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Primary care–based cognitive–behavioural therapy improves anxiety and depression

Twomey C, O`Reilly G, Byrne M Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract. 2015;32:3-15.

Review question

Is primary care–based cognitive–behavioural therapy (CBT) effective for treating anxiety and/or depression?

Background

CBT is a therapy in which people learn about how their thinking may be inaccurate or overly negative, and that they can restructure their thinking and improve the way they respond to challenging situations.

CBT is known to be effective for treating anxiety and depression. Most of the research that shows that CBT is effective has assessed CBT provided by mental health specialists. However, recently, more primary care doctors (family doctors or general practitioners) have been providing CBT.

How the review was done

The researchers did a systematic review, based on studies published between 1997 and June 2014.

They found 29 randomized controlled trials with 4,736 people (average age 28 to 74 years). In these trials, 53% to 100% of the people were women.

The key features of the trials were:

  • people had anxiety or depression;
  • treatments for symptoms of anxiety or depression were set in primary care or included people referred from general practitioners;
  • CBT was delivered face-to-face (standard or group formats), by computer/online, as guided self-help, or by telephone;
  • CBT was provided by a variety of people including clinical psychologists/therapists/counsellors, physicians, graduate mental health workers, assistant psychologists, masters level students, non-qualified graduates, nurses, and computer programs;
  • people received an average of 2 to 12 CBT sessions; and
  • CBT was compared with no primary care treatment for anxiety or depression or usual primary care treatment for anxiety or depression (including medication, emotional support, referral for counseling, and advice).

What the researchers found

Compared with no treatment or with usual primary care treatment, primary care–based CBT improved anxiety and depression by a small to medium amount.

Primary care–based CBT added to usual primary care treatment improved anxiety and depression by a small amount compared with usual primary care treatment alone.

Conclusion

Primary care–based cognitive–behavioural therapy improves anxiety and/or depression.

Primary care–based cognitive–behavioural therapy (CBT) for anxiety and/or depression

Type CBT

Comparator

Effect on anxiety and/or depression*

Any type

No primary care treatment

Medium improvement in anxiety and/or depression (7 trials), anxiety alone (4 trials), or depression alone (3 trials) at 2 months after CBT

Specific types

No primary care treatment

Medium improvement in anxiety and/or depression at 2 months after computerized/online CBT (3 trials)

Small improvement in anxiety and/or depression at 2 months after guided self-help CBT (3 trials)

Any type

Usual primary care treatment

Small improvement in anxiety and/or depression (14 trials), anxiety alone (3 trials), or depression alone (11 trials) at 4 months after CBT

Medium improvement in anxiety and /or depression at 6 months after CBT (11 trials)

Specific types

Usual primary care treatment

Small improvement in anxiety and/or depression at 5 months after face-to-face CBT (7 trials) or guided self-help CBT (4 trials) and at 2 months after computerized/online CBT (3 trials)

Any type plus usual primary care

Usual primary care treatment

Small improvement in anxiety and/or depression at 4 months (9 trials) or 9 months (7 trials) after CBT

Specific types plus usual primary care

Usual primary care treatment

Small improvement in depression at 4 months after face-to-face CBT plus usual primary care (5 trials) or at 6 months after computerized/online CBT plus usual primary care (3 trials)

*Based on standard mean differences (SMD); small = 0.2 to 0.49 SMD, medium = 0.5 to 0.79, large = 0.8 or more.

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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