The authors concluded that behavioural therapy was effective for depression and equivalent to the recommended psychological intervention. The authors’ conclusions appeared supported by the evidence presented, but incomplete reporting of review methods and study quality made it difficult to assess their reliability.

To evaluate the effects of behavioural therapy for depression.

MEDLINE, EMBASE, PsycINFO, The Cochrane Library, DARE, CINAHL, AMED and British Nursing Index were searched from inception to January 2006. Details of the search strategy were provided online. No language restrictions were applied. Reference lists of identified studies were screened.

Randomised controlled trials (RCTs) that compared individual time-limited behaviourally orientated psychotherapy (behavioural therapy) with usual treatment/no-treatment, cognitive behavioural therapy (CBT)/cognitive therapy (CT), brief psychotherapy or supportive counselling in adults (aged 16 years or over) with a primary diagnosis of depression were eligible for inclusion. Studies evaluating marital, couple or group therapy were excluded. Patients could be treated in the community or as in-patients.

The primary review outcome was depression symptom level. Symptom level was self rated/clinician rated (presented as means and standard deviations), or a dichotomous measure of clinical improvement/non improvement. Self-rated symptom measures were preferred to clinician-rated measures. Other outcomes included drop-out rates. Participants varied and included psychiatric in- and out-patients, volunteer groups of adults, older adults and students. Where reported, mean ages of participants ranged from 22 to 68 years. In most studies, females formed more than half of the sample. In all of the studies, behavioural therapy was administered by psychologically or psychotherapy trained individuals.

Two reviewers selected studies. It was not stated if this was done independently or not.

Two reviewers independently assessed validity based on selection, measurement, performance and attrition bias. Disagreements were resolved by discussion. Possible quality scores ranged from 1 to a maximum of 8.

The authors stated neither how data were extracted for the review nor how many reviewers performed the data extraction.

For each study, the number of events per treatment group were extracted and used to calculate odds ratios (OR) and means and standard deviations were extracted and used to calculate mean differences. Authors were contacted for missing data. Absent standard deviations were imputed from other relevant studies.

The studies were grouped by comparator intervention and outcome. Pooled standardised mean differences (SMD) and pooled odds ratios with 95% confidence intervals (CI) were calculated using random-effects models. Where studies contained more than one control group, each comparison was entered separately and the number of patients in the behavioural arm was halved. Effect sizes were classified as small (SMD 0 to 0.32), medium (SMD 0.33 to 0.55) and large (SMD 0.56 or larger). Heterogeneity was assessed using the I² statistic. Sensitivity analyses and meta-regression were used to examine the influence of baseline depression severity, level of therapist training, number of sessions, study quality and use of clinician-rated in preference to self-rated depression scores. The potential for publication bias was assessed using a funnel plot and Egger’s test.

Seventeen RCTs were included (n= 1,109).

Behavioural therapy versus usual treatment/no-treatment (12 studies, n=459): Behavioural therapy was associated with a large and statistically significant reduction in post-treatment symptom-level depression scores (SMD -0.70, 95% CI -1.00 to -0.39, p<0.00, I²=55.1%; 12 studies) and a statistically significant increase in recovery rates (OR 4.18, 95% CI 1.14 to 15.28, p=0.03, I²=52.6%; three studies) compared to control. There was no significant difference between treatments in drop-out rates.

Behavioural therapy versus CBT/CT (12 studies, n=476): There was no significant difference between treatments in post-treatment symptom level depression scores, symptom level scores at follow-up, drop-out rates or recovery rates.

Behavioural therapy versus brief psychotherapy (three studies, n=166): Behavioural therapy was associated with a large and statistically significant reduction in post-treatment symptom-level depression scores (SMD -0.56, 95% CI -1.00 to -0.12, p=0.01, I²=43.4%), a statistically significant reduction in follow-up depression scores (SMD -0.50, 95% CI -0.90 to -0.09, p=0.02, I²=0%; two studies) and a statistically significant improvement in recovery rates (OR 2.37, 95% CI 1.23 to 4.57, p=0.01, I²=0%; three studies) compared to brief psychotherapy. There was no significant difference between treatments in drop-out rates.

Behavioural therapy versus supportive therapy (two studies, n=45): Behavioural therapy was associated with a large and statistically significant reduction in post-treatment symptom-level depression scores (SMD -0.75, 95% CI -1.37 to -0.14, p=0.02, I²=0%).

There was either no evidence of publication bias for the above comparisons or too few studies for an assessment.

Behavioural therapy was effective for the treatment of depression and equivalent to the recommended psychological intervention of cognitive behavioural therapy

The review question was clearly stated and appropriate inclusion criteria were defined. Several relevant sources were searched. No language restrictions were applied. No specific attempts to identify unpublished studies were reported, but no evidence of publication bias was found for comparisons with a sufficient number of studies to permit an assessment. Appropriate methods were used to minimise reviewer error and bias during the assessment of validity, but the study selection and data extraction processes were incompletely or not described and it was unclear whether similar steps were taken for these processes. Validity was assessed, but results of the assessment were not reported and so it was not possible to judge the quality of the included studies. Studies were appropriately grouped by comparator and pooled using meta-analysis. Heterogeneity was assessed and various sensitivity analyses conducted including an exploration of the influence of study quality score. The authors’ conclusions appeared to be supported by the evidence presented, but incomplete reporting of review methods and lack of reporting of study quality made it difficult to assess their reliability.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research was required to evaluate behaviour therapies for depression, especially an examination of the duration and level of training required for the effective delivery of behavioural therapy .

Not stated.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.