Rush, A. J., Beck, A. T., Kovacs, M., & Hollon, S. (1977). Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy and Research, 1, 17–37. https://link.springer.com/article/10.1007/BF01173502

Type of Study: Randomized controlled trial
Number of Participants: 41

Population:

• Age — Mean=35.70 years
• Race/Ethnicity — 39 White, 2 Nonwhite
• Gender — 26 Female and 15 Male
• Status — Participants were unipolar depressed outpatients.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the efficacy of cognitive therapy [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)] compared to a generally accepted standard treatment, tricyclic pharmacotherapy. Participants were randomized to either cognitive therapy or to a pharmacotherapy comparison group that received imipramine. Measures utilized include the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRS-D), Raskin Depression Scale, and Hamilton Rating Scale for Anxiety (HRS-A). Results indicate that cognitive therapy resulted in significantly greater improvement than did pharmacotherapy on both a self-administered measure of depression (Beck Depression Inventory) and clinical ratings (Hamilton Rating Scale for Depression and Raskin Scale). Moreover, 78.9% of the participants in cognitive therapy showed marked improvement or complete remission of symptoms as compared to 22.7% of the participants in pharmacotherapy. Follow-up contacts at three and six months indicate that treatment gains evident at termination were maintained over time. Moreover, while 68%of the pharmacotherapy group re-entered treatment for depression, only 16% of the psychotherapy patients did so. Limitations include a small sample size and concerns over generalizability due to racial demographics.

Length of controlled postintervention follow-up: 6 months.

Elkin, I., Shea, T. M., Watkins, J. T., Imber, S. D., Sotsky, S M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., Fiester, S. J., & Parloff, M. B. (1989). National Institute of Mental Health treatment of depression collaborative research program: General effectiveness of treatments. Archives of General Psychiatry, 46(11), 971–982. https://doi.org/10.1001/archpsyc.1989.01810110013002

Type of Study: Randomized controlled trial
Number of Participants: 250

Population:

• Age — Participants: Mean=35 years; Therapists: 30–60 years (Mean=41.5 years)
• Race/Ethnicity — Participants: 89% White; Therapists: Not specified
• Gender — Participants: 70% Female; Therapists: Not specified
• Status — Participants were adults with major depressive disorder.

Location/Institution: University of Pittsburgh (PA), George Washington University (Washington, DC) and the University of Oklahoma, (Oklahoma City)

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effectiveness of Cognitive-Behavioral Therapy (CBT) [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)] and interpersonal psychotherapy for the treatment of outpatients with major depressive disorder. Participants were randomly assigned to one of four 16-week treatment conditions: Interpersonal Psychotherapy, CBT, imipramine hydrochloride plus clinical management, and placebo plus clinical management. Measures utilized include the Schedule for Affective Disorders and Schizophrenia Interview, the Hamilton Rating Scale for Depression, the Global Assessment Scale (GAS), the Beck Depression Inventory (BDI), the Hopkins Symptom Checklist-90 Total Score (HSCL-90 T), and the Collaborative Study Psychotherapy Rating Scale. Results indicate that patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total sample without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical managements. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of function, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients. Limitations include lack of generalizability due to gender and ethnicity, and lack of follow up.

Length of controlled postintervention follow-up: Not specified.

Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S., & Startup, M. (1994). Effects of treatment duration and severity of depression on the effectiveness of Cognitive-behavioral and psychodynamic-interpersonal Psychotherapy. Journal of Consulting and Clinical Psychology, 62(3), 522–534. https://doi.org/10.1037/0022-006X.62.3.522

Type of Study: Randomized controlled trial
Number of Participants: 117

Population:

• Age — Mean=40.5 years
• Race/Ethnicity — Predominately White Anglo-Saxon
• Gender — 52% Female
• Status — Participants were adults with depression.

Location/Institution: Sheffield, United Kingdom

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Cognitive-Behavioral Psychotherapy (CB) [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)] and Psychodynamic Interpersonal Psychotherapy (PI) on clients presenting with mild, moderate, and severe depression. Participants in each of the three ranges were randomly assigned to 8 or 16 weekly sessions of CB or PI. Measures utilized include the Beck Depression Inventory (BDI), the Present State Examination, and the Diagnostic Interview Schedule. Results indicate that on most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the BDI. There was no evidence that the effects of CB were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions. Limitations include poor generalizability due to ethnicity as well as to treatment regarding range of depression severity, and therapist bias.

Length of controlled postintervention follow-up: 3 months.

DeRubeis, R. J., Gelfand, L. A., Tang, T. Z., & Simons, A. D. (1999). Medications versus Cognitive Behavior Therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons. American Journal of Psychiatry, 156(7), 1007–1013. https://doi.org/10.1176/ajp.156.7.1007

Type of Study: Randomized controlled trial
Number of Participants: Not specified

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were adults with severe depression.

Location/Institution: University of Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the acute outcomes of antidepressant medication and Cognitive-Behavioral Therapy (CBT) [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)] in the severely depressed outpatient subgroups of four major randomized trials. Participants were randomized to either medications, CBT, or to a pill placebo group. Measures utilized include the Hamilton Depression Scale and the Beck Depression Inventory. Results indicate that at 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Limitations include the differences between the four studies examined and lack of controlled post-intervention follow-up.

Length of controlled postintervention follow-up: None.

Blatt, S. J., Zuroff, D. C., Bondi, C. M., & Sanislow, C. A., (2000). Short and long-term effects of medication and psychotherapy in the brief treatment of depression: Further analyses of data from the NIMH TDCRP. Psychotherapy Research, 10(2), 215–234. https://doi.org/10.1080/713663676

Type of Study: Randomized controlled trial
Number of Participants: 239

Population:

• Age — Mean=35 years
• Race/Ethnicity — Not specified
• Gender — 70% Female
• Status — Participants were adults who were severely depressed.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Elkin et al. (1989). The purpose of the study was to analyze data from the NIMH-sponsored Treatment for Depression Collaborative Research Program (TDCRP) which examined depression treatment with Imipramine (IMI-CM), Cognitive-Behavioral Therapy (CBT), [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)] or Interpersonal Therapy (IPT). Participants were randomly assigned to placebo or one of three active treatments: IMI-CM, CBT, or IPT. Measures utilized include the Social Adjustment Scale, Schedule for Affective Disorders and Schizophrenia-Change Version (SADS-C), the Hamilton Rating Scale for Depression, Global Adjustment Scale, the Hopkins Symptom Checklist, and the Beck Depression Inventory. Results indicate that there were no significant differences between the three treatments at the end of the study. Significant treatment differences emerged, however, at the 18-month follow-up time point. Patients in the IPT group reported greater satisfaction with treatment, and patients in both the IPT and CBT groups reported significantly greater effects of treatment on their capacity to establish and maintain interpersonal relationships and to recognize and understand sources of their depression. Limitations include lack of generalizability due to gender and that only a subsample of the original sample was analyzed.

Length of controlled postintervention follow-up: 18 months.

Vittengl, J. R., Jarrett, R. B., Weitz, E., Hollon, S. D., Twisk, J., Cristea, I., David, D., DeRubeis, R. J., Dimidjian, S., Dunlop, B. W., Faramarzi, M., Hegerl, U., Kennedy, S. H., Kheirkhah, F., Mergl, R., Miranda, J., Mohr, D. C., Rush, A. J., Segal , Z. V.,…Cuijpers, P. (2016). Divergent outcomes in Cognitive-Behavioral Therapy and pharmacotherapy for adult depression. American Journal of Psychiatry, 173(5), 481–490. https://doi.org/10.1176/appi.ajp.2015.15040492

Type of Study: Randomized controlled trial
Number of Participants: 1,700

Population:

• Age — Mean=37.38 years
• Race/Ethnicity — Not specified
• Gender — 69% Female
• Status — Participants were adults with depression.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate sixteen randomized clinical trials comparing Cognitive-Behavioral Therapy (CBT) for Adult Depression and pharmacotherapy for unipolar depression. Participants were randomized to either pharmacotherapy or CBT. Measures utilized include the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory (BDI). Results indicate that at posttreatment, treatment with pharmacotherapy versus CBT increased patients’ odds of superior improvement from the clinician’s perspective. Also at posttreatment, deterioration/extreme nonresponse and, similarly, superior improvement/superior response, both occur infrequently in randomized clinical trials comparing CBT and pharmacotherapy for depression. Pretreatment symptom levels help forecast both negative and unusually positive outcomes but do not guide selection of CBT versus pharmacotherapy. Limitations include low base rates of divergent outcomes and attrition may have limited detection of predictors and moderators, results from randomized clinical trials may not generalize fully to routine clinical practice, lack of follow-up, and finally, the analyses focused on trials of CBT versus pharmacotherapy and do not address combinations, sequences, dissemination, or the quality of implementation of treatments.

Length of controlled postintervention follow-up: None.

A-Tjak, J. G. L., Morina, N., Topper, M., & Emmelkamp, P. M. G. (2018). A randomized controlled trial in routine clinical practice comparing Acceptance and Commitment Therapy with Cognitive Behavioral Therapy for the treatment of major depressive disorder. Psychotherapy and Psychosomatics, 87(3), 154–163. https://doi.org/10.1159/000486807

Type of Study: Randomized controlled trial
Number of Participants: 82

Population:

• Age — 18–65 years
• Race/Ethnicity — CBT: 32 Dutch, 5 Non-European, and 1 European; ACT: 35 Dutch, 8 Non-European, and 1 European
• Gender — CBT: 50% Female and 50% Male; ACT: 52% Female and 48% Male
• Status — Participants were patients suffering from major depressive disorder (MDD).

Location/Institution: PsyQ, an outpatient clinic, in the Netherlands

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Acceptance and Commitment Therapy (ACT) with Cognitive Behavioral Therapy (CBT) for depression [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)]. Participants were randomized to either CBT or ACT. Measures utilized include the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Personality Disorder Belief Questionnaire (PBQ), the Hamilton Depression Rating Scale (HDRS-17), the Quick Inventory of Depressive Symptomatology (QIDS), and the European Health Interview Surveys Quality of Life Scale (EUROHIS). Results indicate that after treatment, the rates of remission from depression were 75% and 80% for the ACT and CBT conditions, respectively. Patients in both conditions further reported significant and large reductions in depressive symptoms and improvement in quality of life from before to after treatment as well as at the follow-up. Findings indicate no significant differences between the two intervention groups. Limitations include the study was underpowered to detect smaller differences in effectiveness between ACT and CBT; no non-treatment control group was included, making conclusive statements about the absolute effectiveness of ACT and CBT impossible; interrater reliability for the SCID diagnoses and the HDRS were not assessed, and the small sample size.

Length of controlled postintervention follow-up: 6 months.

Callesen, P., Reeves, D., Heal, C., & Wells, A. (2020). Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with major depression: A parallel single-blind randomised trial. Scientific Reports, 10, Article 7878. https://doi.org/10.1038/s41598-020-64577-1

Type of Study: Randomized controlled trial
Number of Participants: 174

Population:

• Age — 18–70 years
• Race/Ethnicity — Not specified
• Gender — CBT: 69% Female and 32% Male; MCT: 70% Female and 30% Male
• Status — Participants were adults meeting Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for major depressive disorder.

Location/Institution: Mental healthcare clinic in Næstved, Denmark

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the clinical efficacy of Metacognitive Therapy (MCT) compared to Cognitive Behavioral Therapy (CBT) [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)]. Participants were randomly assigned to either MCT or CBT. Measures utilized include the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory II (BDI-II), the Beck Anxiety Inventory (BAI), the Metacognitions Questionnaire 30 (MCQ-30), the Negative Beliefs about Rumination Scale (NBRS), the Positive Beliefs about Rumination Scale (PBRS), the Rumination Response Scale (RRS), the Dysfunctional Attitudes Scale (DAS) and Young’s Schema Questionnaire Short Version (YSQ-SF). Results indicate that there were no differences on the HDRS at post treatment or follow-up but floor effects on this outcome are high. A significant difference favoring MCT was found on the BDI-II at post treatment, which was maintained at six-month follow-up. Following MCT 74% of patients compared with 52% in CBT met formal criteria for recovery on the BDI-II at posttreatment. At follow-up the proportions were 74% compared to 56% recovery. Significant differences favoring MCT, also maintained over time, were observed for most secondary outcomes. The results were robust against controlling for time under therapy and when outcomes were assessed at a common 90-day mid-term time-point. Limitations include the use of only two therapists where one treated 69% of patients; possible allegiance effects as the study was conducted in an established CBT clinic, and the chief investigator is the originator of MCT; and group differences in time under therapy.

Length of controlled postintervention follow-up: 6 months.

A-Tjak, J. G. L., Morina, N., Topper, M., & Emmelkamp, P. M. G. (2021). One year follow-up and mediation in Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for adult depression. BMC Psychiatry, 21, Article 41. https://doi.org/10.1186/s12888-020-03020-1

Type of Study: Randomized controlled trial
Number of Participants: 82

Population:

• Age — 18–65 years
• Race/Ethnicity — Not Specified
• Gender — Not Specified
• Status — Participants were patients suffering from major depressive disorder (MDD).

Location/Institution: PsyQ, an outpatient treatment facility

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as A-Tjak et al. (2018). The purpose of the study was to examine the long-term efficacy of Cognitive Behavioral Therapy (CBT) [referred to by CEBC as Cognitive-Behavioral Therapy for Adult Depression (CBT)] and Acceptance and Commitment Therapy (ACT) for major depressive disorder (MDD). Participants were randomized to either CBT or ACT. Measures utilized include the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), the European Health Interview Surveys Quality of Life Scale (EUROHIS), the Dysfunctional Attitude Scale-revised (DAS-17), the Decentering subscale of the Experiences Questionnaire (EQ-D), and the Acceptance and Action Questionnaire (AAQ-II). Results indicate that patients in both conditions reported significant and large reductions of depressive symptoms and improvement in quality of life 12 months following treatment. Findings indicate no significant differences between the two interventions. Dysfunctional attitudes and decentering mediated treatment effects of depressive symptoms in both CBT and ACT, whereas experiential avoidance mediated treatment effects in ACT only. Limitations include small sample size and lack of a non-treatment control group.

Length of controlled postintervention follow-up: 1 year.