Reviewing the Evidence for NICE Recommended Psychotherapies for Depression
Introduction: Depression is a common mental health problem affecting 1 in 6 people in the UK, which represents a considerable burden (Lépine and Briley, 2011). Cognitive behavioural therapy (CBT) is recommended by the National Institute for Heath and Care Excellence (NICE) as first line treatment for depression on the basis of the evidence available in the depression guidelines (NCCMH, 2010). However, there remains controversy and debate about the strength of the evidence supporting CBT, the relative efficacy of psychotherapies and concerns about the current evidence‐based practice paradigm used by NICE to recommend psychotherapies. The current project aimed to examine the secondary evidence base for CBT and other psychological therapies recommended by NICE for the treatment and management of adult depression. Methods: An exploratory data analysis was conducted to assess the strength of the evidence, using meta‐analytic outcomes as units of analysis (effect sizes and risk associations) for CBT and other psychotherapies. Further analysis examined the relationship between different evidence characteristics (including treatment comparators, study quality etc.) and meta‐analytic outcomes for the two psychotherapy groups. Results: The analyses revealed significant differences in the overall mean effect sizes for CBT and other psychotherapies, which consisted of larger mean effects within the other psychotherapy group. However, the evidence base within the CBT group was stronger than the other psychotherapies group when the two groups were compared to medication comparators. Furthermore, significant relationships were found between the psychotherapy effects and evidence quality, suggesting that greater amounts of low quality evidence associated with favourable effects for CBT. Implications: The findings in this review question the strength of the evidence base for CBT as a front line psychological intervention for the treatment of depression, particularly when considered against the collective evidence for other psychotherapies. The findings highlight how guideline evidence used to recommend psychological treatments of depression are constructed to fit within a medical context and the impact that this has on the choice of psychotherapies available to clients and practitioners are considered.
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