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On the Phone, In a Group, Online: New Study Evaluates Effectiveness of Different Therapy Delivery Methods

  • August 26, 2019
  • Depression, Patients and Families

Cognitive behavioral therapy (CBT) has been shown an effective treatment for depression and other mental health conditions. CBT helps people identify and change thinking and behaviors that are harmful or ineffective and, instead, focus on solving current problems.

In addition to being delivered in individual therapy, CBT can be offered in other ways, such as group therapy and self-help programs. A new meta-analysis examining various delivery formats found group, telephone-administered, and guided self-help formats as effective as individual therapy.

A group of researchers, led by Pim Cuijpers, Ph.D., with the Amsterdam Public Health Research Institute (the Netherlands), used a network meta-analysis technique that allows for comparison of multiple formats of therapy simultaneously rather than comparing only two. They looked at both the effectiveness and the acceptability of several different therapy delivery formats, including individual, group, telephone-administered, guided self-help and unguided self-help. The acceptability of the formats was measured by looking at the number of people dropping out of the treatment versus those staying with the treatment.

In guided self-help, an individual works through an online course or workbook with the support of a mental health professional. With unguided self-help, the individual works through the materials without support.

Cuijpers and colleagues looked at a total of 155 studies with more than 15,000 patients. The study focused on CBT with the core component of cognitive restructuring (aimed at evaluating, challenging and changing a person’s inaccurate negative beliefs). Most of the treatments also included other components, such as behavioral activation, problem-solving, mindfulness and social skills training.

They found that individual, group, guided self-help and phone CBT were ranked best for effectiveness with little differences between them. They were more effective than going without treatmentand more effective than unguided self-help. Unguided self-help was significantly less effective than the other formats but more effective than no treatment.

Phone CBT was ranked highest for acceptability followed by individual, group and unguided self-help. While guided self-help CBT was as effective as individual, group and phone CBT, it was significantly less acceptable.

The authors conclude that for “acute symptoms of depression, group, telephone and guided self-help treatment formats appeared to be effective interventions, which may be considered as alternatives to individual CBT.” They also note that having various options will make it easier to deliver therapy to diverse patient populations and across different settings.


Cuijpers, P. et al. Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults with Depression: A Network Meta-analysis. JAMA Psychiatry. 2019:76(7);700-707.

Karyotaki, E., et. al. Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data. JAMA Psychiatry. 2017;74(4):351-359

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