title: Behavioural therapies versus other psychological therapies for depression.
abstract: BACKGROUND
  Behavioural therapies represent one of several categories of psychological therapies that are currently used in the treatment of depression. However, the effectiveness and acceptability of behavioural therapies for depression compared with other psychological therapies remain unclear.
  
  
  OBJECTIVE
  1. To examine the effects of all BT approaches compared with all other psychological therapy approaches for acute depression.2. To examine the effects of different BT approaches (behavioural therapy, behavioural activation, social skills training and relaxation training) compared with all other psychological therapy approaches for acute depression.3. To examine the effects of all BT approaches compared with different psychological therapy approaches (CBT, third wave CBT, psychodynamic, humanistic and integrative psychological therapies) for acute depression.
  
  
  METHODS
  We searched the Cochrane Depression Anxiety and Neurosis Group Trials Specialised Register (CCDANCTR, 31/07/2013), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE, (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies.
  
  
  METHODS
  Randomised controlled trials that compared behavioural therapies with other psychological therapies for acute depression in adults.
  
  
  METHODS
  Two or more review authors independently identified studies, assessed trial quality and extracted data. We contacted study authors for additional information.
  
  
  RESULTS
  Twenty-five trials involving 955 participants compared behavioural therapies with one or more of five other major categories of psychological therapies (cognitive-behavioural, third wave cognitive-behavioural, psychodynamic, humanistic and integrative therapies). Most studies had a small sample size and were assessed as being at unclear or high risk of bias. Compared with all other psychological therapies together, behavioural therapies showed no significant difference in response rate (18 studies, 690 participants, risk ratio (RR) 0.97, 95% confidence interval (CI) 0.86 to 1.09) or in acceptability (15 studies, 495 participants, RR of total dropout rate 1.02, 95% CI 0.65 to 1.61). Similarly, in comparison with each of the other classes of psychological therapies, low-quality evidence showed better response to cognitive-behavioural therapies than to behavioural therapies (15 studies, 544 participants, RR 0.93, 95% CI 0.83 to 1.05) and low-quality evidence of better response to behavioural therapies over psychodynamic therapies (2 studies, 110 participants, RR 1.24, 95% CI 0.84 to 1.82).When compared with integrative therapies and humanistic therapies, only one study was included in each comparison, and the analysis showed no significant difference between behavioural therapies and integrative or humanistic therapies.
  
  
  CONCLUSIONS
  We found low- to moderate-quality evidence that behavioural therapies and other psychological therapies are equally effective. The current evidence base that evaluates the relative benefits and harms of behavioural therapies is very weak. This limits our confidence in both the size of the effect and its precision for our key outcomes related to response and withdrawal. Studies recruiting larger samples with improved reporting of design and fidelity to treatment would improve the quality of evidence in this review.
authors.affiliation: Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan, 601-8501.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Shinohara
authors.forename: Mina
authors.initials: M
authors.lastname: Honyashiki
authors.forename: Hissei
authors.initials: H
authors.lastname: Imai
authors.forename: Vivien
authors.initials: V
authors.lastname: Hunot
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Caldwell
authors.forename: Philippa
authors.initials: P
authors.lastname: Davies
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Moore
authors.forename: Toshi A
authors.initials: TA
authors.lastname: Furukawa
authors.forename: Rachel
authors.initials: R
authors.lastname: Churchill
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts / Q000706:statistics & numerical data; D064889:Psychotherapy, Psychodynamic / Q000379:methods; D016032:Randomized Controlled Trials as Topic