Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome

Haby, M. M., Donnelly, M., Corry, J. and Vos, T. (2006) Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome. Australian And New Zealand Journal of Psychiatry, 40 1: 9-19. doi:10.1080/j.1440-1614.2006.01736.x


Author Haby, M. M.
Donnelly, M.
Corry, J.
Vos, T.
Title Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome
Journal name Australian And New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 0004-8674
1440-1614
Publication date 2006-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1080/j.1440-1614.2006.01736.x
Volume 40
Issue 1
Start page 9
End page 19
Total pages 11
Editor P. Joyce
Place of publication UK/Australia
Publisher Taylor & Francis Limited
Collection year 2006
Language eng
Subject C1
321204 Mental Health
730211 Mental health
Formatted abstract
Objective: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial.

Method:
We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder ( with or without agoraphobia) or generalized anxiety disorder ( GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment.

Results:
Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI= 0.51 - 0.84, n= 33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size.

Conclusions:
Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.
Keyword Anxiety Disorders
Behaviour Therapy
Cognitive Therapy
Major Depression
Meta-analysis
Panic Disorder
Problem-solving Therapy
Unipolar Depression
Applied Relaxation
Comparative Efficacy
Older Adults
Clinical-trial
Double-blind
Bibliotherapy
Metaanalysis
Agoraphobia
Q-Index Code C1

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Public Health Publications
 
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Created: Wed, 15 Aug 2007, 10:26:34 EST