Thursday, April 18, 2019

Certain Variations of CBT Found as Effective as Individual CBT

Group, telephone, and guided self-help formats of cognitive-behavioral therapy (CBT) are as effective as individual CBT to treat depression, according to a study published yesterday in JAMA Psychiatry. However, guided self-help CBT is associated with a higher rate of dropouts than the other formats.

“This study suggests that group, telephone, and guided self-help treatments … may be considered as alternatives to individual CBT,” wrote Pim Cuijpers, Ph.D., of Vrije University in the Netherlands and colleagues. “Applying effective and acceptable CBT in a range of different formats will make CBT easier to implement, disseminate, and deliver across different settings and diverse patient populations.”

Cuijpers and colleagues used a technique known as a network meta-analysis to compare 155 clinical trials involving CBT for the treatment of depression. These trials included CBT delivered in individual, group, telephone-based, guided self-help (in which a therapist provides some assistance), and unguided self-help (no therapist contact) formats. The self-help categories grouped together both internet and non-internet (for example, book) delivery methods. These studies also included two types of control groups: usual care and wait list.

The comparisons showed that individual, group, guided self-help, and telephone CBT were all statistically more effective than unguided self-help CBT, as well as wait-list and usual-care controls. No significant differences were found between individual, group, guided self-help, and telephone CBT.

“Unguided self-help differs from the others in that it is the only modality that does not involve at least some contact with a helping person,” wrote Holly Swartz, M.D., and Jay Fournier, Ph.D., of the University of Pittsburgh School of Medicine, in an accompanying editorial. “This finding is consistent with other reports suggesting that individuals with depression benefit more from psychotherapy when there is at least a modicum of human interaction.”

The researchers also assessed differences in acceptability based on the responses of participants who dropped out for any reason. There were no differences in acceptability between individual, group, telephone, and unguided CBT, but guided self-help CBT was less acceptable than both individual and group CBT and both control conditions.

“It is not clear why the acceptability of guided self-help CBT was lower compared with that for the other formats,” Cuijpers and colleagues wrote. “Maybe the absence of direct contact with a professional makes it easier to stop the treatment because there is less personal-relationship pressure to continue with the treatment or the study. However, lower acceptability would then also be expected to happen in unguided CBT, which we did not find. More research is needed to examine this issue.”

To read more about different CBT modalities, see the Psychiatric News article “Guided Online CBT Benefits Patients With Depression, Anxiety.”

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