Is CBT effective compared with behavioural activation?

Quality assessmentSummary of findingsImportance
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsCBTBARelative (95% CI)Absolute
Leaving study early
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none7/55 (12.7%)12/53 (22.6%)RR 0.56 (0.24 to 1.33)100 fewer per 1000 (from 172 fewer to 75 more)⊕⊕⊕○
MODERATE
CRITICAL
0%0 fewer per 1000 (from 0 fewer to 0 more)
By severity: High severity: Depression scores: continuous measures at 8-week endpoint (self-reported) (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none2122-SMD 0.34 higher (0.26 lower to 0.95 higher)⊕⊕○○
LOW
CRITICAL
By severity: High severity: Depression scores: continuous measures at 8-week endpoint (clinician-reported) (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none2122-SMD 0.03 lower (0.62 lower to 0.57 higher)⊕⊕○○
LOW
CRITICAL
By severity: High severity: Depression scores: continuous measures at 16-week endpoint (self-reported) (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none1816-SMD 0.67 higher (0.02 lower to 1.37 higher)⊕⊕○○
LOW
CRITICAL
By severity: High severity: Depression scores: continuous measures at 16-week endpoint (clinician-reported) (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none1618-SMD 0.37 lower (1.05 lower to 0.31 higher)⊕⊕○○
LOW
CRITICAL
By severity: Moderate: Depression scores: continuous measures at 8-week endpoint (self-reported) (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none1715-SMD 0.23 lower (0.93 lower to 0.47 higher)⊕⊕○○
LOW
CRITICAL
By severity: Moderate: Depression scores: continuous measures at 8-week endpoint (clinician-reported) (Better indicated by lower values)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none1715-SMD 0.36 lower (1.06 lower to 0.34 higher)⊕⊕○○
LOW
CRITICAL
By severity: Moderate: Depression scores: continuous measures at 16-week endpoint (self-reported) (Better indicated by lower values)
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none6769-SMD 0.06 higher (0.28 lower to 0.4 higher)⊕⊕⊕○
MODERATE
CRITICAL
By severity: Moderate: Depression scores: continuous measures at 16-week endpoint (clinician-reported) (Better indicated by lower values)
2randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessserious1none6466-SMD 0.08 higher (0.26 lower to 0.43 higher)⊕⊕⊕;○
MODERATE
CRITICAL
Relapse at 1 year
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none9/30 (30%)9/27 (33.3%)RR 0.90 (0.42 to 1.93)33 fewer per 1000 (from 193 fewer to 310 more)⊕⊕○○
LOW
CRITICAL
0%0 fewer per 1000 (from 0 fewer to 0 more)
Recurrence at 2 years
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none4/17 (23.5%)3/12 (25%)RR 0.94 (0.26 to 3.46)15 fewer per 1000 (from 185 fewer to 615 more)⊕⊕○○
LOW
CRITICAL
0%0 fewer per 1000 (from 0 fewer to 0 more)
Not achieving remission (BDI <=10)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none33/45 (73.3%)24/43 (55.8%)RR 1.31 (0.96 to 1.81)173 more per 1000 (from 22 fewer to 452 more)⊕⊕○○
LOW
CRITICAL
0%0 more per 1000 (from 0 fewer to 0 more)
not achieving remission (HRSD <=7)
1randomised trialsno serious limitationsno serious inconsistencyno serious indirectnessvery serious2none35/45 (77.8%)28/43 (65.1%)RR 1.19 (0.91 to 1.56)124 more per 1000 (from 59 fewer to 365 more)⊕⊕○○
LOW
CRITICAL
0%0 more per 1000 (from 0 fewer to 0 more)
1

Inconclusive effect size

2

Single study, inconclusive effect size

From: APPENDIX 16, CLINICAL EVIDENCE PROFILES

Cover of Depression
Depression: The Treatment and Management of Depression in Adults (Updated Edition).
NICE Clinical Guidelines, No. 90.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2010.
Copyright © The British Psychological Society & The Royal College of Psychiatrists, 2010.

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