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Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder

Published online by Cambridge University Press:  16 October 2019

Aoife Whiston ,
Claudi L. H. Bockting  and
Maria Semkovska Open the ORCID record for Maria Semkovska [Opens in a new window]
Aoife Whiston
Affiliation:
Department of Psychology, University of Limerick, Limerick, Ireland
Claudi L. H. Bockting
Affiliation:
Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
Maria Semkovska*
Affiliation:
Department of Psychology, University of Limerick, Limerick, Ireland Health Research Institute, University of Limerick, Limerick, Ireland
*
Author for correspondence: Maria Semkovska, E-mail: [email protected]
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Abstract

Background

Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies.

Methods

PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted.

Results

In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators.

Conclusions

Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.

Keywords

Cognitive behavioural therapyefficacy moderatorface-to-face therapyinterpersonal psychotherapymajor depressionmeta-analysissystematic review
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 16 , December 2019 , pp. 2657 - 2668
Copyright
Copyright © Cambridge University Press 2019 

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