Psychological Medicine

Invited Review

A meta-analysis of randomized trials of behavioural treatment of depression

D. Ekersa1 c1, D. Richardsa2 and S. Gilbodya2

a1 Tees Esk & Wear Valleys NHS Trust/University of York Department of Health Sciences, The Health Centre, Newcastle Road, Chester le Street, Co. Durham, UK

a2 Department of Health Sciences, Seebohm Rowntree Building, University of York, York, UK


Background Depression is a common, disabling condition for which psychological treatments, in particular cognitive behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for depression, determine the effect of such interventions and examine any moderators of such effect.

Method Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were extracted and analysed using meta-analysis and meta-regression respectively.

Results Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls [standardized mean difference (SMD) −0.70, 95% CI −1.00 to −0.39, k=12, n=459], brief psychotherapy (SMD −0.56, 95% CI −1.0 to −0.12, k=3, n=166), supportive therapy (SMD −0.75, 95% CI −1.37 to −0.14, k=2, n=45) and equal to cognitive behavioural therapy (SMD 0.08, 95% CI −0.14 to 0.30, k=12, n=476).

Conclusions The results in this study indicate behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues of parsimony of such interventions.

(Received March 30 2007)

(Revised July 25 2007)

(Accepted July 31 2007)

(Online publication October 01 2007)