1.45, 95% CrI -1.88 to -1.02 [m.d. = -10.73]) were all significant in reducing depression up to 6 months from treatment onset. The significant benefits of the ultra-complex (s.m.d. = -1.09, 95% CrI -1.61 to -0.56 [m.d. = -8.07]) and complex CBT (s.m.d. = -0.73, 95% CrI -1.36 to -0.11 [m.d. = -5.40]) extended beyond 6 months. Ultra-complex CBT was most effective in individuals presenting comorbid mental health problems and when delivered by non-mental health specialists. Ultra-complex and complex CBT were more effective for people younger than 59 years. CONCLUSIONS: For people without comorbid conditions healthcare and policy organisations should invest in core CBT. For people <59 years of age with comorbid conditions investments should focus on ultra-complex and complex CBT delivered without the help of mental health professionals.

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  • Psychotherapeutic treatment can help relieve symptoms of depression and lower the risk of depression relapse by guiding individuals to better understand what is causing their symptoms.

    “Psychotherapeutic treatment can help to relieve the symptoms of depression by helping individuals deal with negative thoughts and lower the risk of depression relapse by guiding the individual to have a better understanding of what is causing their symptoms (Angelakis 2022).”

    From Psychotherapeutic treatments for depression in older adults (2024) · cites this paper as Angelakis 2022

    The Abstract (page not provided) describes CBT as a treatment for depression and says cognitive restructuring challenges maladaptive thoughts. The Summary of main findings (page not provided) reports reduced depressive symptoms, including sustained benefits for some CBT protocols. Although the paper lists relapse prevention as a possible component, it does not show that treatment lowers relapse risk by helping people understand the causes of their symptoms. (LLM, conf=0.88)

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Authors
Angelakis, I., Huggett, C., Gooding, P., Panagioti, M., & Hodkinson, A.
Affiliations
  • University of South Wales (GB)
  • Greater Manchester Mental Health NHS Foundation Trust (GB)
  • Manchester Academic Health Science Centre (GB)
  • University of Manchester (GB)
Corresponding author
Angelakis, Ioannis
ORCID
Venue
The British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2022-03-29
Volume
221
Issue
2
Pages
459-467
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.2022.35
OpenAlex
W4220788936
Cited by
17
References
39
Citations by year
2026: 3 · 2025: 6 · 2024: 4 · 2023: 3 · 2022: 1
FWCI
0.51
Type
journal article
Language
en
Open access
Licence
Locations
  • The British Journal of Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
Funders
  • National Institute for Health and Care Research
  • Patient Safety Translational Research Centre
  • NIHR School for Primary Care Research
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
cognitive behavioral therapy, depression, psychological intervention, antidepressants, psychiatric comorbidity, treatment moderators
MeSH terms
Network Meta-Analysis, Network Meta-Analysis as Topic, Adult, Cognition, Depression, Humans, Psychotherapy, Cognitive Behavioral Therapy

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