Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators
Section snippets
Meta-analytic Findings
CBT has a medium effect size (d = 0.67) relative to a variety of control conditions ranging from the absence of treatment to nonspecific controls.8 Translated into numbers needed to treat (NNT), this effect size corresponds to an NNT of 2.75; this means that for just less than every 3 patients treated with CBT, one will get better solely because of having come into therapy. By way of comparison, medication treatment of severe hypertension produces an NNT of 15 and taking aspirin alone for
CBT to prevent relapse and recurrence
Depression is a chronically recurrent disorder. Although up to two-thirds of all patients respond to acute treatment with ADM (about half of whom fully remit), a sizable number experience a return of symptoms after treatment is over.28 According to conventions developed in the pharmacotherapy literature, symptom return during the first 6 to 12 months among remitted patients is assumed to represent a return of the treated episode (relapse) and treatment provided during that interval is called
CBT to prevent relapse in bipolar disorder
Whereas the distinction between relapse and recurrence is relevant to unipolar depression (patients are either in episode and thus at risk for relapse when asymptomatic or not in episode and thus at risk for recurrence), bipolar disorder is thought of as a chronic disorder that never goes away and is marked by periodic symptomatic relapses into mania and depression. Although stabilization on medications is the cornerstone of treatment of bipolar disorder, there has been considerable interest in
Predictors of CBT efficacy
Because different patients respond differently to different treatments, it is important to know who responds best to what with particular reference to CBT. Two types of information are relevant to this question: prognostic information in which you hold treatment constant and allow patient characteristics to vary, and prescriptive information in which you hold patient characteristics constant and allow treatment to vary.58 Prognostic factors predict outcome to a given treatment (or to treatment
Mediators of CBT efficacy
Although CBT has been found to be efficacious in the treatment and prevention of depression, questions remain about precisely how it works (mediation). Such questions are relevant to the identification of the active ingredients in the treatment process and the mechanisms of change within the patient. Cognitive theory posits that negative automatic thoughts and maladaptive information-processing proclivities play a causal role in the cause and maintenance of depression.7 According to this
Summary
CBT has been found superior to control conditions and as least as efficacious as other psychotherapies and ADM in the acute treatment of depression. When adequately implemented, CBT can be as efficacious as ADM for patients with more severe depressions. CBT may also be of use as an adjunct to medications in the treatment of bipolar disorder, although the evidence there is not so clear or extensive. CBT reduces relapse/recurrence rates, with a magnitude of effect that might be comparable to
References (95)
- et al.
Global mortality, disability, and the contribution of risk factors: global burden of disease study
Lancet
(1997) - et al.
Sequenced treatment alternatives to relieve depression (STAR∗D): rationale and design
Control Clin Trials
(2004) - et al.
Affective disorders
- et al.
A meta-analysis of the effects of cognitive therapy in depressed patients
J Affect Disord
(1998) - et al.
A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression
J Affect Disord
(2002) - et al.
The empirical status of cognitive-behavioral therapy: a review of meta-analyses
Clin Psychol Rev
(2006) - et al.
A two-year naturalistic follow-up of depressed patients treated with cognitive therapy, pharmacotherapy and a combination of both
J Affect Disord
(1986) - et al.
Cognitive therapy of depression: pretreatment patient predictors of outcome
Clin Psychol Rev
(2002) - et al.
Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report
Psychiatry Res
(1991) - et al.
The relation of patients' treatment preference to outcome in a randomized clinical trial
Behav Ther
(2007)
The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R)
JAMA
Long-term treatment of recurrent and chronic depression
J Clin Psychiatry
Diagnostic and statistical manual of mental disorders, fourth edition, text review
Cognitive therapy of depression
Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis
Eur J Psychiatry
Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients
Cognit Ther Res
The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination
Br J Psychiatry
Cognitive therapy and pharmacotherapy. Singly and together in the treatment of depression
Arch Gen Psychiatry
Cognitive therapy and pharmacotherapy for depression: singly and in combination
Arch Gen Psychiatry
Treatment of depression collaborative research program: general effectiveness of treatments
Arch Gen Psychiatry
Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program
J Consult Clin Psychol
Practice guideline for the treatment of patients with major depressive disorder [revision]
Am J Psychiatry
Cognitive behavior therapy vs. pharmacotherapy: now that the jury's returned its verdict, its time to present the rest of the evidence
J Consult Clin Psychol
Prospects for future comparisons between drugs and psychotherapy: lessons from the CBT vs. pharmacotherapy exchange
J Consult Clin Psychol
Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial
Arch Gen Psychiatry
Cognitive therapy vs medications in the treatment of moderate to severe depression
Arch Gen Psychiatry
Antidepressant medications versus cognitive therapy in depressed patients with or without personality disorder
Br J Psychiatry
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression
J Consult Clin Psychol
Extreme non-response in cognitive therapy: can behavioral activation succeed where cognitive therapy fails?
J Consult Clin Psychol
A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression
N Engl J Med
Treatment and prevention of depression
Psychol Sci Publ Interest
Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence
Arch Gen Psychiatry
Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety
Annu Rev Psychol
Reducing relapse and recurrence in unipolar depression, a comparative meta-analysis of cognitive-behavioral therapy's effects
J Consult Clin Psychol
Prevention of relapse following cognitive therapy vs medications in moderate to severe depression
Arch Gen Psychiatry
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression
J Consult Clin Psychol
Preventing hung juries about therapy studies
J Consult Clin Psychol
Prevention of recurrent depression with cognitive behavioral therapy
Arch Gen Psychiatry
Six-year outcome of cognitive behavior therapy for prevention of recurrent depression
Am J Psychiatry
Prevention of relapse in residual depression by cognitive therapy. A controlled trial
Arch Gen Psychiatry
Duration of relapse prevention after cognitive therapy for residual depression: follow-up of controlled trial
Psychol Med
Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial
J Consult Clin Psychol
Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy
J Consult Clin Psychol
Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects
J Consult Clin Psychol
Effects of adding cognitive therapy to fluoxetine dose increase on risk of relapse and residual depressive symptoms in continuation treatment of major depressive disorder
J Clin Psychopharmacol
Preventing recurrent depression using cognitive therapy with and without a continuation phase. A randomized clinical trial
Arch Gen Psychiatry
Cited by (212)
Preliminary results of anti-inflammatory cytokine concentrations predicting therapy outcome in panic disorder
2024, Comprehensive PsychoneuroendocrinologyStandardising the role of a digital navigator in behavioural health: a systematic review
2023, The Lancet Digital HealthMental health and unemployment: A systematic review and meta-analysis of interventions to improve depression and anxiety outcomes
2023, Journal of Affective DisordersHow can the DSM-5 alternative model of personality disorders advance understanding of depression?
2023, Journal of Affective DisordersNeuroinflammation and neuroprogression in depression: Effects of alternative drug treatments
2022, Brain, Behavior, and Immunity - Health
Preparation of this manuscript was supported by National Institute of Mental Health Grant MH01697 (K02) to the second author.