Specificity of CBT for Depression: A Contribution from Multiple Treatments Meta-analyses
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The “Dodo bird verdict,” which claims that all psychotherapies are equally effective, has been a source of bewilderment and intense controversy among psychiatrists and psychologists. To examine this issue, we focused on cognitive-behavior therapy (CBT) and applied the newly developed review method known as multiple treatments meta-analysis (MTM). We identified randomized controlled trials comparing CBT against a psychological placebo (PP) and/or no treatment (NT) controls during the acute phase treatment of adults with depression. A random-effects MTM was conducted within a Bayesian framework. All the analyses were performed on an intention-to-treat basis. The MTM of the evidence network from 18 studies (39 treatment arms, 1,153 participants) revealed that CBT was significantly more likely to yield a response than NT (OR 2.24, 1.32–3.88) and that CBT was nominally, but not significantly, superior to PP (OR 1.30, 0.53–2.94), which in turn was superior to NT (OR 1.73, 0.67–4.84). The intervention effects in MTM were associated with the number of sessions, and the specificity of CBT increased as the number of sessions increased. The specific component of CBT was estimated to constitute 50.4 % (19.7–85.0) when CBT was given for ten or more sessions. Despite the quantitatively and qualitatively limited body of randomized evidence examining this issue, the present study strongly suggested a non-null specific component of CBT when given for an adequate length.
KeywordsMultiple treatments meta-analysis Cognitive behavior therapy Dodo bird verdict Common factor Specific factor
This review was supported in part by the Health and Labour Sciences Research Grant (H22-Psychiatry-General-005, Principal investigator: Yutaka Ono, MD, PhD) from the Ministry of Health, Labour and Welfare, Japan to Furukawa. This is one publication of the High Impact Reviews of Effectiveness in Depression (HIRED) project in which a group of researchers within the Cochrane Collaboration Depression, Anxiety and Neurosis Group conducted a systematic review of all available evidence for all psychotherapies for treating depression. Altogether they will contribute data to the network meta-analysis of psychotherapies and pharmacotherapies for treating depression. We thank Dr Kiyomi Shinohara and Dr Hissei Imai for help with data extraction. MH extracted the data and wrote the first draft of the protocol and the paper; HN analyzed the data; ST provided technical advice on analysis; PC, KI, MO extracted the data; RC is the principle investigator of HIRED project and contributed to the study selection and data collection process. VH contributed to study selection and data collection process. DC advised on the statistical analyses and contributed to data collection. TAF provided theoretical and clinical expertise for this paper. He was responsible for supervising the writing and preparing of this review. All the authors have seen, commented on, and approved the final manuscript.
Conflict of interest
TAF has received honoraria for speaking at CME meetings sponsored by Asahi Kasei, Eli Lilly, GlaxoSmithKline, Mochida, MSD, Otsuka, Pfizer, Shionogi and Tanabe-Mitsubishi. He is 18 diplomate of the Academy of Cognitive Therapy. He has received royalties from Igaku-Shoin, Seiwa-Shoten and Nihon Bunka Kagaku-sha. He is on advisory board for Sekisui Chemicals and Takeda Science Foundation. All the other authors have no conflicts of interest to declare. This study was supported in part by Grant-in-Aid by the Ministry of Health, Labour and Welfare to TAF. The study has not been presented at any meeting.
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