No Significant Differences Between CBT Delivery Formats for Depression

Researchers found data that showed facilitated therapy for individuals, groups, by telephone, and CBT is more effective than unguided self-help.

The efficacy of individual, group, telephone-administered, and guided self-help delivery formats for cognitive behavioral therapy (CBT) do not differ significantly in the treatment of depression, according to a study published in JAMA Psychiatry.

In this network meta-analysis, researchers searched for randomized clinical trials of CBT for adult depression from PubMed, PsycINFO, Embase, and the Cochrane Library for literature published between January 1, 1966, through January 1, 2018. Studies in which CBT was examined in individual, group, telephone, guided self-help, and unguided self-help were included. The validity of the included studies was assessed by 2 independent researchers using 4 criteria of the risk-of-bias assessment tool from the Cochrane Collection. Data were pooled using a random-effects model.

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A total of 155 studies with 15,191 patients met the inclusion criteria; 2 studies that had 2 CBT interventions underwent separate comparisons. Individual, group, guided self-help, and telephone CBT were significantly more effective than unguided self-help CBT (standardized mean difference 0.34-0.59). There were no statistically significant differences between individual, group, guided self-help, and telephone CBT; a small but significant superiority of group CBT over guided self-help CBT was found (standard mean difference 0.25). Unguided self-help was statistically less effective than individual, group, telephone, and guided help CBT. Results of these analyses were broadly confirmed in several sensitivity analyses.

This meta-analysis was limited by the lack of studies on comparisons with placebo and relatively few studies examining the effectiveness of telephone CBT. Substantial heterogeneity was found in several of the comparisons that were examined.

These findings are similar to those found by previous meta-analytic research that shows comparable effectiveness between individual, group, telephone, and self-help CBT. In this analysis, researchers took advantage of all direct and indirect comparisons, making estimates more precise and consistent. More research is needed to examine the reasons why the absence of direct contact with a professional makes it simpler for patients to stop treatment.

Several authors acknowledge conflicts of interest. Please see reference for the full list of disclosures.


Cuijpers P, Noma H, Karyotaki E, Cipriani A, Furukawa TA. Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: a network meta-analysis [published April 17, 2019]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2019.0268