Is cognitive behavioral therapy for adult depression as effective as its components?

What is it about?

We aimed to identify crucial components of cognitive behavioral therapy by comparing the effectiveness of its full version, containing both cognitive restructuring and behavioral activation, to cognitive restructuring only and behavioral activation only, and to control conditions. The three treatments were effective in comparison to controls, but no evidence of difference in effectiveness was found between them. Therefore, accessibility of given treatments, patients’ and clinicians’ preferences, and predictors of differential effectiveness (which are an important direction of future research) should play a role when choosing a treatment of an adult individual with depression. However, we recommend additional investigation into effectiveness of cognitive restructuring only, as evidence for this treatment was limited.

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Why is it important?

While adult depression can be treated effectively with psychotherapy, it is still unclear how psychotherapies work and on what psychotherapy components is their effectiveness dependent. Identifying crucial components of psychotherapy is important for psychotherapy optimization, but also delivering the most efficient version of psychotherapy, meaning including only the components that are necessary. Such identification may then, in turn, lead to shortening of waiting lists in mental health care, and increasing accessibility of psychotherapy in contexts where individuals with depression still cannot access it, for example thanks to delivering the necessary components through task-sharing or digital interventions.