Review: individual behavioural therapy reduces symptoms of depression.

QUESTION Question: How effective are behavioural therapies for depression? METHODS Design: Systematic review with meta-analysis. Index were searched from inception to January 2006 for randomised controlled trials (RCTs). Reference lists of identified studies were hand searched. Study selection and analysis: Two reviewers appraised studies and selected RCTs of behavioural therapy in adults (aged >16 years) with a primary diagnosis of depression. Treatments could be delivered in a community or inpatient setting. Behavioural therapy had to be individual, time limited, and based on changing the behavioural consequences of environmental or cognitive triggers. Comparator treatments could include cognitive behavioural therapy (CBT) or cognitive therapy, brief psychotherapies, supportive counselling, treatment as usual, waiting list or other inactive control. Two reviewers rated study quality and extracted data. Authors were contacted to obtain missing data, but if this was not successful, standard deviations were imputed from other related studies. Random effect meta-analyses were conducted using RevMan software. Separate meta-analyses were carried out for different comparator groups. Heterogeneity was investigated using the I 2 statistic. MAIN RESULTS Twenty RCTs were identified which met inclusion criteria, but 3 of the RCTs did not have enough data to be included in the meta-analyses. Behavioural therapy reduced depressive symptoms compared to control at the end of treatment (12 RCTs, 459 participants; controls included waiting lists, treatment as usual and relaxation). There was no significant difference between behavioural therapy and cognitive therapy or CBT in depressive symptoms post-treatment or at an average of 4 months' follow-up (post-treatment: 12 RCTs, 476 participants; follow up: 8 RCTs, 271 participants). Behavioural therapy reduced depressive symptoms post-treatment and at an average of 4.5 months' follow-up compared to brief psychotherapy (post-treatment: 3 RCTs, 166 participants; follow up: 2 RCTs, 96 participants). Compared to supportive counselling, behavioural therapy reduced symptoms of depression post-treatment (2 RCTs, 45 participants). See online table. CONCLUSIONS Individual behavioural therapy reduces symptoms of depression more than control, supportive counselling or brief psychotherapy. It provides similar reductions in depressive symptoms to cognitive therapy and CBT. A meta-analysis of randomized trials of behavioural treatment of depression. COMMENTARY C ognitive behaviour therapy (CBT) is the most well-researched and established psychother-apeutic approach for treating depression. 1 However, as with antidepressant medications, 2 many unanswered questions remain about the mechanisms through which CBT for depression produces its therapeutic effects. Is it the distinctive cognitive techniques that are producing the majority of the benefits, or are the other …