Cognitive behavioural group therapy is moderately effective for depression, with continued effect for up to 6 months but not beyond
- Correspondence to:Thomas J Currid
Mental Health and Learning Disabilities, London South Bank University, Havering Campus, Harold Wood, Romford, London RM30BE, UK;
Implications for practice and research
Cognitive behavioural therapy (CBT) is one of the most important evidence-based approaches for depression and is recommended as a core psychological intervention in clinical treatment guidelines.
Currently the demand for trained CBT practitioners outweighs availability, necessitating alternative CBT approaches.
Trained nurses are in a pivotal position to deliver cognitive group behavioural therapy (CGBT).
CGBT has the potential to meet patients’ needs while allowing patient access to treatment in an expedient manner.
There is a need for further research on the process and the components that are effective in CGBT.
Future studies should explore the factors contributing to the discontinuation of CGBT.
The WHO projects that by 2020, depression will be ranked second as a cause of years of potential life lost due to premature mortality, and years of productive life lost due to disability.1 Depression can have a lifelong course of relapse and remission, and can adversely affect the life of an individual, family and society. It can be particularly debilitating, and in severe cases may lead to suicide. These factors add weight to the robustness of the argument and rationale that supports the prioritisation of depression as a public health concern. Based on good-quality evidence, CBGT has a definitive role to play in treating depressive episodes.
Feng and colleagues have carried out a meta-analysis. They applied several approaches that strengthened quality processes in meta-analysis2 including: clearly and coherently outlining the inclusion criteria, study selection, data collection process, analysis and synthesis of results while also explaining the statistical approaches used to address indicators of homogeneity and heterogeneity. Unlike previous meta-analyses3 ,4 only randomised controlled trials were included in this study.
This study found that CGBT had a moderate effect on the severity of depression, and a small effect on relapse rates. The results indicate that CGBT has a greater effect on those with lower levels of depression at commencement of therapy than for those with more severe forms of depression. Findings indicate that although CBGT has an immediate and continuous effect over 6 months, it has no continuous effect after 6 months.
When compared with similar studies, the results of this study found that CGBT was less effective than previous meta-analyses. The authors postulate that patients in their study had greater severity of depression at treatment inception than other studies. Another explanation is that patients who are more severely depressed initially may have greater cognitive impairment and therefore may have greater difficulty in assimilating and processing the psycho-educational aspects of CBGT.
While this study demonstrates that CGBT is effective in the short term, future studies will need to take account of patient characteristics that may impact on design, process and outcome. It is recognised that depression is not a homogenous condition and therefore at an individual level it is difficult to predict who may benefit from CBGT.5 ,6 Within the context of systematic and meta-analytical reviews, studies are often heterogeneous in nature despite methodological approaches employed to address variance in characteristics of the sample. The synergy of variables in depressive episodes such as social support and problem-solving skills culminate in making depression a unique experience for the individual.7 Although patients may report similar experiences about the onset, symptomatology and morbidity of the episode, factors such as predisposing, precipitating and perpetuating mechanisms contribute to the uniqueness of the distress for that individual.