title: Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis.
abstract: BACKGROUND
  Cognitive behavioural therapy (CBT) is increasingly being delivered in primary care, in a variety of delivery formats such as guided self-help CBT, telephone-based CBT, computerized CBT and standard, one-to-one CBT. However, the vast majority of research has focused on CBT in specialized services, and no previous meta-analysis has examined CBT's effectiveness across delivery formats in primary care.
  
  
  OBJECTIVE
  To determine the effectiveness of multi-modal CBT (i.e. CBT across delivery formats) for symptoms of anxiety and depression, in primary care.
  
  
  METHODS
  A meta-analysis of CBT-focused RCTs, for symptoms of anxiety or depression, in primary care. The authors searched four databases. To be included, RCTs had to be set in primary care or have primary care participants.
  
  
  RESULTS
  Twenty-nine RCTs were included in three separate meta-analyses. Results showed multi-modal CBT was more effective than no primary care treatment (d =0.59), and primary care treatment-as-usual (TAU) (d = 0.48) for anxiety and depression symptoms. Moreover, multi-modal CBT in addition to primary care TAU was shown to be more effective than primary care TAU for depression symptoms (no comparisons of this kind were available for anxiety) (d = 0.37).
  
  
  CONCLUSIONS
  The results from conducted meta-analyses indicate that multi-modal CBT is effective for anxiety and depression symptoms in primary care. Furthermore, based on CBT's economic viability, increasing the provision of CBT in primary care seems justified. Future research should examine if varying levels of qualification among primary care CBT practitioners impacts on the effectiveness of CBT in this setting.
authors.affiliation: School of Psychology, University College Dublin, Dublin, Ireland, School of Psychology, University of Southampton, Southampton, UK.
authors.forename: Conal
authors.initials: C
authors.lastname: Twomey
authors.affiliation: School of Psychology, University College Dublin, Dublin, Ireland.
authors.forename: Gary
authors.initials: G
authors.lastname: O'Reilly
authors.affiliation: Psychology Department, Health Service Executive Dublin Mid-Leinster, Offaly, Ireland michaelj.byrne@hse.ie.
authors.forename: Michael
authors.initials: M
authors.lastname: Byrne
mesh_terms: D001007:Anxiety / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D006801:Humans; D015233:Models, Statistical; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Anxiety; cognitive behaviour therapy; computer-assisted therapy; depression; meta-analysis; multimodal treatment.; primary care