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Question: How effective are behavioural therapies for depression?Outcomes: Depressive symptoms (either self-rated -- eg, Beck Depression Inventory, or clinician rated -- eg, Hamilton Depression Rating Scale).METHODSDesign: Systematic review with meta-analysis.Data sources: MEDLINE, EMBASE, PsycINFO, Cochrane Library, DARE, CINAHL, AMED and the British Nursing 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 I2 statistic.MAIN RESULTSTwenty 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.CONCLUSIONSIndividual 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. [ABSTRACT FROM AUTHOR]

Is cognitive behavioural therapy effective for the treatment of depression, panic disorder, and generalised anxiety disorder, and what factors affect outcome?METHODSDesign: Systematic review with meta-analysis and meta-regression.Data sources: Existing meta-analyses of cognitive behavioural therapy (CBT) for depression, panic disorder, and generalised anxiety disorder (GAD), and searches of MEDLINE and the Cochrane Collaboration Trials Register up to November 2002.Study selection and analysis: The review included randomised controlled trials of (RCTs) of CBT, behavioural therapy, or cognitive therapy with a wait list, no treatment, attention placebo, or pill placebo control group. Participants were aged 18 or over with DSM-III or DSM-III-R major depression or dysthymia (excluding psychotic disorder and bipolar disorder), panic disorder or DSM-III-R or DSM-IV generalised anxiety disorder. RCTs were only included if means and standard deviations were reported for continuous outcome measures, to enable the calculation of effect sizes. Effect sizes for each study were calculated using Hedges' adjusted g, by averaging across the relevant outcome measures. These effect sizes were then pooled to produce overall effect sizes, and a meta-regression was performed for the effect size for all studies.Outcomes: Effect sizes pooled continuous measures of symptoms, functioning, and quality of life.MAIN RESULTSA total of 33 RCTs met the inclusion criteria, representing 52 treatment versus control comparisons. CBT had a moderate to large effect size overall (0.68, 95% CI 0.51 to 0.84), but there was significant heterogeneity among studies (p<0.001). Multivariate regression analysis found that the inclusion of people with severe disorders significantly reduced effect size (p = 0.048). It also found that the type of control group used significantly contributed to effect size (p = 0.002), with RCTs using an attention placebo having smaller effect sizes than RCTs with a wait list control. Effect sizes did not differ significantly for the different disorders. The effect size for depression was 0.77 (95% CI 0.44 to 1.10; 11 RCTs, 17 comparisons), the effect size for panic disorder was 0.64 (95% CI 0.43 to 0.86; 19 RCTs, 30 comparisons), and the effect size for GAD was 0.64 (95% CI 0.28 to 1.00; 3 RCTs, 5 comparisons).CONCLUSIONSCBT is an effective treatment for depression, panic disorder, and GAD. CBT may be less effective when used in people with severe disorders, or when compared to an attention placebo.NOTESStudies were classified as including people with severe disorders based on whether a specific statement to this effect was made in the paper. Therefore the accuracy of these results depends on the quality of reporting in the trials. The definition of severity may have varied between trials. [ABSTRACT FROM AUTHOR]