About the research on talking therapies for depression
What is the research that this Highlight is based on?
This Highlight is based on findings from the following four NIHR-funded studies:
- Littlewood E, Duarte A, Hewitt C, Knowles S, Palmer S, Walker S, et al. A randomised controlled trial of computerised cognitive behaviour therapy for the treatment of depression in primary care: the Randomised Evaluation of the Effectiveness and Acceptability of Computerised Therapy (REEACT) trial. Health Technol Assess 2015;19(101)
- Wiles N, Thomas L, Abel A, Barnes M, Carroll F, Ridgway N, et al. Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial. Health Technol Assess 2014;18(31)
- Wiles, Nicola J et al. Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial. The Lancet Psychiatry 2016.
- Kuyken W, Hayes R, Barrett B, Byng R, Dalgleish T, Kessler D, et al. The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study). Health Technol Assess 2015;19(73)
We selected these studies because they are relatively recent, high quality and fall within the specific area of cognitive therapies for depression. There are two further studies underway which are highly relevant to the issues discussed here, and which publish later in 2016:
The NIHR is also funding research on another talking therapy, called behavioural activation, and these studies will publish during 2016:
There are other NIHR studies that have some relevance to the topic – you can find out more at nihr.ac.uk or nets.nihr.ac.uk .
How strong is the research evidence in this area?
There is already good evidence to support the use of cognitive behavioural therapy for depression. Previous studies have found CBT more effective than no treatment, more effective than some alternatives, and about the same as medication for chronic depression.
There is also existing evidence that mindfulness-based cognitive therapy is more effective than usual care alone in preventing depression relapse, although this seems to be the case mainly for people who have experienced three or more previous episodes of depression.
This Highlight is not a systematic review and does not aim to pull together all the relevant evidence on depression or on cognitive therapies, but rather to focus on a small group of interesting new studies. All the studies discussed in this Highlight are randomised controlled trials (RCTs), with between 400 and 700 participants. Although they are single studies – rather than reviews of a number of studies – they can be considered good quality evidence. Each study provides evidence on a specific aspect of depression care that was previously missing, or weak.
How does this fit with current guidance?
NICE has published detailed guidance on the management of depression, which includes advice on when cognitive therapies may be most appropriate. The studies covered in this Highlight in some cases support NICE guidance, and in others provide additional useful context or clarification:
- NICE guidance states that ‘low intensity’ psychosocial treatments – such as computerised CBT – should be offered to people with mild to moderate depression, with limited facilitation from a trained practitioner. The study discussed here suggests that people with depression may have difficulty completing a course of computerised CBT if it is delivered without support from a trained practitioner.
- NICE guidance recommends the use of CBT in combination with anti-depressants for people with moderate or severe depression, or who have not responded to previous treatment. The evidence reported here supports this.
- NICE guidance recommends the use of MBCT for people who are currently well, but have experienced three or more previous episodes of depression, and are considered to be at risk of relapse. The evidence reported here supports use of MBCT as an alternative to anti-depressants in these circumstances.
Disclaimer: This report by the NIHR Dissemination Centre presents a synthesis of independent research. The views and opinions expressed by the authors of this publication are those of the authors and do not necessarily reflect those of the NHS or the Department of Health. Where blogs, sound recordings and verbatim quotations are included in this publication the views and opinions expressed are those of the named individuals and do not necessarily reflect those of the authors, the NHS, the NIHR or the Department of Health.