Cognitive behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

Beth Fordham; Thavapriya Sugavanam; Katherine Edwards; Karla Hemming; Jeremy Howick; Bethan Copsey; Hopin Lee; Milla Kaidesoja; Shona Kirtley; Sally Hopewell; Roshan das Nair; Robert Howard; Paul Stallard; Julia Hamer-Hunt; Zafra Cooper; Sarah E Lamb

doi:10.3310/hta25090

Health Technology Assessment

Cognitive behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

Type:

Extended Research Article Our publication formats
Headline:

This review found that the best-quality evidence, across different conditions, estimated that CBT consistently produces a modest benefit in health-related quality of life.
Authors:
Beth Fordham ,

Thavapriya Sugavanam ,

Katherine Edwards ,

Karla Hemming ,

Jeremy Howick ,

Bethan Copsey ,

Hopin Lee ,

Milla Kaidesoja ,

Shona Kirtley ,

Sally Hopewell ,

Roshan das Nair ,

Robert Howard ,

Paul Stallard ,

Julia Hamer-Hunt,

Zafra Cooper ,

Sarah E Lamb
Detailed Author information

Beth Fordham^1,*, Thavapriya Sugavanam¹, Katherine Edwards¹, Karla Hemming², Jeremy Howick³, Bethan Copsey¹, Hopin Lee¹, Milla Kaidesoja⁴, Shona Kirtley¹, Sally Hopewell¹, Roshan das Nair^5,6, Robert Howard⁷, Paul Stallard⁸, Julia Hamer-Hunt⁹, Zafra Cooper¹⁰, Sarah E Lamb^1,11

¹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

² Institute of Applied Health Research, University of Birmingham, Birmingham, UK

³ Faculty of Philosophy, University of Oxford, Oxford, UK

⁴ Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland

⁵ Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK

⁶ Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK

⁷ Division of Psychiatry, University College London, London, UK

⁸ Department for Health, University of Bath, Bath, UK

⁹ Public and patient representative, Oxford, UK

¹⁰ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

¹¹ College of Medicine and Health, University of Exeter, Exeter, UK

* Corresponding author email: beth.fordham@ndorms.ox.ac.uk

Declared competing interests of authors: Zafra Cooper reports occasional fees for lectures and workshops on cognitive–behaviour therapy (CBT) for eating disorders, and payment to provide various clinical and research groups with supervision in CBT for eating disorders. Roshan das Nair reports being chairperson of the National Institute for Health Research (NIHR) Research for Patient Benefit East Midlands Regional Advisory Committee (2019 to present); he was also a NIHR Health Services and Delivery Research funding panel member (2018–20). Sally Hopewell reports membership of the Health Technology Assessment (HTA) Clinical Evaluation and Trials Committee from 2018 to the present. Robert Howard reports grants from NIHR HTA and Efficacy and Mechanism Evaluation programmes during the conduct of the study. He was a member of the HTA Commissioning Committee (2013–18) and the HTA Commissioning Sub-board (2016–17). Milla Kaidesoja reports grants from the Helsinki Institute of Life Science during the conduct of the study. Sarah E Lamb was on the HTA Additional Capacity Funding Board (2012–15), the HTA End of Life Care and Add-on Studies Board (September 2015), the HTA Prioritisation Group Board (2010–15) and the HTA Trauma Board (2007–8).
Funding:

Health Technology Assessment programme
Journal:

Health Technology Assessment
Issue:

Volume: 25, Issue: 9
Published:

February 2021
Citation:

Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, et al. Cognitive–behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021;25(9). https://doi.org/10.3310/hta25090
DOI:

https://doi.org/10.3310/hta25090

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Background

Cognitive–behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive–behavioural therapy systematic reviews suggested that cognitive–behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials.

Objectives

This project was undertaken to map the quality and gaps in the cognitive–behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive–behavioural therapy.

Data sources

The overview was designed with cognitive–behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019.

Review methods

Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive–behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive–behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I² < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality.

Results

A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive–behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive–behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.05 to 0.50, I² = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval –0.28 to 0.88, I² = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.28 to 0.74, I² = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions.

Limitations

Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them.

Conclusion

Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive–behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes.

Future work

Future research should focus on how the modest effect sizes seen with cognitive–behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality.

Study registration

This study is registered as PROSPERO CRD42017078690.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

Notes

Article history

The research reported in this issue of the journal was funded by the HTA programme as project number 15/174/24. The contractual start date was in January 2018. The draft report began editorial review in April 2020 and was accepted for publication in July 2020. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

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Chapter 1 Background

Cognitive–behavioural therapy (CBT) is an amalgam of interventions that emerged from cognitive and behavioural psychological models. It aims to improve patients’ quality of life by changing their maladaptive cognitions that maintain problematic symptoms. The basic principles of CBT are presented in Figure 1.

Cognitive–behavioural therapy can be delivered in different formats. High-intensity CBT has been defined as formal CBT with a trained health professional, predominantly delivered face to face, in an individual or group format. 1 Low-intensity CBT focuses on self-help and can be delivered by health professionals with brief CBT training (non-psychologists) and via several platforms (internet, telephone, paper based or face to face). 1 The distinction can become less clear in some forms of CBT in which high-intensity therapy is combined with low-intensity self-help methods.

A previous overview of CBT reviews,2 conducted in 2012, identified 296 reviews. However, only 11 of these synthesised randomised controlled trial (RCT) evidence; therefore, the conclusions are subject to increased bias. 2 Since this overview,2 there have been many more trials and reviews. There has also been more guidance for conducting and reporting high-quality trials and reviews. 3–6 The existing CBT trial and review evidence base is large, yet the majority of expenditure on psychological treatment research remains focused on CBT effectiveness. 7 Some researchers have argued that CBT is in a ‘virtuous circle: money pours into research, evidence accumulates, more financial support is given to . . . [CBT] . . . and other forms of psychotherapy are excluded’8 (Peter Fonagy, University College London) (Copyright © The Economist Newspaper Limited 2014. Reproduced with permission). In providing a comprehensive cross-sectional map of the best-quality available evidence, we can provide an indication of where CBT has an evidence base to support its effectiveness and where future research resources would be best directed.

Cognitive–behavioural therapy interventions share an underlying process, common therapeutic style and employ similar techniques (e.g. guided discovery), yet the condition-, population- and context-specific protocols can look very different from one another. Because of the commonality of CBT interventions across conditions, it is plausible that CBT can produce a general effect across conditions. However, to date, to our knowledge, there is no overarching estimate regarding the consistency of CBT’s effect across different condition categories. We propose to generate such an effect by performing panoramic meta-analyses (PMAs) on the effect estimates generated in each condition.

The concept and methodology of systematically reviewing systematic reviews is established, and includes quality and reporting guidelines. 9,10 However, the existing reviews of systematic reviews are typically undertaken to compare multiple interventions in one condition. 11,12 For this overview, we are interested in examining one intervention (CBT) across multiple conditions. In this overview, the classification of a ‘condition’ was based on the World Health Organization’s (WHO’s) International Classification of Diseases, Eleventh Revision (ICD-11). 13 The WHO must consider cultural, religious and political differences that can influence condition categorisation. In using this internationally recognised tool, we developed research findings that are meaningful to a global audience. In looking across conditions, we examined the effect of CBT across all populations, with CBT compared with all types of comparator. Our primary outcome is health-related quality of life (HRQoL), and we include three secondary outcomes (depression, anxiety and pain) that would contribute to an individual’s quality-of-life rating.

We employ PMA, which is an emerging methodology to synthesise systematic reviews across conditions. 14,15 When methodological assumptions are met, it allows pooling of effect sizes across conditions. This produces an average effect across conditions, which, because of enlarged sample sizes, is estimated with more precision than within-condition pooled estimates.

Chapter 2 Aim and objectives

Aim

The overarching aim of the overview was to map the existing CBT systematic review evidence base and to examine if CBT produced an across-condition, general effect on HRQoL.

Objectives

To answer these research aims, the following steps were undertaken.

Step 1: data mapping

We identified all available systematic reviews of CBT and mapped these according to:

conditions (ICD-11 category, severity)
populations (age, sex, ethnicity, countries where the trials were conducted)
context (delivery format, care setting, intervention timing)
quality of the reviews.

The mapping exercise identified where there is/is not a high- or low-quality systematic review or meta-analysis of RCTs examining the effectiveness of CBT.

Step 2: panoramic meta-analysis

Reviews from step 1 that had sufficient quantitative data were entered into a PMA for the primary outcome of HRQoL and for the secondary outcomes of depression, anxiety and pain. Sensitivity analyses based on quality were performed.

If across-condition heterogeneity was not considerable, an across-condition general effect was generated for each outcome. Subgroup analyses based on age, CBT intensity, duration of follow-up and type of comparators were undertaken. We checked every within-condition and subgroup analysis to examine if there was evidence of inconsistency with the overall effect estimate.

In Chapter 6, we explore the extent to which the existing evidence base could be used to guide treatment, commissioning and research investment decisions. The aim of the patient and public input into the overview was to ensure that the overview produced work that remained rooted in the overall aim: to improve health for patients receiving CBT.

Chapter 3 Review methods

The methods for the mapping stage of the overview are presented first, followed by the methods for the PMA. The protocol was registered with PROSPERO, the international prospective register of systematic reviews (number CRD42017078690), and published open access. 16

Mapping

Inclusion and exclusion criteria for the mapping

Types of reviews

We included all reviews that reported RCTs if they met four of the five methodological criteria outlined by the Centre for Reviews and Dissemination (CRD) at the University of York, as part of the Database of Abstracts of Reviews of Effects (DARE). 17 DARE was consulted for its guidance in the application of the criteria:

Were inclusion/exclusion criteria reported?
Was the search adequate? (Databases stated, more than one database searched or one database plus checking references, hand-searching, contact with researchers, citation searching, internet searching.)
Were the included studies synthesised?
Was the quality of the included studies assessed?
Are sufficient details about the individual studies presented? (Details on the population/setting, intervention and a result for each included study.)

We included reviews of RCTs comparing CBT with an active or non-active comparator. Reviews containing randomised and non-randomised studies were included only if RCT data were summarised separately. We excluded reviews based on any other study designs (e.g. quasi-randomised, non-randomised).

Type of health condition

The ICD-11 classifies mental and physical diseases, disorders, injuries and other related health problems in a comprehensive and hierarchical fashion, and is used as a standard for both clinical and research purposes. 13 The term condition will be used throughout this report to represent diseases, disorders and injuries. Participants with any conditions recognised by the ICD-11 or its nominal categorisation, and of any severity, were included. Non-health-related problems, such as procrastination, were excluded.

For physical conditions, we categorised reviews under the primary ICD-11 codes. For mental conditions, we used the secondary level of ICD-11 codes listed underneath the primary code of 06 mental, behavioural or neurodevelopmental disorders. A review was categorised according to its primary aims. For example, if a review examined the effectiveness of CBT to improve quality of life for people living with diabetes, then 05: Endocrine diseases was the condition category. However, if a review examined the effectiveness of CBT for improving depression in people living with diabetes, then the review was classified as 6A60-80 mood disorders, with comorbid 05 endocrine diseases. Box 1 shows all of the primary and secondary codes that could be considered in grouping reviews together.

BOX 1 - Primary and secondary ICD-11 codes

ICD-11 primary codes

01 Certain infectious or parasitic diseases.
02 Neoplasms.
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system.
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system.
14 Diseases of the skin.
15 Diseases of the musculoskeletal system.
16 Diseases of the genitourinary system.
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs not elsewhere classified.

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders.
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders.
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors not elsewhere classified.

Types of participants

We included participants of any age [children/adolescents (aged < 18 years), adults (aged 18–65 years) and older adults (aged > 65 years)], either sex and any ethnicity.

Types of health-care setting

We included reviews of RCTs that were conducted in any setting [e.g. primary care, secondary care, school/university, institutional (residential care)] and in any country.

Types of delivery timing

We included reviews of RCTs in which CBT was delivered preventatively, as a standard responsive care or as a relapse prevention.

Types of interventions

We included only reviews that evaluated CBT. Interventions were accepted as CBT when authors explicitly stated so in the title, abstract or keywords, or when the review defined the intervention as including at least one cognitive and one behavioural element.

If a trial intervention combined CBT with another therapy and the other therapy was used as a comparator condition (e.g. CBT plus pharmacotherapy compared with pharmacotherapy), then we included these trials. If a trial combined CBT with another therapy and this was compared with another type of comparator [e.g. CBT plus pharmacotherapy compared with wait-list control (WLC)], then we excluded these reviews because we could not extract the isolated effects of CBT.

All modes of CBT delivery were included and categorised into high or low intensity, based on the definitions by Roth and Pilling. 1 High-intensity CBT was defined as face-to-face, individual or group therapy, delivered by a trained CBT therapist. Low-intensity was CBT delivered via media (internet, written, telephone), or was when face-to-face, individual or group CBT was administered by a non-CBT therapist (paraprofessional or layperson). If the review did not report the intensity of the intervention, it was assumed to be high-intensity CBT. We excluded all non-CBTs: cognitive therapy, behavioural therapy, third-wave CBT (e.g. acceptance and commitment therapy, mindfulness therapy), motivational interviewing, stress inoculation therapy, problem-solving therapy and stress management therapy.

Types of comparators

We included reviews that compared CBT with one of the following: (1) a non-CBT-based active comparator (e.g. other psychological therapy, pharmacotherapy), (2) a non-active comparator [e.g. placebo, WLC, treatment as usual (TAU), standard care, no treatment] or (3) a CBT-based active comparator of different intensity [e.g. face-to-face CBT (high intensity) compared with internet-based CBT (low intensity)]. We excluded reviews that compared variations of high-intensity (e.g. group CBT compared with individual CBT) or low-intensity CBT (internet CBT compared with bibliotherapy CBT).

Types of outcomes

We included reviews if they reported data on at least one of the following outcomes: HRQoL, anxiety, depression or a condition-specific outcome (e.g. pain).

Length of follow-up

We included reviews with post-treatment, short-term (< 12 months) or long-term (≥ 12 months) follow-up data. If both short- and long-term follow-up data were reported, the synthesis of only the longest follow-up time point was included.

Search methods for identification of systematic reviews

We followed the principles of the Cochrane Handbook for Systematic Reviews of Interventions3 and recommendations for conducting overviews of systematic reviews9 to identify systematic reviews for the overview.

Information sources

The DARE (up to March 2015), Cochrane Database of Systematic Reviews, MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (via EBSCOhost), Child Development & Adolescent Studies (via EBSCOhost) and OpenGrey databases were searched on 25–27 April 2018 to identify relevant systematic reviews published between 1992 and 2018. An updated search was run on all the above databases on 30 January 2019, covering the period from April 2018 to 30 January 2019, excluding DARE, which is no longer updated. Owing to the volume of material being processed and the time constraints associated with this process, the reference lists of included reviews were not hand-searched for additional reviews. We did not contact authors for additional information to confirm inclusion/exclusion.

Search strategy

Comprehensive search strategies for each of the eight databases were designed by a senior research information specialist (SK). Each search strategy was developed iteratively, and a sensitivity check was performed in each database for the ability of each strategy to retrieve 36 key known papers (where indexed) that had been identified a priori (see Appendix 1). The included search terms were identified from these reviews and their associated database indexing terms, and with input from the expert consultation group (ECG). The search strategies utilised a combination of free text and controlled vocabulary search terms covering variations of ‘CBT’ searched in the title, abstract or keyword fields, and were combined with validated study-type filters for ‘systematic review’. The Scottish Intercollegiate Guidelines Network systematic review search filters available on the InterTASC (Technology Appraisal Support Collaboration) Information Specialists’ Sub-Group website18 was used to search the MEDLINE, EMBASE and CINAHL databases. The McMaster University Health Information Research Unit systematic review filter19 was modified and used in the PsycINFO search. The full search strategies for all the databases can be found in Appendix 2.

Restrictions

The scoping work identified that the earliest published review of CBT is from 1992. 20 Therefore, we restricted our search to reviews published since 1992. The search was not restricted in terms of language, although we subsequently excluded non-English-language reviews (see Protocol revisions).

Data management

The database search results were exported into Endnote [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA] for deduplication and then exported into Covidence (Melbourne, VIC, Australia), a Cochrane technology platform designed and recommended for systematic review management,3 and a final deduplication check was performed. The full texts of reviews shortlisted for full-text analysis were also uploaded to and screened in Covidence. Data extraction was performed using Microsoft Excel® (Microsoft Corporation, Redmond, WA, USA).

Study selection

Two review authors (TS and BF) independently screened the titles and abstracts of all the references identified by the search strategy. The full texts of the selected reviews were obtained via online resources or through Bodleian Libraries. Reviews were screened for eligibility by two review authors (KE and TS), using the criteria stipulated in Inclusion and exclusion criteria for the mapping; disagreements were resolved by consensus or deliberation with a third reviewer (BF).

Data extraction

A bespoke data extraction form was developed. This form was piloted by two reviewers (BF and TS) using the sensitivity check papers recommended by the ECG (see Appendix 1).

We extracted the following information:

review identification details – author, date of publication, aim, number of included RCTs and number of participants, risk-of-bias tool used
participant details – primary condition (that which the intervention is primarily aiming to treat) and comorbid conditions, severity, age category (children and adolescents aged < 18 years, adults aged 18–65 years and older adults aged > 65 years), sex, ethnicity
setting – from where participants were recruited, treatment timing (e.g. preventative, early, standard, relapse prevention) and countries where the individual RCTs were conducted
intervention details – CBT intensity, and, if available, number, duration and frequency of sessions and intervention content description
comparator details – description of comparator interventions (active: CBT or non-CBT interventions; non-active: WLC, TAU, no treatment)
outcomes: what outcome was measured, follow-up period (short or long), the number of RCTs and number of participants summarised for this outcome, and whether or not a meta-analysis was conducted.

No numerical data were extracted at this stage. If a review had looked for one of our relevant outcomes but did not find any CBT RCTs, this was recorded. When available, we extracted information on patients’ perspectives of CBT, for example patient satisfaction ratings, levels of adherence, dropout rates and any reported adverse events. When available, we extracted information on patient satisfaction, acceptability, adverse events and economic evaluations. An example data extraction form can be found in Appendix 3.

Quality assessment of reviews

The methodological quality of all the included systematic reviews was independently assessed by two review authors (KE, TS or BC) using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2 checklist. 4 This checklist assesses the quality of the review design, analysis and reporting, but does not account for the risk of bias of the included RCTs. Because of the overview design (i.e. the review was conducted at the review level), it was outside the scope of this study to return to the RCT level to perform risk-of-bias assessments. Discrepancies between reviewers were adjudicated by another reviewer (BF). We used the online checklist21 (see Appendix 4) to complete the 16 items scored either as ‘yes’, ‘no’ or ‘partial yes.’ This automatically generated a review rating of ‘critically low’, ‘low’, ‘moderate’ or ‘high’ quality. We stratified the reviews based on their AMSTAR-2 score into higher-quality reviews (those rated ‘high’ or ‘moderate’ on the AMSTAR-2 checklist) and lower-quality reviews (those rated as ‘low’ or ‘critically low’) (Beverly Shea, University of Ottawa, 25 March 2019, personal communication).

We calculated the agreement on the overall quality rating between the two main reviewers (KE and TS) using weighted kappa (κ_w) (interpreted as < 0.20, poor; 0.21–0.40, fair; 0.41–0.60, moderate; 0.61–0.80, good; and 0.81–1.00, very good). 22

Independent, double data extraction was undertaken by two reviewers (KE, TS or BC). All data extraction forms and quality checklists were then cross-checked by a third reviewer (BF). All information from the data extraction sheets was entered into a review database, and graphic representation of quality was provided.

Visualisations mapping

The evidence from all the included systematic reviews was synthesised using the following types of charts, tables and maps.

Bubble chart

The evidence was grouped under the corresponding ICD-11 primary or secondary code. The volume of evidence, in terms of number of reviews, RCTs and participants, was then imported from Microsoft Excel into TIBCO Spotfire^® (TIBCO, Software Inc., Palo Alto, CA, USA) software23 to produce a bubble chart. The axes of the bubble charts were very large, ranging from 0 to 45,000 participants. To help readability of the charts, we stratified reviews into those with < 1000 participants and those with ≥ 1000 participants.

Summary tables

The detailed description of each included review was represented in summary tables.

Gap maps

The condition and population and context characteristics extracted from the included reviews were populated in an Excel spreadsheet to identify any gaps in the evidence base, and were summarised.

Panoramic meta-analysis

Inclusion and exclusion criteria

From the reviews identified in the mapping stage, we selected the higher-quality reviews (rated ‘high’ or ‘moderate’ on AMSTAR-2) that contained quantitative data (either a single RCT or a meta-analytic effect estimate generated from pooling across multiple RCTs). We extracted these data for HRQoL, depression, anxiety and pain (the most commonly reported condition-specific outcome).

Reviews often contained multiple meta-analyses conducted on data from the same participants for a single outcome (e.g. CBT vs. active comparators, CBT vs. non-active comparators, symptom response, recovery, relapse, remission). To avoid double-counting studies, one meta-analysis per outcome per condition had to be chosen from each review. We used a predefined, step-by-step, hierarchy system in line with the review objectives. We included the meta-analysis (or single RCT) (1) with the longest follow-up time; (2) with the largest number of included RCTs; (3) that used measurement tools with the highest psychometric properties; (4) with the largest number of participants; (5) for which an active comparator was prioritised over non-active comparators; (6) for which continuous outcomes were prioritised over dichotomous outcomes; (7) for which, within dichotomous outcomes, the odds ratio (OR) was prioritised over the risk ratio (RR); (8) for which a random-effects meta-analysis was prioritised over fixed effects; and (9) for which self-report measures were prioritised over clinician-rated measures.

We then grouped the reviews that included quantitative data on each outcome (HRQoL, depression, anxiety and pain). Some of the reviews shared the same RCTs. To avoid double-counting evidence, we had to select one review to include in the PMA. We used a predefined selection process. 15 If two or more reviews shared the same RCT(s), we included the review (1) with the longest follow-up time, (2) with the highest AMSTAR-2 rating, (3) that was the most recently published, (4) with the largest number of RCTs or (5) with the largest number of participants.

Data extraction

We extracted the following data: number of participants in total and per group, number of participants who achieved the desired outcome in the case of dichotomous outcomes, effect sizes, confidence intervals (CIs), direction of effect, heterogeneity measures and type of meta-analysis. An example data extraction form can be found in Appendix 5.

Data management

Data from the data extraction sheets were entered into a master database (Excel) and exported into Stata® versions 13.1 and 16.0 (StataCorp LP, College Station, TX, USA). The PMAs were conducted by four reviewers (BC, HL, KE and TS).

Data analyses

Heterogeneity tests

We conducted a PMA per outcome measure. Review data were entered into an ICD-11 condition subgroup analysis and we tested the within-condition statistical heterogeneity across the reviews. In parallel, we tested the heterogeneity across the ICD-11 condition subgroup categories.

Assumptions for pooling across conditions

We developed three a priori conditions that must be met for us to pool the effect estimates across ICD-11 conditions categories:

Intervention homogeneity: the ECG and investigators (see Expert consultation group including patient and public involvement) agreed that, although investigators often use condition-, population- and context-specific protocols, the principles of CBT (see Figure 1) are the same across all conditions. This allows us to make a judgement of intervention homogeneity and, provided the other criteria are met, to pool estimates across conditions.
Design homogeneity: it is possible that meta-analytic estimates of effects would be moderated by differences between the review’s underlying design and methodologies. The review estimates would also be influenced by the quality of the included RCTs. However, a RCT-level quality assessment was beyond the scope of this overview. Therefore, we used the proxy of assuming that the highest-quality reviews would be more likely to be unbiased in their methods and would probably report from the best-available evidence. We minimised review design (but not RCT design) variation by including only reviews that adhered to the CRD review criteria and were graded as being of high or moderate quality on the AMSTAR-2 tool (higher-quality reviews); hence, we could claim design homogeneity. We ran a sensitivity analysis (which included higher- and lower-quality review data) to ascertain if the variation in review quality affected the homogeneity of effect estimates across conditions.
Statistical homogeneity: statistical heterogeneity was assessed using the I² statistic; this is expressed as a percentage. A higher percentage is indicative of greater heterogeneity. I² reflects the variation in effect estimates between reviews that is attributable to heterogeneity. 24 There is no guidance regarding acceptable heterogeneity for PMAs. We used the guidance for meta-analysis heterogeneity,25 which suggests that I² of < 75% is acceptable for pooling across the categories.

Panoramic meta-analysis method

The PMA was undertaken using a two-step frequentist approach random-effects model using the ‘metan’ command in Stata (versions 13.1 and 16). The two-step analysis consists of performing a conventional meta-analysis of a series of meta-analyses. The first step is undertaken by the original reviewers in obtaining a pooled treatment effect based on their included trials. Many of these will have been estimated via a random-effects meta-analysis, but some will have been analysed using a fixed-effects approach. Nonetheless, we assume that within-review variability has been appropriately allowed for. In the second step, the pooled estimates (with CIs) from each of the systematic reviews are combined into an overall (over all reviews) pooled estimate. At this point, we use a random-effects approach using the DerSimonian–Laird26 approach. We obtained a pooled estimate from within condition and also across conditions, if the across-condition heterogeneity was < 75%. In the few cases where data required for the meta-analysis, such as standard deviations or CIs, were missing, we referred to the individual RCT paper to extract this information.

Primary analysis

The primary analysis was conducted on continuous, end-point data extracted from higher-quality reviews (AMSTAR-2 rating of ‘moderate’ or ‘high’ quality) if there were more than two systematic review per comparison. The primary outcome was HRQoL and the secondary outcomes were depression, anxiety and pain.

We analysed the standardised mean differences (SMDs). When reviews reported values as mean differences, we converted the pooled estimate into a SMD using the standard deviation reported. 27 We reported the 95% CIs and the prediction intervals. These offer a prediction of the distribution of SMDs from future reviews, perhaps in other conditions that have not been included in our overview.

Secondary analysis

Some reviews reported change scores only; we pooled these separately because of concerns that these may be biased as a result of regression to the mean. 28 We performed separate PMAs for RRs and ORs.

We grouped reviews that directly compared high- with low-intensity CBT, irrespective of the condition, and analysed this group separately.

Transforming the standardised mean difference into a mean difference

To make meaningful interpretations, the overall pooled estimate (i.e. the SMD) for each outcome was transformed into a mean difference. The SMD was multiplied by the standard deviation of the most commonly used outcome measure (e.g. Beck Depression Inventory for depression) for each outcome. 29 To find a suitable standard deviation for the measurement tool, we identified a higher-quality review, which included a low risk-of-bias RCT that had used the most common outcome measure. From that trial, we extracted the standard deviation of the outcome measure at baseline.

Publication bias

When ≥ 10 reviews were included in the meta-analysis, publication bias and small-study effects were tested for using Egger’s regression intercept30 and a visual assessment of funnel plot asymmetry. We used a conservative value of p < 0.1 at CIs of 95% to reflect asymmetry.

Subgroup analysis

Subgroup analyses were agreed a priori and were performed if four or more reviews were included in the meta-analysis across all conditions for each of the outcomes on the following: (1) CBT intensity (high/low intensity), (2) age (children and adolescents, adults, older adults), (3) duration of follow-up (short: < 12 months, long: > 12 months) and (4) comparator group (active, non-active). The subgroups were separated using the ‘by()’ command in Stata.

We ran interaction tests between the subgroups using an exploratory meta-regression. The meta-regression used the method of moments estimate of between-study variance and the ‘metareg’ command in Stata.

If we identified any reviews that directly compared high-intensity CBT with low-intensity CBT, we grouped these reviews together by outcomes (HRQoL, depression, anxiety and pain). If their estimates were homogeneous, then we pooled across the reviews as an example of direct comparison.

Sensitivity analysis

To test whether or not the quality of the reviews moderated the effect estimate and or heterogeneity, we ran a sensitivity analysis in which we included data from all reviews, irrespective of their AMSTAR-2 quality, for each outcome PMA. Then we compared the heterogeneity and pooled effect estimates between the sensitivity analyses and the primary analyses (which included only data from higher-quality reviews, i.e. those of ‘high’ and ‘moderate’ AMSTAR-2 quality).

We also conducted a sensitivity analysis in the HRQoL PMA for the two subscales of the Short Form questionnaire-12 items (SF-12)/Short Form questionnaire-36 items (SF-36) instruments. These instruments include a physical composite score and a mental composite score, but the tool does not pool them together. We prioritised the physical component scale (as recommended by the ECG; see Expert consultation group including patient and public involvement), then we re-ran the analyses using the mental component scale to determine if this changed the results.

Consistency of effect

We employed an ontological argument, which suggests that a lack of inconsistency across evidence suggests consistency of effect. 31 We examined the effect estimates from each condition subgroup (pooled effect across all reviews conducted within one condition), subgroup analyses (e.g. active/non-active comparator groups), sensitivity analyses (including the additional condition subgroup analyses) and secondary analyses (e.g. pooled effects across dichotomous outcomes). If any analyses produced a statistically significant effect in favour of the group (comparator or CBT) that was contrary to the overall pooled effect estimate, then the evidence for the general effect was inconsistent across the included conditions. If we did not identify any contrary evidence across any of the conditions or subgroups, then we declared that the overall effect was consistent across all included conditions.

Expert consultation group including patient and public involvement

We worked with a CBT ECG consisting of clinical academics (n = 6), research academics (n = 8) and patient representatives (n = 4). We met with this group directly on three occasions (January 2018, February 2019 and September 2019) and communicated via telephone/e-mail throughout the overview process. For each meeting, the group was sent a workbook of the work to date and a set of questions for the members to comment on. These were collected at the end of each meeting to ensure that all members’ contributions were collated and recognised. The group was not involved in any of the data extraction or quality assessment of the reviews. The ECG provided advice on methods and interpretation, but the final decisions were taken by the study investigators.

Expert consultation group meeting 1: January 2018

In the first meeting, we achieved consensus on the search strategy (terms and databases), the inclusion/exclusion criteria (population, intervention, comparison, outcomes, review design), data extraction form (data to extract) and analysis plan (avoid double-counting of RCTs, subgroup analyses).

Expert consultation group meeting 2: February 2019

The results of the data screening and extraction and the plan for the data synthesis were presented at this meeting. The ECG agreed the following actions:

Protocol amendment to include both pooled and single trial data in the PMAs
Protocol amendment to include behavioural outcomes as condition-specific outcomes.
The ECG did not reach consensus on how the generalisation framework should be used (see Chapter 6). Beth Fordham, Jeremy Howick and Karla Hemming were to continue work on how this could be conceptualised for sharing with the ECG at the next meeting.

Expert consultation group meeting 3: September 2019

The preliminary results were presented at the third meeting. The ECG were in agreement for the mapping and PMA processes. We agreed to prioritise higher-quality reviews over any-quality reviews. However, again, we did not reach agreement on the generalisation framework. The ECG agreed that there was intervention homogeneity, but could not agree that CBT always effects change through the same mechanisms. It agreed that CBT is implemented via the core principles (see Figure 1), but it felt that it was important to recognise that the mechanisms for change would be different for patients living with different conditions. The ECG suggested that a review of all the mechanistic evidence for CBT’s effectiveness was required in order to assume that there is a common mechanism of action.

The patient and public involvement (PPI) representatives guided our visual representation of the data and reflected that the real-life mechanisms of CBT will ‘feel’ very different for each individual receiving the treatment.

Protocol revisions

We intended to translate non-English-language reviews. However, the resource and time allocations were unprepared for the number and complexity of reviews that were found. On discussion with the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme board, we made a change to the protocol and excluded non-English-language reviews at the full-text screening stage.

In the protocol, we selected three general outcomes (HRQoL, depression and anxiety) and suggested collecting condition-specific outcomes, such as psychosis and physical/physiological outcomes. Subsequently, we chose to present the three general outcomes plus the most commonly reported other outcome, which was pain.

We had not envisaged the problem of a review reporting the mental and the physical component subscales of the SF-12 HRQoL tool separately. After consulting the ECG, we selected the physical subscale to be included in the primary analysis, and conducted a sensitivity analysis using the mental subscale data to examine if that affected the PMA estimates and heterogeneity.

Other specific changes included to:

include both single RCT data and pooled meta-analysis data in a PMA
include behavioural outcomes as condition-specific outcomes
prioritise higher-quality reviews over any-quality reviews.

All the above changes were approved by the NIHR HTA programme board.

In response to comments from reviewers of the draft HTA monograph, we have included prediction intervals to our primary panoramic meta-analyses.

Chapter 4 Results: mapping

Process of study selection

The initial search of eight databases in April 2018 retrieved 12,339 references, and the updated search in January 2019 retrieved 916 references. In total, 7738 titles and abstracts were screened after deduplication, from which 2948 reviews were selected for full-text analysis. On full-text analysis, 494 systematic reviews32–523 were selected for final inclusion. Data extraction for the mapping was done for all these reviews, the synthesis of which is presented in this chapter. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram describing each of these stages is presented in Figure 2.

Excluded studies

We excluded 2454 reviews at the full-text screening stage. Nearly half of these exclusions (1108/2454, 45%) were because the review did not provide a synthesis of CBT trials. Ten per cent (237/2454) of reviews were excluded because they were not available in English. References for the excluded reviews along with their reasons for exclusion are presented in Appendix 6.

Description of the included systematic reviews

We included 494 systematic reviews, which reported 2052 RCTs involving 221,128 participants. 32–523 The included reviews were synthesised in three main formats: summary tables, bubble charts and gap maps.

Summary tables

The summary tables provide comprehensive details of all the 494 included reviews, split into the ICD-11 codes (see Appendix 7, Tables 5–33).

Bubble charts

The 494 systematic reviews identified by the search examine the effectiveness of CBT on HRQoL, depression, anxiety or a condition-specific outcome in conditions represented in 14 out of 20 primary (physical) and 13 out of 20 secondary (mental) ICD-11 codes. This equates to 68% of all ICD-11 categories (27/40). ‘Mood disorders [6A60-80]’ were the most researched condition (92 reviews, 272 RCTs, 42,676 participants). The primary and secondary ICD-11 categories that are represented in the included reviews are listed in the unshaded rows presented in Box 2; those that are not represented (i.e. evidence gaps) are listed in the shaded rows in Box 2. The volume of reviews, trials and participants are represented in two bubble maps in Figure 3: (1) conditions that include < 1000 participants and (2) conditions that include > 1000 participants.

BOX 2 - Primary and secondary ICD-11 codes represented and not represented in the CBT evidence map

ICD-11 primary codes

01 Certain infectious or parasitic diseases.
02 Neoplasms.
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system.
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system.
14 Diseases of the skin.
15 Diseases of the musculoskeletal system.
16 Diseases of the genitourinary system.
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs NOS (MG30 pain, MG22 fatigue, MG43.6 excessive weight gain).

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders.
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders.
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors NOS (MB23.0 aggressive behaviour).

NOS, not otherwise specified.

Shading indicates the ICD-11 categories that are not represented in the included reviews (i.e. evidence gaps).

Gap maps

We produced a gap map that details the context and population characteristics of all the reviews conducted within each ICD-11 category (see Appendix 8, Tables 34–37). We have summarised the information in the following section.

Context characteristics of the included reviews

In Table 1, we present the number of reviews that included trials conducted in different contexts. One review could include some trials conducted in one context and also include trials conducted in another context. Therefore, that one review could represent two or more context characteristics. Consequently, the percentages presented across the rows will not always add up to 100% (n = 494 reviews). The shaded cells represent how many reviews did not report on this characteristic.

TABLE 1 - Context characteristics of the included reviews

GP, general practitioner; NR, not reported.

**Notes**

The shaded cells represent how many reviews did not report on this characteristic. Some reviews (and RCTs) recruited participants from different settings with varying levels of severity, included both types of intensities and considered both short- and long-term follow-up; therefore, the total in each category may not always add up to 100% (n = 494 reviews).
Reviews	Reviews, n (%)
	Who: severity					What: intensity			When: delivered				Where: participants recruited							Follow-up
	Subclinical	Clinical	Chronic	Severe	NR	High	Low	NR	Preventative	Standard	Relapse prevention	NR	Community	GP primary	Outpatients	Inpatients	School/university	Institution	NR	Short term	Long term	NR
Reviews included in mapping: N = 494 (2052 RCTs; 221,128 participants)	16 (3)	216 (44)	19 (4)	10 (2)	247 (50)	397 (80)	139 (28)	8 (2)	29 (6)	463 (94)	7 (1)	0 (0)	92 (19)	41 (8)	114 (23)	35 (7)	36 (7)	4 (1)	283 (57)	402 (81)	130 (26)	7 (1)

Context characteristics well reported

Nearly all the included reviews (486/494, 98%) reported whether or not they examined high- or low-intensity CBT. The majority were conducted on high-intensity CBT, but low-intensity CBT trials were included in 28% (139/494) of reviews across 14 out of 40 (35%) ICD-11 categories. Nearly all reviews (487/494, 99%) reported when follow-up data were collected. One-third of reviews (130/494, 26%) included a long-term (> 12 months) follow-up time point.

Context characteristics poorly reported

Only half of the reviews (247/494, 50%) reported on the severity of participants’ symptoms. Of these, the majority described participants as having a clinical diagnosis (216/494, 44%), with no further description on the severity of the symptoms (i.e. chronic or severe). Only 3% (16/494) of reviews examined participants with subclinical symptoms.

Over half of the included reviews (283/494, 57%) did not report from which care setting they had recruited their samples. Of the reviews that did report this, the majority recruited their samples from outpatient settings (114/494, 23%).

Context characteristics rarely examined

All the included reviews reported when the intervention was delivered (494/494, 100%); only 7% (36/494) examined the use of CBT in a preventative context.

Population characteristics of the included reviews

In Table 2, we present the number of reviews that included trials with samples representing different characteristics. One review could include some trials conducted with one type of population (e.g. children and adolescents) and other trials conducted with another population (e.g. adults), or one trial that included children, adolescents and adults. Therefore, that one review could represent two (or more) sample characteristics. Consequently, the percentages presented across the rows will not always add up to 100% (n = 494 reviews). The shaded cells represent how many reviews did not report on this characteristic.

TABLE 2 - Population characteristics of the included reviews

NR, not reported.

**Notes**

The shaded cells represent how many reviews did not report on this characteristic. Some reviews (and RCTs) included participants across various subcategories; therefore, the total in each category may not always add up to 100% (n = 494 reviews).
Reviews	Reviews, n (%)
	Age (years)				Sex				Ethnicity					Continent where the included RCTs were conducted
	< 18	18–65	> 65	NR	< 50% female sample	> 50% female sample	Mixed	NR	< 25% non-white sample	25–75% non-white sample	> 75% non-white sample	Mixed	NR	Europe, North America, Australasia	Asia	Africa, South America	NR
Reviews included in mapping: N = 494 (2052 RCTs; 221,128 participants)	108 (22)	378 (77)	30 (6)	19 (4)	44 (9)	167 (34)	65 (13)	218 (44)	10 (2)	6 (1)	9 (2)	11 (2)	458 (93)	231 (47)	37 (8)	8 (2)	218 (44)

Population characteristics well reported

Most reviews reported the age of their samples (475/494, 96%); of these, only 6% (30/494 reviews, 81 RCTs and 6629 participants) were conducted with an older adult population.

Population characteristics poorly reported

Most reviews (458/494, 93%) did not report the ethnicity of the samples of their included trials. Of the 36 reviews that did report the ethnicity of their samples, we found an equal number of reviews that reported more white than non-white participants (10/494, 2%) and that reported more non-white than white participants (10/494, 2%).

Nearly half of the reviews (218/494, 44%) did not report on the sex of their trial samples or the country where their included trials were conducted. When reported, a higher number of reviews had a greater representation of female participants (167/494, 34%) in their trial samples, and most reviews included trials conducted in Europe, North America and Australasia (231/494, 47%).

The AMSTAR-2 review quality rating

Every review (n = 494) was assessed twice (by KE and TS) using the AMSTAR-2 checklist. The agreement between reviewers (KE and TS) in assessing the quality of reviews using the AMSTAR-2 checklist was good (327/494, 66%) (κ_w = 0.63, 95% CI 0.62 to 0.65). Figure 4 presents the proportion of reviews conducted over the preceding 20 years, classified into the four AMSTAR-2 quality categories.

Over the previous 20 years, the quality of systematic reviews has improved; however, in the latest time epoch (2015–19), we still identified that 36% of the included reviews were of critically low quality and only 29% of reviews were classified as being of moderate or high quality.

Table 3 represents the item summaries from the AMSTAR-2 checklist. Of the ‘critical’ items on the checklist, 68% (336/494) of the reviews failed to register the protocol before commencement of the review (item 2), 76% (373/494) failed to provide the list of excluded studies along with the reasons for exclusion of each (item 7) and 50% (248/494) of reviews did not report an adequate search strategy.

TABLE 3 - The AMSTAR-2 items summary (n = 494)

PICO, population, intervention, comparator, outcome.

Critical item.
AMSTAR-2 items	Response, n (%)
AMSTAR-2 items	Yes	Partial yes or 0	No
Components of PICO in research questions and inclusion criteria (item 1)	266 (54)	–	228 (46)
Protocol registered before commencement of the review (item 2)a	153 (31)	5 (1)	336 (68)
Justification for selection of study design for inclusion (item 3)	80 (16)	–	414 (84)
Adequacy of the literature search (item 4)a	67 (14)	179 (36)	248 (50)
Study selection performed in duplicate (item 5)	325 (66)	–	169 (34)
Data extraction performed in duplicate (item 6)	322 (65)	–	172 (35)
Justification for excluding individual studies (item 7)a	108 (22)	13 (3)	373 (76)
Included studies reported in adequate detail (item 8)	106 (21)	350 (71)	38 (8)
Risk of bias from individual studies being included in the review (item 9)a	291 (59)	27 (5)	176 (36)
Reporting funding sources of included studies (item 10)	48 (10)	–	446 (90)
Appropriateness of meta-analytical methods (item 11)a	292 (59)	195 (39)	7 (1)
Assessment of potential impact of risk of bias on results of the review (item 12)	196 (40)	186 (38)	112 (23)
Consideration of risk of bias when interpreting the results of the review (item 13)a	277 (56)	–	217 (44)
Explanation/discussion of heterogeneity observed (item 14)	299 (61)	–	195 (39)
Assessment of presence and likely impact of publication bias (item 15)a	209 (42)	70 (14)	215 (44)
Reporting conflicts of interest and funding (item 16)	376 (76)	–	118 (24)

Patient perspective and safety data

Of the 494 reviews, 118 (24%) reviews reported data on dropout rates, adherence and satisfaction analyses. Twenty reviews32,53,56,68,78,103,133,153,165,198,219,234,244,251,266,367,376,402,464,469 searched for safety data, of which nine reviews included reports of adverse events occurring in the CBT groups. We have summarised all the patient perspective and safety data under the relevant conditions in Box 3.

BOX 3 - Patient perspective and safety data

Dropout Anxiety

Adelman et al. 34 reported that children, adolescents and adults with anxiety disorders are more likely to drop out of CBT than out of WLC groups (OR 1.76, 95% CI 1.27 to 2.44). Participants were more likely to drop out of internet-based CBT than out of face-to-face CBT (OR 1.36, 95% CI 0.79 to 2.33).

Three reviews of anxiety disorders in children and adolescents reported no difference in the risk of participants dropping out between CBT and WLC groups (OR 0.94, 95% CI 0.58 to 1.51),509 TAU groups (OR 1.01, 95% CI 0.31 to 3.3)227 or placebo-pill control groups (RR 0.53, 95% CI 0.30 to 0.95). 487

A review reported that more RCTs of CBT with adult participants than those with older adults report attrition levels below the 15% attrition threshold (67% vs. 40%). 252

Mood disorders

The dropout rates of adults and older adults from CBT groups ranged from 7% to 40%217,420 and were not significantly different between CBT and comparator groups (active or non-active). 59,145,280,501

Anxiety and/or mood

Dropout rates for CBT ranged from 6% to 50% across children/adolescent and adult populations. 101,459 A review45 found no difference in dropout rates between high- and low-intensity (internet-based CBT) interventions (OR 0.79, 95% CI 0.57 to 1.09).

Obsessive–compulsive disorders (hypochondriasis)

A review of adults with hypochondriasis reported no difference between CBT and TAU/pharmacotherapy/placebo comparator in the likelihood for participants to drop out of their trial arm (OR 1.14, 95% CI 0.56 to 2.32). 450

Obsessive–compulsive disorders (body dysmorphic disorder)

No difference was detected in the number of children/adolescents and adults who dropped out between CBT and WLC groups (RR 1.00, 95% CI 0.96 to 1.05), and the effects of CBT on depression outcomes were not altered if dropouts were treated as non-responders. 195

Eating disorders

A review of adults with bulimia nervosa/binge-eating disorder reported no difference in dropout rates between CBT and active or non-active comparator groups [F(2,55) = 1.66; p = 0.20]. 179 This remained true in adults with binge-eating disorder when CBT was an adjunct to pharmacotherapy [i.e. fluoxetine alone (22%) or fluoxetine plus CBT (23%)]. 378

Stress disorders

Two reviews reported dropout rates of between zero and 30%355,422 from CBT in adult populations with post-traumatic stress disorder, and that these rates did not differ significantly between the CBT and other active comparator groups. 96

Bodily distress disorders

There were no significant differences in dropout rates between CBT and progressive muscle relaxation groups in adults with medically unexplained symptoms (SMD 0.98, 95% CI 0.83 to 1.15; n = 90). 469

Addiction

One review reported, without statistics, that fewer adults with psychostimulant abuse disorder dropped out of CBT groups than out of the TAU groups. 312

Neoplasms

Two reviews report very similar dropout rates from CBT interventions: 15% and 22%. 65,238

Nervous system disorders (post-viral fatigue)

Castell et al. 93 reported that 17% of adults with post-viral fatigue syndrome dropped out of the CBT groups. Participants were more likely to drop out of CBT than out of a no-treatment control (RR 1.71, 95% CI 1.29 to 2.27), but not when compared with other active comparators170 (RR 0.97, 95% CI 0.28 to 1.25), including exercise interventions266 (RR 0.59, 95% CI 0.28 to 1.25).

Conditions with symptoms of pain

Three reviews reported that a range of 0–22% of patients dropped out of CBT interventions for pain patients in both adult and children/adolescent populations. 32,285,375

Disorders of the ear (tinnitus)

One review examined adults’ and older adults’ satisfaction with internet-based CBT and found that more participants dropped out of internet-based CBT than out of an online education programme. 213

Adherence Mood

Across the trials of adults with depression, the adherence rates ranged greatly, from 10% to 100%. 165,459 A review of CBT for depression in children and adolescents reported that only 50% completed the full CBT programme. 106 Adherence rates were reported to significantly predict treatment response (β = 0.90; p < 0.001). 240

Anxiety and mood

Adherence (defined as between 75% and 100% adherence) rates from RCTs of children/adolescents (86%), adults and older adults (24–90%) across anxiety and depression ranged from 24% to 90%. 327,356,466

Eating disorders

In children and adolescents with bulimia nervosa or EDNOS, the adherence rates were similar between CBT and other psychotherapies (family therapy). 243 However, one review of bulimia nervosa in children, adolescents and adults estimated that 16% (95% CI 13% to 19%) of participants did not complete the CBT intervention. 438

Adherence rates were similar between high-intensity and low-intensity (i.e. internet-based) CBT. 353 However, the acceptability ratings were higher for high-intensity CBT than for internet-based CBT. 367

Conditions with symptoms of pain

One review of predominantly male (92%) veterans with comorbid pain, depression and substance abuse reported completion rates of only 38% for CBT interventions. 58

Insomnia

A review of internet-based CBT for insomnia reported that 78% of adult participants (range 67–100%) completed their treatment. 97 The review also reported that 71% of participants found internet-based CBT ‘mostly’ or ‘very’ effective.

Satisfaction Mood

One review49 suggests that older adults prefer psychological therapies, such as CBT, over pharmacotherapy because the side effects of pharmacotherapy become more problematic with increased comorbidity in older age. 49

There was no difference between children’s and adolescents’ reported levels of acceptability for CBT, compared with WLC or TAU comparator groups. 510

Anxiety and mood

Two reviews46,324 reported that 62–100% of adults were satisfied with internet-based CBT. One review324 found that participants reported more enjoyment when they were communicating with a therapist in face-to-face CBT.

Eating disorders

The acceptability ratings were higher for high-intensity CBT than for internet-based CBT. 367

Stress disorders

One review reported, in great depth, the acceptability of CBT for children and adolescents with post-traumatic stress disorder. 291 It is recognised to be acceptable for children and their caregivers, but there are concerns regarding the trauma exposure component. This is considered central to the effectiveness of CBT, but some evidence suggests that this element is linked to patient dropout rates. CBT is delivered most commonly in a clinic, but this review suggests that home delivery could be more acceptable. It also suggests that CBT delivered in a group setting is more acceptable than individual CBT in ethnically diverse, urban children in the USA. 291

Psychosis

Cognitive–behavioural therapy was reported to be less acceptable than TAU for schizophrenia patients in one review,66 whereas another review116 found no difference in acceptability. Therapists reported that it was harder to engage younger schizophrenic patients with the CBT intervention. 51

Disorders of the ear (tinnitus)

Participants reported that the intervention was not engaging enough, and authors suggested that it might be too much of a commitment for those with low distress levels. 213

Adverse events

One or two patients per CBT group reported that their symptoms worsened because of participation in CBT in adults with post-viral fatigue syndrome,56,103,266 bodily distress (medically unexplained symptoms)469 and mixed mental conditions (mood disorder, anxiety and obsessive–compulsive disorders). 53 Adverse events were reported in reviews of other conditions, such as people with substance misuse conditions during withdrawal, schizophrenic patients and eating disorder patients, but there was no evidence to suggest that this was due to participating in CBT. 133,198,219,234

EDNOS, eating disorder not otherwise specified.

Overall, there does not seem to be a great difference in dropout rates between CBT and active or non-active comparator groups. However, it appears that more participants drop out of low-intensity internet-based CBT than out of face-to-face CBT, and patients reported greater satisfaction with the therapeutic relationship in face-to-face CBT. Older adults appeared to drop out more than younger adults, but they also reported preferring psychological therapies, such as CBT, over pharmacological therapies. There may be certain groups who do not find CBT acceptable; for example, one review of mainly male veterans reported very low completion rates. 58 Participants with common mental and physical conditions seemed generally satisfied with CBT, but schizophrenic patients seemed more likely to find CBT an unacceptable treatment option. In relation to adverse events, there is a lack of reporting on safety data from CBT reviews. However, the evidence we found does not suggest that participating in CBT could cause harm to participants.

Chapter 5 Results: panoramic meta-analysis

The map of the CBT review evidence base included 494 reviews. Of these, 171 reviews included data suitable for inclusion in the PMAs. The majority of the reviews reported in the mapping exercise, but excluded from the PMA, were not suitable because we could not extract the CBT RCT-specific data in isolation for any of the four outcomes (n = 279). This could be for any one of the following reasons:

The review may not have performed a meta-analysis or reported any quantitative data from single RCTs.
The review may have looked for RCTs reporting on the outcome but not identified any evidence.
We may have been unable to extract CBT RCT data in isolation, for example a review that presented a subgroup analysis of 10 CBT trials, but one of these trials was not a RCT. We could not isolate the purely CBT RCT evidence; therefore, the data were not included in the PMA. To have included these RCTs, we would have needed to return to the original RCT and perform a new meta-analysis including only the RCT data.

Of the 126 reviews eligible for the end-point PMA, 7132,37,39,46,50,59,63,68,89,102,117,126,134,143,149,165,167–169,175,188,193,197–199,205,206,211,219–221,227,231,234–236,246,249,251,259,261,267,275,286,291,299,315,317,340,343,347,357,369,371,373,397,401,405,409,432,445,446,448,450,454,464,469,480,484,507,518 were higher-quality reviews (i.e. ‘moderate’ or ‘high’ on AMSTAR-2); the primary analyses for each outcome were conducted using these 71 higher-quality reviews. The PRISMA flow diagram describing review selection for the PMAs from the mapping stage is presented in Figure 5.

For reviews reporting data as change scores or dichotomous outcomes (RR, OR), separate PMAs for each outcome were undertaken; these are presented in Appendices 9–12.

Health-related quality of life

We identified 24 higher-quality systematic reviews32,39,63,165,188,193,219,220,231,235,236,275,286,299,317,343,347,371,409,445,446,464,469,518 that met the eligibility criteria to be included in the HRQoL PMA. One review343 included two meta-analyses for different disorders; hence, the number of comparisons is 25. These reviews included 49 RCTs, 4304 participants and represent 12 out of 40 ICD-11 categories (30%), as presented in Box 4. The white rows represent those ICD-11 codes that are represented in the primary analysis, the purple rows represent those conditions that are represented in the sensitivity analyses (see Sensitivity analysis) and the orange rows represent those ICD-11 codes that are not represented.

BOX 4 - The ICD-11 categories (not) represented in the primary PMA of higher-quality reviews for the HRQoL outcome

ICD-11 primary codes

01 Certain infectious or parasitic diseases.
02 Neoplasms (in lower-quality reviews only).
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system.
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system (in lower-quality reviews only).
14 Diseases of the skin.
15 Diseases of the musculoskeletal system.
16 Diseases of the genitourinary system.
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs NOS (MG30 pain, MG22 fatigue).

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders.
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders.
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors NOS (MB23.0 aggressive behaviour).

NOS, not otherwise specified.

White rows represent ICD-11 codes represented in the primary analysis, purple shaded rows represent ICD-11 codes represented in the sensitivity analyses and orange shaded rows represent ICD-11 codes that are not represented in the HRQoL PMA.

The most commonly used measure of HRQoL was the Short Form questionnaire-36 items (SF-36) (n = 6). Other measurements included the Quality of Life Inventory (n = 5), the EuroQol-5 Dimensions (n = 2), the WHO Quality of Life-BREF (n = 1), the Global Assessment of Functioning (n = 1) and the Modular System for Quality of Life-54 (n = 1). The remaining reviews used population-specific (e.g. KIDSCREEN-27; KINDL-R; Comprehensive Quality of Life Scale, Intellectual Disability) or condition-specific [e.g. Fibromyalgia Impact Questionnaire, ADHD (attention deficit hyperactivity disorder) Impact Module-Adult™, Quality of Life in Alzheimer’s Disease, Diabetes Quality of Life for Youths] quality-of-life measurements.

Some reviews included trials with mixed characteristics, for example one review could include trials with adults and with older adults; in such a case, we would record that there was one review with adult data and one with older adult data. Consequently, the counts do not always add to 24 reviews. The mapping results demonstrate that the majority of these meta-analyses were focused on adults (n = 21), with only three reviews of children/adolescents and one review of older people. A higher number of reviews (12/24) had samples that included more female than male participants than reviews with samples of more male than female participants (6/24). Only three reviews reported the ethnicity of their samples: two reviews had samples with < 25% non-white participants and one included a sample with > 75% non-white participants.

The majority of reviews reported on the management of clinical conditions (16/24), through high-intensity CBT (17/24), delivered in outpatient settings (16/24), and with short-term follow-up (19/24). Seven reviews shared these three contexts but were conducted across different conditions. The majority of the included RCTs were from Europe, North America and Australasia (21/24).

The number of reviews containing only one trial was 6 out of 25; for some conditions, the numbers in each trial were very small (Figure 6). Comparators were active (8/24), mixed (3/24) and non-active (13/24).

Primary analysis

Within-condition heterogeneity (I²) varied between 0% and 56%, and across-condition heterogeneity was 32%; hence, the criteria for PMA were met. The pooled across-condition SMD between control groups and CBT intervention groups gave a modest effect in favour of CBT on outcomes of HRQoL (SMD 0.23, 95% CI 0.14 to 0.33) (see Figure 6). Variation in effects was observed across conditions; for example, in aggression, the estimate mean effect was almost zero, although it was estimated with considerable uncertainty (SMD –0.02, 95% CI –0.28 to 0.32), whereas, in anxiety disorders, the estimated effect was positive and was estimated with much greater certainty (SMD 0.42, 95% CI 0.20 to 0.64). This heterogeneity is reflected in the resulting prediction intervals, which, indicated for the overall effect (within any given condition), were between –0.03 and 0.50, indicating, at worst (and with little support in the prediction interval), a small negative effect of CBT for some conditions and, at best, a large positive effect for other conditions.

No publication bias was detected using funnel plots (Figure 7) and Egger’s test showed that there were no small-study effects (p = 0.18).

Mean difference in health-related quality of life

We identified a standard deviation (10.93 points) of the SF-36 physical composite score from a trial,525 deemed to have a low risk of bias, in a higher-quality review. 464 The SMD translated to an estimated mean difference on the SF-36 of 3 points (95% CI 2 to 4 points).

Subgroup analysis

The only interaction test that was statistically significant was between reviews of CBT compared with active comparators and reviews of CBT compared with non-active comparators. All other subgroup interaction tests were not statistically significant and are, therefore, consistent with the general effect of CBT on HRQoL outcomes.

Cognitive–behavioural therapy intensity

Overall, high- and low-intensity CBT reviews were distributed evenly across the different conditions and characteristics. High- and low-intensity CBT reviews both included populations diagnosed with 6B00-06 anxiety or fear-related disorders, 6A60-80 mood disorders, 6A00-06 neurodevelopmental disorders, 6B20-25 obsessive–compulsive disorders, 21 pain and 6B40-45 disorders specifically associated with stress. They included patients with chronic symptoms (6A60-80 mood disorders and 21 pain). The reviews included children, adolescents and adults, of both sexes, from all care settings in Europe, North America, Australasia and Asia. Reviews of both intensities included long-term follow-up data. Reviews of high-intensity, but not low-intensity, CBT included (1) populations diagnosed with 6C20-21 disorders of bodily distress, 08 diseases of the nervous system or 6A20-25 schizophrenia or other primary psychotic disorders; (2) older adults; and (3) CBT delivered in a preventative context. Reviews of low-intensity, but not high-intensity, CBT were conducted in populations diagnosed with 6C40-4H addiction and MB23 aggressive behaviour.

There was little difference between effect estimates in reviews of high-intensity and low-intensity CBT, although heterogeneity was substantially higher for low-intensity CBT (SMD 0.23, 95% CI 0.03 to 0.42; I² = 68%) than for high-intensity CBT (SMD 0.21, 95% CI 0.11 to 0.32; I² = 0%) (Figure 8). The interaction test between high- and low-intensity CBT reviews was not statistically significant (p = 0.99).

We identified three reviews318,343,521 (four RCTs, 243 participants; two reviews of lower quality and one review of higher quality) that directly compared high- with low-intensity CBT interventions on HRQoL outcomes in 6B00-06 anxiety or fear-related disorders and 6A60-80 mood disorders. One review provided separate data for both 6B01 panic and 6B04 social anxiety disorder populations, and so the PMA included four meta-analyses. In this subset of direct comparisons, there was no difference between high- and low-intensity CBT (SMD 0.15, 95% CI –0.10 to 0.40; I² = 0%) (Figure 9).

The direct evidence (see Figure 9) comparing high- with low-intensity CBT in 6B00-06: Anxiety and 6A60-80: Mood disorders supports our indirect evidence (see Figure 8) from subgroup analyses of high and low intensity. In summary, we have found no direct or indirect evidence that high- or low-intensity CBT produced different effect sizes.

Type of comparators

The choice of comparator had a significant effect on the treatment estimates. Comparison to an active intervention was associated with a very small effect (SMD 0.09, 95% CI –0.01 to 0.19; I² = 0%) (Figure 10). The active comparators tested in these reviews were education, exercise, pharmacotherapy, physiotherapy, psychotherapy/counselling and relaxation. Comparison with a non-active control was associated with a larger effect estimate (SMD 0.31, 95% CI 0.18 to 0.45; I² = 40%). The interaction test was statistically significant (p = 0.04).

Duration of follow-up

Effect estimates were higher in reviews reporting short-term follow-up (SMD 0.29, 95% CI 0.17 to 0.42; I² = 30%) than in reviews reporting long-term follow-up (SMD 0.11, 95% CI 0.02 to 0.20; I² = 0%) (Figure 11). However, the interaction test did not find a statistically significant difference between the groups (p = 0.06).

Age

Effect estimates were similar in reviews of children and adolescents (SMD 0.20, 95% CI –0.15 to 0.56; I² = 0%) and adults (SMD 0.23, 95% CI 0.14 to 0.33; I² = 39%) (Figure 12). However, the sample sizes were much smaller in the reviews of children and adolescents, and the consequent CIs crossed zero. The interaction test did not find a statistically significant difference between the children/adolescents and adult groups (p = 0.06). The effect size for older adults was larger (SMD 0.39, 95% CI –0.24 to 1.02), but was generated from one review, with one trial and only 39 participants, and, again, the 95% CIs crossed zero (see Figure 12).

Sensitivity analysis

The sensitivity analysis was conducted with an additional 10 reviews that had been rated as low or critically low on the AMSTAR-2. Therefore, the sensitivity analysis was conducted with 34 reviews (76 RCTs, 7466 participants). 32,39,63,82,165,188,193,219,220,231,235,236,270,275,276,279,286,299,317,329,343,347,356,371,409,413,445,446,464,467,469,513,518,521 Inclusion of lower-quality reviews increased the estimate of effect (SMD 0.28, 95% CI 0.17 to 0.38) and raised the levels of heterogeneity (I² = 71%) (see Appendix 9, Figure 15). This analysis included reviews from more physical conditions: 13: Digestive system, 02: Neoplasms, 08: Headaches and epilepsy and 21: Symptoms such as tinnitus and fatigue (see Box 4). All of the additional within-condition group estimates were consistent with the general effect, that is, an absence of inconsistent effects.

We re-ran the PMA replacing the physical component scores with the mental component scores from the SF-12/SF-36 in the two reviews that presented both the physical and the mental component scores. 220,464 The replacement did not change the overall effect or heterogeneity rating for the HRQoL outcome (SMD 0.24, 95% CI 0.14 to 0.33; I² = 38%) (see Appendix 9, Figure 16).

Health-related quality-of-life change scores and risk ratio data

Four reviews (four RCTs, 185 participants), two of higher and two of lower quality, presented HRQoL data as change scores. 158,246,406,523 These included reviews of 6B00-06 anxiety and 6A60-80 mood disorders, 13 digestive system, 21 pain and 12 respiratory system disorders. The overall pooling reported acceptable heterogeneity and a moderate effect in favour of CBT (SMD 0.58, 95% CI 0.15 to 1.00; I² = 66%) (see Appendix 9, Figure 17).

One lower-quality review (two RCTs, 145 participants) presented HRQoL data as a RR. 170 This review identified a large effect (SMD 1.57, 95% CI 0.78 to 2.37; I², not applicable) in favour of CBT (see Appendix 9, Figure 18).

Discussion

From the highest-quality reviews, we found that CBT produced consistent, positive effects on HRQoL across 10 different conditions. Effect estimates suggest a modest, long-term improvement, compared with no intervention. These effects became very small when CBT is compared with other active treatments, including education, exercise, pharmacotherapy, physiotherapy, psychotherapy/counselling and relaxation. We did not find a difference between the effect sizes of reviews conducted with low-intensity CBT or high-intensity CBT.

The effect estimates were generated by synthesising data from samples of children, adolescents and adults, of both sexes, mainly living in countries in Europe, North America and Australasia. There is a lack of higher-quality evidence of CBT’s effectiveness for older adults.

We do not know if CBT will be effective when delivered preventatively or when delivered to patients with severe or subclinical symptoms. We do not know if CBT is equally effective across different ethnic groups nor do we know its effect for people living in countries in Africa, Asia or South America.

Depression

We identified 48 higher-quality systematic reviews37,39,46,50,59,63,117,126,143,167–169,175,197–199,205,206,220,221,231,234,235,246,249,261,267,275,286,299,340,357,369,371,373,401,405,409,432,445,446,448,450,454,469,480,484,507 that met the eligibility criteria to be included in the primary depression PMA. One review included six meta-analyses for different disorders; hence, the number of comparisons is 53. These included 130 RCTs and 14,073 participants, and represent 16 out of 40 possible ICD-11 categories (40%). Box 5 includes the ICD-11 codes represented in the primary PMA (white cells) and those codes not represented (shaded cells).

BOX 5 - The ICD-11 categories (not) represented in the primary PMA of higher-quality reviews for depression outcome

ICD-11 primary codes

01 Certain infectious or parasitic diseases.
02 Neoplasms.
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system.
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system.
14 Diseases of the skin.
15 Diseases of the musculoskeletal system.
16 Diseases of the genitourinary system.
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs NOS (MG30 pain, MG22 fatigue).

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders.
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders.
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors NOS (MB23.0 aggressive behaviour, QE01 caregiver stress).

NOS, not otherwise specified.

White rows represent ICD-11 codes represented in the primary analysis; purple shaded rows represent ICD-11 codes that are not represented in the depression PMA.

The most commonly used measure of depression was the Beck Depression Inventory (n = 22). Other measurements included the Hamilton Depression Rating Scale (n = 7), the Hospital Anxiety and Depression Scale (n = 4), the Patient Health Questionnaire-9 items (n = 2), the Montgomery–Åsberg Depression Rating Scale (n = 2), the Center for Epidemiologic Studies Depression Scale (n = 2), the Profile of Mood States (n = 1), the Depression Anxiety Stress Scale (n = 1) and the Hopkins Symptoms Checklist (n = 1). The remaining reviews used population-specific depression measures [Glasgow Depression Scale for People with a Learning Disability (n = 1), Children’s Depression Inventory-revised (n = 3)].

The majority of these meta-analyses were focused on adults (37/48), with seven reviews focusing on adolescents/children and one review focusing on older people. More reviews had samples that included more female than male participants (23/48) than samples with more male than female participants (9/48). Only seven reviews reported the ethnicity of their samples. Of these, four reviews had samples with < 25% non-white participants and one included a sample with > 75% non-white participants.

The majority of reviews reported on the management of clinical conditions (26/48), on interventions of high intensity (26/48), delivered in outpatient settings (27/48), and with short-term follow-up (39/48). The majority of included RCTs in the reviews were from Europe, North America and Australasia (33/48). Many of the reviews contained only one trial (54%, 26/48), and, for some conditions, such as personality disorders, the numbers in those trials were very small (see Appendix 10, Figure 19).

Primary analysis

Within-condition heterogeneity (I²) varied between 0% (6D10-11: Personality disorders) and 86.3% (6A60-80: Mood disorders), and across-condition heterogeneity was 81%. The across-condition heterogeneity was too high for us to pool across the ICD-11 category groups (see Appendix 10, Figure 19). Ten of the within-condition groups reported effects in favour of CBT with some certainty. However, aggression, eating disorders, mixed mental conditions, nervous system disorders and stress-related disorders report within-condition effects of close to zero.

The heterogeneity was too high to pool across ICD-11 categories in any of the subgroup or sensitivity analyses. There was no evidence of publication bias or of small-study effects (Egger’s test p = 0.87) (see Appendix 10, Figure 20).

Discussion

Depression was the most commonly reported outcome in the review evidence base. The variation between the effect estimates generated for the within-condition subgroups was too wide-ranging to pool across the ICD-11 condition groups. No further subgroup or sensitivity analyses were conducted to compare with the primary analysis.

Anxiety

We identified 34 higher-quality systematic reviews37,39,89,134,143,168,175,205,227,234–236,246,249,251,259,275,286,291,315,340,343,347,371,373,397,409,432,445,446,450,464,469,480 that met the eligibility criteria. Two reviews included meta-analyses for different disorders; hence, the number of comparisons is 36. These included 59 RCTs and 4673 participants, and represent 13 out of 40 possible ICD-11 categories (33%). Box 6 includes the ICD-11 codes represented in the primary PMA (white rows), those conditions represented in the sensitivity analysis only, namely lower-quality reviews (purple rows) and those codes not represented (orange rows).

BOX 6 - The ICD-11 categories (not) represented in the primary PMA of higher-quality reviews for anxiety outcome

ICD-11 primary codes

01 Certain infectious or parasitic diseases.
02 Neoplasms.
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system.
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system.
14 Diseases of the skin.
15 Diseases of the musculoskeletal system.
16 Diseases of the genitourinary system.
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs NOS (MG30 pain, MG22 fatigue).

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders.
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders.
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors NOS (MB23.0 aggressive behaviour).

NOS, not otherwise specified.

White rows represent ICD-11 codes represented in the primary analysis, purple rows represent ICD-11 codes represented in the sensitivity analyses and orange rows represent ICD-11 codes that are not represented in the anxiety PMA.

The most commonly used measure of anxiety was the Beck Anxiety Inventory (BAI) (n = 9). Other measurements included the Hospital Anxiety and Depression Scale (n = 6), the State–Trait Anxiety Inventory (n = 6), the Hamilton Anxiety Rating Scale (n = 1), the Hopkins Symptom Checklist (n = 1) and the Profile of Mood States (n = 1). The remaining reviews used population-specific [Glasgow Anxiety Scale for People with an Intellectual Disability, Revised Children’s Manifest Anxiety Scale (n = 4)] or condition-specific [Generalised Anxiety Disorder-7 (n = 3), Dental Anxiety Scale, Cardiac Anxiety Questionnaire] measurements.

The majority of these meta-analyses focused on adults (23/34), with seven reviews of adolescents/children and two reviews of older people. More reviews had samples that included more female than male participants (14/34) than samples with more male than female participants (9/34). Only five reviews reported the ethnicity of their samples. Of these, four reviews had samples with > 75% white participants and none included a sample with < 25% white participants.

The majority of reviews reported on the management of clinical conditions (20/34), on interventions of high intensity (29/34), delivered in outpatient settings (22/34), and with a short-term follow-up (27/34). The majority of included RCTs were from Europe, North America and Australasia (22/34). Out of 34 reviews, 24 contained only one trial, and, in some cases, the numbers in each trial were very low (Figure 13 presents the data).

These analyses also included reviews with trials conducted in less common contexts and populations, for example patients with subclinical mood (6A60-80) conditions (n = 1), and CBT delivered in preventative contexts to mood disorder (6A60-80), psychosis (6A20-25) (n = 2) and inpatient psychosis patients (n = 2), and to older adults living with stress disorders (6B40-45), obsessive disorders (6B20-25), anxiety (6B00-06) and mood (6A60-80) disorders (n = 2). None of these specific reviews produced effect estimates that were inconsistent with the primary anxiety PMA.

Primary analysis

Within-condition heterogeneity varied between 0% (MG30 pain) and 75% (6B40-45 stress-related disorders) and across-condition heterogeneity was 62%. The pooled across-condition SMD gave a modest effect in favour of CBT on outcomes of anxiety (SMD 0.30, 95% CI 0.18 to 0.43) (see Figure 13). The prediction intervals for the overall effect were –0.28 to 0.88. No inconsistent effects were identified across the conditions.

Once again, variation in effects was observed across conditions. This heterogeneity is reflected in the resulting prediction interval, which, indicated for the overall effect (within any given condition), was between –0.28 to 0.88, indicating a possible small negative effect of CBT for some conditions and, at best, a large positive effect for other conditions.

There was no evidence of publication bias or of small-study effects (Egger’s test p = 0.70) (see Appendix 11, Figure 21).

Mean difference in anxiety

We transformed the across-condition SMD into a mean difference of the most commonly reported anxiety outcome, the BAI. 526 We identified a standard deviation (13.46 points) of the BAI from a low risk-of-bias trial525 in a higher-quality review. 464 The SMD translated to an estimated mean difference on the BAI of 4 points (95% CI 2 to 6 points).

Subgroup analysis

None of the interaction tests between the subgroups was significant and the evidence is consistent with the primary anxiety PMA.

Cognitive–behavioural therapy intensity

Reviews of low- and high-intensity CBT examined similar populations and conditions. The ICD-11 categories that were represented by high-intensity CBT only, and not low-intensity CBT, were 6A20-25 schizophrenia or other primary psychotic disorders, 6D10-11 personality disorders and related traits, 6A00-06 neurodevelopmental disorders and 12 diseases of the respiratory system. The populations who were sampled in reviews of high-intensity CBT but not in reviews of low-intensity CBT were older adults (06B40-45 disorders specifically associated with stress, 6B20-25 obsessive–compulsive disorders, 6B00-06 anxiety or fear-related disorders and 6A60-80 mood disorders) and subclinical populations (6A60-80 mood disorders). High-intensity, but not low-intensity, CBT reviews included trials delivered in preventative contexts (6A20-25 schizophrenia or other primary psychotic disorders and 6A60-80 mood disorders) and to inpatient samples (6A20-25 schizophrenia or other primary psychotic disorders).

The heterogeneity was too high to pool across the low-intensity CBT reviews (I² = 78%). The low-intensity CBT reviews included trials examining CBT delivered via paraprofessionals (n = 3) or via the internet (n = 4). The heterogeneity was much lower in high-intensity CBT reviews (SMD 0.28, 95% CI 0.15 to 0.42; I² = 54%). The interaction test between high- and low-intensity CBT reviews was not statistically significant (p = 0.62) (see Appendix 11, Figure 22).

We identified five reviews87,306,343,360,521 (11 RCTs, 503 participants) that directly compared high- with low-intensity CBT interventions on anxiety outcomes in 6B00-06: Anxiety, 6A60-80: Mood and pain [including tinnitus 21 Symptoms and signs not otherwise specified (MG30 pain)] conditions. In this subset of direct comparisons, there was no difference between high- and low-intensity CBT (SMD 0.03, 95% CI –0.14 to 0.21; I² = 20%) (see Appendix 11, Figure 23). This direct evidence comparing high- with low-intensity CBT in anxiety and mood and pain conditions supports our indirect evidence (see Appendix 11, Figure 22) from the high- and low-intensity CBT subgroup analyses. We have found no direct or indirect evidence that high- or low-intensity CBT produce different effect sizes.

Type of comparators

The effect was larger and significant when CBT was compared with non-active comparators (SMD 0.37, 95% CI 0.19 to 0.55; I² = 64%) and smaller and non-significant when compared with active comparators (SMD 0.19, 95% CI 0.00 to 0.37; I² = 49%) (see Appendix 11, Figure 24). However, the interaction test between the two groups was not significant (p = 0.24).

Duration of follow-up

Effect estimates were higher in reviews reporting long-term follow-up (SMD 0.38, 95% CI 0.15 to 0.60; I² = 66%) than in those reporting short-term follow-up (SMD 0.27, 95% CI 0.12 to 0.43; I² = 59%) (see Appendix 11, Figure 25). However, the interaction test did not find a statistically significant difference between the groups (p = 0.48).

Age

Effect estimates were similar in reviews of children and adolescents (SMD 0.37, 95% CI 0.12 to 0.62; I² = 67.1%) and adults (SMD 0.32, 95% CI 0.15 to 0.48; I² = 63.6%). The estimates in the two reviews of older adults were much lower and the 95% CIs crossed zero (SMD 0.06, 95% CI –0.30 to 0.43; I² = 0%) (see Appendix 11, Figure 26). The interaction test did not find a statistically significant difference between the three groups (p = 0.69).

Sensitivity analyses

We identified 56 reviews (117 RCTs, 11,409 participants)34,37,39,89,134,143,168,171,175,205,215,216,227,234–236,241,246,249,251,259,266,275,277,286,291,294,306,315,329,340,343,347,356,371,373,377,379,397,398,409,410,413,425,429,432,445,446,450,463,464,466,469,480,497,513 of any quality with data suitable for inclusion in the sensitivity anxiety PMA. Five reviews had separate valid data representing different conditions; therefore, the total number of comparisons in the all-quality anxiety PMA is 64. Inclusion of lower-quality reviews increased the heterogeneity across conditions (I² = 76%) beyond our threshold for pooling across the conditions (see Appendix 11, Figure 27). All of the ICD-11 category within-condition effects were consistent with the primary analysis for anxiety outcomes.

Anxiety change scores/dichotomous outcomes

Four lower-quality reviews (four RCTs, 255 participants) reported anxiety outcome data as change scores. 56,105,336,457 These included reviews of 6B00-06 anxiety, 6A60-80 mood disorders and 08 diseases of the nervous system. The heterogeneity was too high (I² = 88.1%) to pool across the reviews (see Appendix 11, Figure 28). One lower-quality review433 reported an OR (one RCT, 112 participants) and found a large effect in favour of CBT (SMD 1.01, 95% CI 0.96 to 1.06; I², not applicable) (see Appendix 11, Figure 29). One lower-quality review332 (one RCT, 27 participants) reported a risk difference and presented a moderate effect in favour of CBT (SMD 0.36, 95% CI 0.01 to 0.71; I², not applicable) (see Appendix 11, Figure 29). There were no data that were inconsistent with the primary analysis for anxiety outcomes from any of the change score or dichotomous data.

Discussion

The primary PMA reported that CBT produces a small, but meaningful, long-term improvement in anxiety symptoms. Results from the primary, subgroup, sensitivity subgroups, change scores and dichotomous data PMAs are all consistent with the primary PMA. Some individual reviews were conducted in less frequently researched contexts (e.g. trials conducted in Africa), under-represented populations (e.g. older adults) and less frequently researched delivery formats (e.g. preventative CBT). Every review generated effect estimates that were consistent with the overall general effect.

Cognitive–behavioural therapy was effective when it was delivered via high-intensity methods, but there was too much variation to conclude whether or not CBT was effective when it was delivered via low-intensity methods. However, there were no statistically significant differences between any of the subgroup tests.

The effect estimates were generated by synthesising data from samples of children, adolescents and adults, of both sexes, mainly living in countries in Europe, North America and Australasia. There is a lack of higher-quality evidence of CBT’s effectiveness for older adults.

We do not know if CBT will be effective when delivered preventatively or when delivered to patients with severe or subclinical symptoms. We do not know if CBT is effective across different ethnic groups nor do we know its effect for people living in countries in Africa, Asia or South America.

Pain

We identified 10 higher-quality systematic reviews32,68,102,134,149,188,211,251,317,446 that met the eligibility criteria. These included 22 RCTs (2581 participants) and represent 5 out of 40 possible ICD-11 categories (13%). Box 7 presents the ICD-11 codes represented in the primary PMA (white rows), those codes represented in the sensitivity analysis (i.e. lower-quality reviews) (purple rows) and those codes not represented (orange rows).

BOX 7 - The ICD-11 categories (not) represented in the primary PMA of higher-quality reviews for the pain outcome

ICD-11 primary codes

01 Certain infectious or parasitic diseases.
02 Neoplasms.
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system (only lower-quality reviews).
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system [DA01.11 oral mucositis (related to cancer treatments)].
14 Diseases of the skin.
15 Diseases of the musculoskeletal system (FA00–05 osteoarthritis).
16 Diseases of the genitourinary system.
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs NOS (MG30 pain).

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders.
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders.
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors NOS.

White rows represent ICD-11 codes represented in the primary analysis, purple shaded rows represent ICD-11 codes represented in the sensitivity analyses and orange shaded rows represent ICD-11 codes that are not represented in the pain PMA.

The most commonly used measure of pain was the 100-mm visual analogue scale (VAS) (n = 6). Other measurements included the numerical rating scale of pain intensity (n = 3), the Wong–Baker Faces Pain Rating Scale (n = 2), the modified von Korff scale (n = 1), the Chronic Pain Grade questionnaire (n = 1) and the McGill Pain Questionnaire (n = 1).

The majority of these meta-analyses were focused on adults (6/10),102,134,149,188,211,317 three reviews focused on adolescents/children32,68,446 and one review did not report the age of the samples. 251 All of the reviews included samples that were equally balanced between male and female participants. Only one review63 reported the ethnicity of its samples (> 75% white participants).

Two reviews specified examining CBT in patients with chronic symptoms of pain, anxiety and mood conditions. Half of the reviews examined high-intensity and half of the reviews examined low-intensity CBT. One review examined using CBT to prevent pain developing post orthodontic treatments, but all the others were using CBT in response to diagnosed problems. Two reviews observed the use of CBT for inpatients with pain conditions, whereas the remaining reviews examined CBT in outpatient/community settings. Three reviews included long-term follow-ups (abdominal pain, back pain, anxiety and mood disorders). Four reviews included only one trial, and five reviews included < 100 participants (Figure 14).

Primary analysis

The across-condition heterogeneity was 64% and the pooled across-condition SMD gave a modest effect in favour of CBT on outcomes of pain (SMD 0.23, 95% CI 0.05 to 0.41) (see Figure 14). The prediction intervals for the overall effect were –0.28 to 0.74.

There was no evidence of publication bias, nor of small-study effects (Eggers test p = 0.19) (see Appendix 12, Figure 30).

Mean difference in pain

We transformed the across-condition SMD into a mean difference of the most commonly reported pain outcome, the 100-mm VAS. We identified a standard deviation (27 mm) of the VAS from a trial527 with a low risk of bias in a higher-quality review. 32 The SMD translated to an estimated mean difference on the VAS of 6 mm (95% CI 1 to 11 mm).

Subgroup analysis

There were no statistically significant interaction effects between any subgroups; therefore, the evidence is consistent with the primary analysis.

Cognitive–behavioural intensity

High- and low-intensity CBT was examined in both children/adolescent and adult populations. The only review149 of preventative CBT delivered low-intensity treatment. There were no other differences in the populations or contexts tested with high- and low-intensity CBT.

The heterogeneity was too high to pool separately across the low-intensity CBT reviews (I² = 84%). The low-intensity CBT reviews included trials examining CBT delivered by paraprofessionals (n = 4), through self-help tools (n = 6). The heterogeneity was much lower in high-intensity CBT reviews (SMD 0.19, 95% CI 0.01 to 0.37; I² = 18%) (see Appendix 12, Figure 31). The interaction test between high- and low-intensity reviews was not statistically significant (p = 0.87).

No reviews directly compared the effectiveness of low-intensity compared with high-intensity CBT on pain outcomes. Therefore, no direct evidence is available to compare with our indirect evidence.

Type of comparators

The effect was larger when CBT was compared with non-active comparators (SMD 0.59, 95% CI 0.07 to 1.11; I² = 69%) and was very small when compared with active comparators (SMD 0.14, 95% CI –0.11 to 0.38; I² = 73%) (see Appendix 12, Figure 32). However, the difference between the two groups was not statistically significant when tested with the interaction test (p = 0.86).

Duration of follow-up

Effect estimates were higher in reviews reporting short-term follow-up (0.32, 95% CI 0.04 to 0.59; I² = 70.5%) than in reviews reporting long-term follow-up (0.19, 95% CI 0.08 to 0.31; I² = 0%) (see Appendix 12, Figure 33). However, the interaction test did not find a statistically significant difference between the groups (p = 0.62).

Age

The effect estimates extracted from reviews conducted in children and adolescent populations were too varied (I² = 87%) to justify pooling across them. Conversely, there was 0% heterogeneity between the reviews in adult populations and the pooled effect was modest (SMD 0.21, 95% CI 0.12 to 0.31; I² = 0%) (see Appendix 12, Figure 34). The interaction test between (1) children and adolescents and (2) adults did not find a significant difference between these groups (p = 0.68).

Sensitivity analysis

We identified 16 reviews (19 comparisons, 39 RCTs, 4592 participants)32,68,102,134,149,188,211,222,251,266,306,317,348,413,446,473 of any quality with data suitable for inclusion in the sensitivity pain PMA. This introduced 08: Nervous system disorders into the analysis. In the sensitivity analysis, all of the ICD-11 within-condition groups were consistent with the primary analysis for pain outcomes. Inclusion of lower-quality reviews marginally reduced the estimate of effect and heterogeneity (SMD 0.21, 95% CI 0.11 to 0.31; I² = 51%), compared with the primary PMA (see Appendix 12, Figure 35).

Pain change scores/dichotomous data

The reviews that reported dichotomous data were consistent with the primary analysis. One lower-quality review, Palermo et al. ,354 presented pain outcome data as ORs. This review demonstrated a non-significant effect for CBT (SMD 7.99, 95% CI –2.72 to 18.70) (see Appendix 12, Figure 36). One lower-quality review, Bernardy et al. ,64 reported pain outcome data as risk differences and showed a non-significant effect for CBT (SMD 0.08, 95% CI –0.03 to 0.19) (see Appendix 12, Figure 36).

Discussion

From a smaller data set of the highest-quality reviews, we found that CBT produced consistent improvements in pain outcomes across six different conditions. Effect estimates suggest a modest long-term improvement in comparison with any other comparator intervention. We did not find a difference in the effect sizes between reviews conducted with low-intensity CBT and those conducted with high-intensity CBT.

The effect estimates were generated by synthesising data from samples of children, adolescents and adults, of both sexes, mainly living in countries in Europe, North America and Australasia. To our knowledge, there is no higher-quality evidence of CBT’s effectiveness for older adults.

The included reviews presented evidence to suggest that CBT can improve pain outcomes when CBT is delivered preventatively to patients with chronic or subclinical symptoms, but there is no evidence regarding severe symptoms. We do not know if CBT is equally effective across different ethnic groups, nor do we know its effect for people living in countries in Africa, Asia or South America.

Chapter 6 Generalisation

One of the aims of the project was to consider the extent to which the existing evidence base could be used to guide treatment, commissioning and research investment decisions.

This necessitated a layer of questions:

In the existing evidence base of systematic reviews, is there evidence of a general effect of CBT across different conditions (categorised by the ICD-11)?

Yes. Our PMA analyses (see Chapter 5) concluded that CBT does produce a general effect across conditions. We were able to meet the criteria of statistical, intervention and design homogeneity for our primary outcome of HRQoL, and two out of three secondary outcomes (anxiety and pain). We can feel confident in generalising the effect across these condition categories.
Can we assume that this effect is robust across all the specific conditions represented in each ICD-11 code?

In our methodology, we classified physical conditions at the primary ICD-11 code level and mental conditions at the secondary level. In each category, there are many subconditions. For some ICD-11 categories, such as musculoskeletal diseases (15), we have reviews representing three (arthropathies, spine conditions and osteopathies) of the five subcategories, whereas for others, such as respiratory disorders (12), we have reviews representing only one subcategory [lower respiratory tract diseases: asthma and chronic obstructive pulmonary disease (COPD)] out of six. We suggest that, as we found no evidence of inconsistent evidence, the effect of CBT will remain consistent across all conditions subsumed beneath each ICD-11 category. The consistency of effect mirrors and reassures the CBT field’s move towards transdiagnostic approaches. For example, literature suggests that a transdiagnostic manual is equally effective as condition-specific manuals for treating patients with all types of eating disorders (anorexia, bulimia, binge-eating and eating disorders not otherwise specified). 528 The benefit of using a transdiagnostic approach is that it is suitable for people with multiple conditions. Our PPI representatives suggested that this was a very important point, particularly because, with an ageing population, more and more people will live with multiple comorbidities.
Can we assume that this general effect is robust across conditions (ICD-11) that are represented by lower-quality reviews only?

Yes. We performed sensitivity analyses and found that the inclusion of lower-quality reviews increased the heterogeneity of review effect estimates, but did not alter the SMD. We can feel confident in generalising the effect across higher- and lower-quality systematic review evidence.
Can we assume that our general effect is robust across the populations and contexts?

Yes. We found no evidence of inconsistency in effect. We mapped the population and context details of the included reviews. We found no reviews, condition analyses or subgroup analyses that reported a statistically significant effect in favour of the comparator over CBT. Table 4 details the population, context and conditions of the reviews included in the primary HRQoL analyses. We identified each review from those populations or contexts that were under-represented and presented the individual review effect estimate. None of the individual or pooled meta-analyses produced an estimate that was inconsistent with the general effect of CBT on HRQoL.

TABLE 4 - Details of the population, context and conditions of the reviews included in the primary HRQoL PMA

**Note**

HRQoL general effect 0.23 (95% CI 0.14 to 0.33; I² = 32%) across 24 reviews, 49 RCTS, 4304 participants.
Generalisation parameter	Details from the included reviews
Condition
Severity of symptoms	Most reviews examined the effect of CBT in patients who received a clinical diagnosis. Three reviews examined the effectiveness of CBT specifically for patients with chronic symptoms and found consistent effects: Mood disorders – SMD 0.08 (95% CI –0.17 to 0.32)220 Anxiety disorder – SMD –0.29 (95% CI –1.13 to 0.55)446 Pain – SMD 0.83 (95% CI 0.06 to 1.59)317
Population
Age	Reviews were conducted with children and adolescents (3/24) living with anxiety and/or mood445,446 and pain32 conditions and older adults with mood disorders (1/24)347 and adults (20/24) in nine different conditions (including anxiety, mood and pain conditions). The age subgroup analysis (see Chapter 5) did not identify a difference between children/adolescents and adults. The older adult review produced a consistent, but uncertain, effect (0.39, 95% CI –0.24 to 1.02)347
Sex	The majority of the reviews were conducted with samples that were equally represented by male and female participants (21/24 reviews). One review of patients with neck pain had a female participant sample of > 75% and reported a consistent but uncertain effect (0.28, 95% CI –0.11 to 0.68).63 Two reviews reported samples with > 75% male participants. The review conducted in anxiety reported an uncertain but consistent effect (0.21, 95% CI –0.04 to 0.47).464 The effect was the same for the review conducted in bodily distress (0.36, 95% CI –0.11 to 0.82)469
Ethnicity	Very few reviews reported the ethnicity of their samples. Of the five reviews that did, four included > 75% white participants. These all produced consistent evidence: In pain conditions – SMD 0.28 (95% CI –0.11 to 0.68)63 In anxiety and mood conditions – SMD 0.24 (95% CI –0.27 to 0.74),445 SMD –0.29 (95% CI –1.13 to 0.55)446 and SMD 0.21 (95% CI –0.04 to 0.47)464 Only one review reported a < 25% white participant sample. This was conducted in anxiety and obsessive–compulsive conditions (–0.06, 95% CI –0.48 to 0.36)299
Context
Country	Five reviews included trials that were conducted in Asia. These were conducted in: Psychosis – SMD 0.07 (95% CI –0.58 to 0.72),235 SMD 0.84 (95% CI 0.10 to 1.58)236 Stress disorders – SMD 0.60 (95% CI 0.08 to 1.12)275 Anxiety and obsessive–compulsive disorders – SMD –0.06 (95% CI –0.48 to 0.36)299 Anxiety and mood disorders – SMD 0.24 (95% CI –0.27 to 0.74)445 All other trials included in the reviews were conducted in Europe, North America and Australasia
Health-care setting	Only five reviews recruited participants from inpatient settings. These were conducted in: Mood disorders – SMD 0.22 (95% CI –0.06 to 0.51)231 Psychosis – SMD 0.07 (95% CI –0.58 to 0.72);235 SMD 0.84 (95% CI 0.10 to 1.58);236 SMD 0.23 (95% CI 0.14 to 0.33)518 Anxiety disorders – SMD 0.21 (95% CI –0.04 to 0.47)464 All other review samples were recruited from community, primary and outpatient settings
Health-care timing	One review implemented CBT as a preventative intervention for patients with schizophrenia (0.09, 95% CI –0.21 to 0.39).219 The other reviews examined CBT delivered as a standard treatment

Can we infer that this treatment effect might be observed across conditions that are not included in the current systematic review evidence base?

Our systematic approach meant that we classified reviews by the primary condition that the CBT was aiming to treat. For example, if a review examined the use of CBT to reduce symptoms of depression [i.e. a mood disorder (6A60-80)] in patients with COPD (12: respiratory disorder), then the review was classified as a review of the effectiveness of CBT for 6A60-80: Mood disorders with comorbid 12: Respiratory disorder (COPD). However, if CBT improves HRQoL in patients with mood disorders and comorbid COPD, then CBT is also improving quality of life for COPD patients. As quality of reviews did not affect the general effect, we generated a list of conditions for which CBT is effective from those reviews included in the sensitivity analyses. The following comorbid conditions are represented in the HRQoL, anxiety and pain outcome sensitivity analyses, but not represented in the primary list of conditions: intellectual disabilities (6A00-4), brain injury (6D70-2), dementia (6D70-2), migraines (08), epilepsy (08), circulatory diseases (11), COPD (12), irritable bowel syndrome (13), arthritis (15), tinnitus (21) and fatigue (21). Therefore, we conclude that CBT’s effect is consistent across 22 out of 40 ICD-11 codes (55%), as presented in Box 8.

BOX 8 - The ICD-11 codes represented by primary and comorbid conditions in the higher- and lower-quality reviews in the HRQoL, anxiety and pain PMAs

ICD-11 primary codes

01 Certain infectious or parasitic diseases (1C60-62: HIV).
02 Neoplasms.
03 Diseases of the blood.
04 Diseases of the immune system.
05 Endocrine, nutritional or metabolic diseases.
07 Sleep–wake disorders.
08 Diseases of the nervous system.
09 Diseases of the visual system.
10 Diseases of the ear or mastoid process.
11 Diseases of the circulatory system.
12 Diseases of the respiratory system.
13 Diseases of the digestive system.
14 Diseases of the skin.
15 Diseases of the musculoskeletal system.
16 Diseases of the genitourinary system (GA33 pregnancy loss).
17 Conditions related to sexual health.
18 Pregnancy, childbirth or the puerperium.
19 Certain conditions originating in the perinatal period.
20 Developmental abnormalities.
21 Symptoms and signs NOS (MG30 pain, MG22 fatigue, MC41 tinnitus).

ICD-11 secondary codes within ‘06 mental, behavioural or neurodevelopmental disorders’

6A00-06: neurodevelopmental disorders (6A02 autism, 6A00 intellectual disability and 6A05 ADHD).
6A20-25: schizophrenia or other primary psychotic disorders.
6A40-41: catatonia.
6A60-80: mood disorders.
6B00-06: anxiety or fear-related disorders.
6B20-25: obsessive–compulsive disorders.
6B40-45: disorders specifically associated with stress.
6B60-66: dissociative disorders.
6B80-85: feeding or eating disorders.
6C00-01: elimination disorders.
6C20-21: disorders of bodily distress.
6C40-51: disorders due to substance use or addictive behaviours.
6C70-73: impulse control disorders.
6C90-91: disruptive behaviour or dissocial disorder.
6D10-11: personality disorders and related traits.
6D30-36: paraphilic disorders.
6D50-51: factitious disorders.
6D70-72: neurocognitive disorders (6D80-86: dementia).
6E20-21: mental or behavioural disorders associated with pregnancy, childbirth or the puerperium.
6E40: psychological or behavioural factors NOS (MB23.0 aggressive behaviour).

HIV, human immunodeficiency virus; NOS, not otherwise specified.

Purple shaded rows indicate the ICD-11 categories that are not represented in any of the PMAs.

To generalise beyond the conditions and comorbidities represented in this overview is a challenging area for CBT, in which there are a diverse range of strongly held perspectives. We specified a priori that we would use a model of generalisation529,530 to guide our thinking, which necessitated that the evidence met three assumptions:

Statistical homogeneity in the systematic reviews being used to generate the estimate of effect. This was fulfilled.
Clinical homogeneity populations and contexts represented in the overview represent the contexts to which the generalisation is being made.
Shared mechanisms of action, which is the assumption that CBT effects change by changing the same or similar mediating variables across all conditions.

This would mean that, to assume an effect of CBT on HRQoL in a condition that has no systematic review evidence, there should be evidence of a general effect on HRQoL among similar patients, contexts and settings (i.e. there is no reason to believe that the treatment should work differently or be harmful). For the final assumption of shared mechanisms to be met, the highest level of evidence we would seek is that that from multiple mediation analyses.

As described, the ECG met on several occasions. We collectively agreed on the criteria for statistical homogeneity and the importance of consistency of effects, and that these were met in the PMA. For clinical homogeneity, we agreed the data extraction variables and framework, and were able to demonstrate where there is adequate evidence on context and where there is not adequate evidence (see Table 4). We demonstrated consistent effects for children, adolescents and adults, of both sexes, with clinical diagnoses, living in Europe, North America and Australasia, being treated in community, primary and secondary care settings with CBT being delivered in response to a diagnosis. However, there was less certainty for older adults, with subclinical, chronic or severe symptoms, living in Asia, Africa or South America, being treated in an inpatient setting or receiving CBT preventatively.

We did not search specifically for systematic reviews of mediation studies. At a basic level, the ECG and investigators were able to agree that the principles of CBT are the same regardless of the condition, namely that we intervene to modify thoughts and feelings, to influence behaviours and, ultimately, to improve health outcomes. The challenge is that the range of thoughts, feelings and behaviours is quite wide, and the ECG and investigators were unable to agree that CBT works through the same therapeutic mechanisms for every condition for which it has been used. The ECG recommended that future research should target identifying what the mechanisms of CBT are for each population. If these mechanisms could improve symptoms in other populations, then the evidence for effectiveness could be meaningfully generalised across the conditions. This will be a judgement call and there are likely to be situations in which details on mechanisms are available and similar to those included in reviews, and that the context and characteristics align to provide confidence in broader generalisation. The ECG suggested that a systematic review of mediation studies of CBT would be helpful in this respect, but this was outside the scope of this study.

Chapter 7 Discussion

Principal findings and their meaning

Cognitive–behavioural therapy has been evaluated (with systematic reviews) in most conditions (68%, 27/40 of ICD-11 categories). These reviews have summarised the RCT evidence of whether or not CBT improved outcomes in these conditions. The review estimates were similar enough between the different conditions for us to generate a general (as opposed to a condition-specific) effect estimate. We found that CBT produced a modest general benefit to HRQoL, anxiety and pain outcomes. The evidence was consistent across all 22 out of 40 (55%) conditions (and comorbidities), populations and contexts that have been tested.

The estimates for depression outcomes between conditions were too different; therefore, we could not produce a pooled general effect estimate. Although there were many more reviews in the depression PMA, the reviews used fewer different outcome measurements than in HRQoL, anxiety and pain PMAs. Therefore, it is unlikely that the high heterogeneity is due to the variation in the outcome measurements used. CBT has been shown to be very effective for people with clinical depression. 531,532 Our overview does not suggest that CBT is not effective for symptoms of depression, only that there was a great variation in how effective it was for changing depression symptoms across different conditions.

Cognitive–behavioural therapy was effective whether it was delivered in high- or low-intensity formats. This is not to imply that CBT can be delivered in high- or low-intensity formats interchangeably. The findings simply state that when low-intensity CBT has been tested in RCTs and synthesised into reviews, we found that it improved HRQoL, anxiety and pain outcomes. This adds strength to the argument that the mechanisms by which CBT is effective remain effective when delivered via high- or low-intensity formats.

Cognitive–behavioural therapy was effective in the short and long term. However, there was a paucity of reporting on the longer-term follow-ups (i.e. > 5 years post intervention); therefore, we have not captured the importance of relapse. We highlighted in the mapping exercise that there is a paucity of systematic review evidence regarding relapse prevention; this is an essential consideration to take into account when interpreting these findings.

When we pooled reviews that compared CBT with active interventions (e.g. pharmacotherapy, psychotherapy, exercise, education or relaxation), the effect estimates became very small. We found a significant interaction in the HRQoL analyses between those reviews that compared CBT with an active comparator and those that compared CBT with an inactive comparator. This could suggest that CBT and these other active interventions share mechanisms that improve HRQoL for patients.

We assume that CBT will help children, adolescents and adults, but we are uncertain as to how much it will help older adults, as there is less available evidence for this age population. We feel confident that CBT will be equally effective for male and female participants. The evidence base over-represents people who live in Europe, North America and Australasia, and poorly reports the ethnicity of the samples in the reviews. Consequently, we do not know if the effects will translate across people of different ethnicities in Europe, North America or Australasia or, to people who live in Asia, Africa or South America.

Strengths

When an individual systematic review pools evidence across many trials, the sample sizes can remain small. Small sample sizes mean that the effect estimate is less certain. One of the major strengths of this overview is that, by pooling data from many reviews across conditions, we become more certain of the effect estimates. Our HRQoL and anxiety outcome estimates include > 4000 participants, which guidance suggests indicates a certain effect. 533

To maintain the lowest risk of bias and the greatest design homogeneity, we conducted our primary analyses with the highest-quality (rated ‘moderate’ or ‘high’ on the AMSTAR-2 checklist) reviews. The most common criticism of all the reviews was that we, as readers, could not access a review protocol to check if the authors had performed what they had intended to perform and had not simply ‘cherry-picked’ results to present in the review publication. Another common problem was reviews not reporting the reasons why they excluded trials from their review. Without this information, we cannot check if there was any bias towards including some, but not other, trials. Our sensitivity analyses suggest that the higher-quality reviews report consistent findings (less heterogeneity), compared with poorer-quality reviews, but the quality of the reviews did not alter the effect estimates.

As the inclusion of the lower-quality reviews did not alter the effect estimates, we concluded that the general effect is consistent across conditions represented by higher- and lower-quality reviews. We also suggested that the effect could be generalised to comorbid conditions represented by these reviews. Consequently, the general effect can be generalised to over half (55%) of all conditions represented in the ICD-11.

Weaknesses

The main methodological weakness was due to our restriction in remaining at the review level, as opposed to including RCT-level extraction and analysis. The mapping exercise identified 494 reviews. Of these, 279 were not included in the PMA because we could not extract the purely CBT RCT evidence. For example, a review that synthesised 10 CBT RCTs with three non-RCTs would be excluded from the PMA unless the review had presented any of the purely RCT evidence in isolation (even if it was one single RCT, which we could include). Similarly, if a review included 30 CBT RCTs combined with six mindfulness-based cognitive therapy RCTs, then this would have been excluded unless the review also presented a separate CBT subgroup analysis. The only way we would have been able to include these RCTs would have been to return to the original RCTs, extract the data and perform a meta-analysis of those data for entry into the PMA. This was a conflicting decision. The evidence base was so large that we did not have the resources to perform RCT-level extraction or analysis, but this was at the expense of many RCTs being excluded from the PMAs.

Another consequence of remaining at the review level was the limitation of the quality assessments. A review of high quality may include RCTs judged to have a high risk of bias. Without performing additional RCT-level assessment and a separate analysis of RCTs with low risks of bias, we could not restrict the data to the best-quality RCT-level data.

This overview does not examine the health economics of the CBT evidence base, which is an essential element of commissioning and is the context of evidence-based medicine. We could not perform this analysis because it was beyond the scope of this current overview.

Our method for classifying reviews was to represent each review in one ICD-11 code. We classified the review by the primary condition the CBT was being used to treat. For example, a review of CBT for depression in COPD patients was classified as a review of CBT for depression with comorbid COPD. This meant that we could not reflect the multimorbidity represented in these reviews. A total of 158 out of 494 reviews included a comorbid condition such as alcohol abuse or dementia. Our methodology means that we have under-represented the number of different conditions for which CBT has been used to improve HRQoL and reduce symptoms of depression, anxiety and pain.

We have mapped the systematic review data across each condition and by the following groups: ‘who’ (populations with different clinical severity), ‘what’ (the CBT intensity format) and ‘when’ (delivered at what time, i.e. preventatively, in response to clinical diagnosis or as a relapse prevention). We were restricted to reporting and analysing the review-level data. Reviews often combined RCTs conducted across multiple subgroups. We did not perform RCT-level exploration of the subgroups, which limits the accuracy of our findings.

Our indirect (intensity subgroup analyses) and direct (high- compared with low-intensity CBT reviews) evidence suggested no difference in effectiveness between using high-intensity and using low-intensity CBT. However, although reviews of high-intensity CBT produced broadly similar estimates of CBT’s effectiveness, the estimates from low-intensity reviews varied widely. The large variation in the low-intensity CBT estimates may be due to our definition of low-intensity CBT. 1 We combined face-to-face delivery of CBT by paraprofessionals with self-help delivery of CBT (e.g. internet CBT). Future subgroup analyses could test if these two methods of delivery moderate the effectiveness of CBT.

When a review did not report how CBT was delivered in the included trials (i.e. high- or low-intensity CBT), we assumed that it was delivered face to face by a specialist (high intensity). We made this assumption because high-intensity CBT was the original and most common delivery method. When we developed our data extraction methods, we checked the trials in reviews that did not specify the CBT intensity. We found that these trials had tested high-intensity CBT. However, we did not check the included trials for every review included in our overview; therefore, this assumption may have led to us over-representing high-intensity CBT.

We made another assumption, whereby, if a review did not specify the time when the follow-up data were collected, we presumed that it was short term (< 12 months post intervention). We made this assumption because the majority of trials employed short-term follow-ups. However, as before, this assumption may be incorrect for some reviews.

Although most reviews estimated their effects with a random-effects meta-analysis, a few used a fixed-effects approach. We made an assumption that the within-review variability had been appropriately allowed for. If this assumption was incorrect, then our results might underestimate the amount of variation within conditions.

To make a meaningful interpretation of our effect estimates, we transformed them into mean differences using the standard deviation of the target outcome measure. If the value of this standard deviation is not a good approximate to the true standard deviation for this outcome, we might be underestimating or overestimating the effect size for each outcome considered.

We used techniques, such as using workbooks to record personal reflections, in the ECG meetings to ensure that each member could contribute equally. However, the debates often became polarised between academic discussions. Nevertheless, talking to PPI representatives more informally and during breaks generated rich feedback that helped the research group. On reflection, we should have included a formal forum at the end of each ECG meeting in which every member could summarise the day’s discussion and ask specific questions.

Implications

We have high-quality systematic review evidence, which demonstrates that, in comparison to no intervention, CBT improves HRQoL, anxiety and pain outcomes by a modest amount. This includes CBT that is delivered through low- and high-intensity formats. The benefit has been consistent in every condition, population and context in which it has been tested and synthesised into a systematic review. There are some conditions and contexts in which we are less certain about generalising the estimates from the PMA. These include conditions for which there is no similar condition already included in the review (e.g. vision impairments), or if CBT is being applied in contexts that we believe will vary substantially because of, among other things, cultural issues and health beliefs.

We have used a framework of broader generalisation that has considered pathophysiological rationale alongside the traditional quality indicators used in evidence-based medicine. 534,535 The early proponents of evidence-based medicine were more subtle in their approach, and demanded that values, circumstances, expertise and even pathophysiologic rationale be considered, especially when generalising evidence from clinical trials. 536,537 The most prominent evidence-based medicine rule of evidence is the GRADE system, which does not allow any role for pathophysiologic rationale at all, even though it does allow for recommendations to populations outside the trial (generalising). 5 We suggested that using the results of the PMA alongside knowledge of mechanistic actions of CBT in particular situations may enable the generalisation of this effective treatment (CBT) to a greater range of physical and mental conditions (and hence patients).

Chapter 8 Conclusion

Cognitive–behavioural therapy can help patients cope with the challenges of living with mental and physical conditions. We have found that it consistently improves quality of life and reduces anxiety and pain symptoms for people living with many different conditions across the 19 ICD-11 categories for which we have systematic review evidence. CBT has been tested in many different populations and contexts, and all these reviews report effects that are consistent with our general effects. High- and low-intensity CBT appear to be equally effective. The biggest area of uncertainty is around whether sociological constructs, such as ethnicity, religion, culture, country or language, could moderate the effectiveness of CBT or whether it will be equally effective across these constructs. We suggest that CBT will be effective for the conditions represented in the ICD-11 codes we have represented in the overview. However, we are unclear if the general effect can be applied to conditions that are not represented at all in the overview.

Chapter 9 Recommendations

Future research

The overview suggests a general benefit of CBT in physical and mental conditions. However, we also identified some unanswered questions. These are not presented in an order of priority:

We do not know what the mediating variables for CBT’s effectiveness are, nor do we know whether or not these are different across conditions. We recommend a review or an overview of CBT mechanisms across conditions.
We do not know the longer-term effects of CBT. Reviews of CBT trials that monitor their participants over ≥ 5 years, and that account for the relapse in patients, are needed to see if the effects remain across all conditions.
We found that CBT produced a modest benefit in HRQoL, anxiety and pain outcomes. Clinical research should focus on identifying how these effects from CBT can be magnified. For example –
- Examining if the delivery of CBT can be modified to increase adherence and reduce dropouts (e.g. examining if the location of therapy delivery influences attendance rates).
- Prioritising assessments of treatment fidelity and quality to check whether or not the therapists delivering CBT are adhering to the same core CBT principles. 1 A novel method to check the content of face-to-face CBT consultations is to use artificial intelligence to monitor if a therapist has used a core CBT technique.
We were not confident to recommend that CBT would work equally for older adults because of an absence of evidence. We are aware of new reviews and existing trials that suggest that CBT will be equally effective for older adults (aged > 65 years). 538 For example, a large, recent review found that the effects for psychotherapy (including CBT) on depression outcomes were equal between adults (aged 24–55 years), older adults (aged 55–75 years) and the oldest adults (aged > 75 years old). 538
We were unsure, owing to a lack of reporting on ethnicity of trial samples, whether or not CBT would be equally effective across ethnic groups. Another review of psychotherapy (including CBT) on depression outcomes between racial/ethnic groups concluded that race/ethnicity did not moderate the effectiveness of psychotherapy. However, authors highlight the problems of defining an ethnic group and encourage future research to include country of residence, language, religion and race in a definition of ethnicity. 539
Owing to an absence of evidence of trials conducted in Africa, Asia and South America, we were unsure if the general effects of CBT would apply to people living in those countries. The overview excluded reviews not published in English. Future research could prioritise reviews of CBT that include trials conducted in Africa, Asia or South America to see if the effects are the same as they have been in Europe, North America and Australasia.

Acknowledgements

Cognitive Behavioural Therapy – Overview Expert Consultation Group (CBT-O ECG)

Bethan Copsey, Medical Statistician, School of Medicine, University of Leeds.
Roshan das Nair, Professor of Clinical Psychology, School of Medicine, University of Nottingham.
Katherine Edwards, Research Assistant, Reviews and Implementation Group, University of Liverpool.
Douglas Findlay, Patient and Public Representative, who was an ECG member and reviewed the report.
Beth Fordham, Senior Psychology Fellow, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford.
Daniel Freeman, Professor of Clinical Psychology, Department of Psychiatry, University of Oxford, who was a member of the ECG and reviewed the report.
Zara Hansen, CBT therapist specialising in pain conditions, NDORMS, University of Oxford.
Karla Hemming, Professor of Biostatistics, Institute of Applied Health Research Professor of Biostatistics, University of Birmingham.
Robert Howard, Professor of Psychiatry, Institute of Mental Health, University College London.
Jeremy Howick, Senior Fellow, Department of Philosophy, University of Oxford.
Sarah E Lamb, Mireille Gillings Professor of Health Innovation, College of Medicine and Health, University of Exeter.
Hopin Lee, Research Fellow, NDORMS, University of Oxford.
Richard Lilford, Professor and Director of National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, who was a member of the ECG.
Michael Lyle, Patient and Public Representative, who was a member of the ECG.
Paul Salkovskis, Professor of Clinical Psychology and Director for the Doctorate in Clinical Psychology, University of Oxford, who was a member of the ECG and reviewed the report.
Michael Sharpe, Professor of Psychological Medicine, Department of Psychiatry, University of Oxford.
Paul Stallard, Professor of Child and Family Mental Health, Department for Health, University of Bath.
Thavapriya Sugavanam, Research Fellow, NDORMS, University of Oxford.

Personal communications

Personal communication with Georgina MacKenzie, PROSPERO Project Manager/Research Project Support Officer, 2018 regarding operationalising the CRD guidelines.

Personal communication with Beverly Shea, developer of the AMSTAR-2 checklist, 2019, regarding the re-classification of the four AMSTAR-2 quality ratings into higher (‘high’ and ‘moderate’ AMSTAR-2 ratings) and lower quality (‘low’ and ‘critically low’ AMSTAR-2 ratings) reviews.

Contributions of authors

Dr Beth Fordham (https://orcid.org/0000-0001-5996-3563) (Senior Health Psychology Fellow) was the principal investigator and the grant holder.

Dr Thavapriya Sugavanam (https://orcid.org/0000-0002-3033-2028) (Post-doctoral Research Assistant) contributed to the protocol development, database selection, search term selection, reference management, title/abstract screening, full-text screening, data extraction, quality assessment, data analysis, interpretation and report writing.

Ms Katherine Edwards (https://orcid.org/0000-0002-1092-0092) (Research Associate) contributed to the full-text retrieval, reference management, title/abstract screening, full-text screening, data extraction, quality assessment, data analysis, interpretation and report writing.

Professor Karla Hemming (https://orcid.org/0000-0002-2226-6550) (Professor of Biostatistics) has expertise in PMA. She made a large contribution to the design, procedure, analysis, interpretation and report writing.

Dr Jeremy Howick (https://orcid.org/0000-0003-0280-7206) (Senior Fellow) has expertise in Epistemology Philosophy of Medicine. He developed the generalisation methodology and contributed to the report writing.

Dr Bethan Copsey (https://orcid.org/0000-0001-9783-6549) (Post-doctoral Research Fellow) designed and ran the PMA and contributed to the data extraction and interpretation.

Dr Hopin Lee (https://orcid.org/0000-0001-5692-0314) (Post-doctoral Research Fellow) contributed to the data analysis, interpretation and writing.

Ms Milla Kaidesoja (https://orcid.org/0000-0003-0372-8251) (HiLIFE Research Trainee) contributed to the data extraction, generalisation and interpretation.

Ms Shona Kirtley (https://orcid.org/0000-0002-7801-5777) (Senior Information Specialist) led the database search and keyword selection aspects of the overview and commented on the methods section of the final report.

Assistant Professor Sally Hopewell (https://orcid.org/0000-0002-6881-6984) (Associate Professor of Trials and Reviews) has methodology expertise and contributed to the design, procedure and interpretation.

Professor Roshan das Nair (https://orcid.org/0000-0001-8143-7893) (Professor of Clinical Psychology) contributed to the methodological design, interpretation and report writing. Professor das Nair has a special interest in cultural and minority representation.

Professor Robert Howard (https://orcid.org/0000-0002-3071-2338) (Professor of Psychiatry) was a member of the ECG and contributed to the report writing and dissemination.

Professor Paul Stallard (https://orcid.org/0000-0001-8046-0784) (Professor of Child and Family Mental Health) was a member of the ECG and contributed to the report writing and dissemination.

Ms Julia Hamer-Hunt (Patient and Public Representative) was an ECG member, reviewed the report and contributed to the plain English summary of the report.

Professor Zafra Cooper (https://orcid.org/0000-0001-7963-656X) (Professor of Psychiatry) was a member of the ECG, reviewed the report and contributed to the report writing.

Professor Sarah E Lamb (https://orcid.org/0000-0003-4349-7195) (Professor of Rehabilitation) was mentor to Dr Beth Fordham throughout the entire project. She contributed to every stage of this project from the design to the interpretation and writing.

Publication

Fordham B, Sugavanam T, Edwards K, Stallard P, Howard R, das Nair R, et al. The evidence for cognitive behavioural therapy in any condition, population or context: a meta-review of systematic reviews and panoramic meta-analysis. Psychol Med 2021;51:21–9.

Data-sharing statement

Requests for access to data should be addressed to the corresponding author.

Disclaimers

This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health and Social Care.

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Kunik ME, Veazey C, Cully JA, Souchek J, Graham DP, Hopko D, et al. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med 2008;38:385-96. https://doi.org/10.1017/S0033291707001687.
Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation; 1993.
Palermo TM, Law EF, Fales J, Bromberg MH, Jessen-Fiddick T, Tai G. Internet-delivered cognitive–behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial. Pain 2016;157:174-85. https://doi.org/10.1097/j.pain.0000000000000348.
Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behav Res Ther 2003;41:509-28. https://doi.org/10.1016/S0005-7967(02)00088-8.
Howick J, Glasziou P, Aronson JK. Can understanding mechanisms solve the problem of extrapolating from study to target populations (the problem of ‘external validity’)?. J R Soc Med 2013;106:81-6. https://doi.org/10.1177/0141076813476498.
Howick J, Glasziou P, Aronson JK. Problems with using mechanisms to solve the problem of extrapolation. Theor Med Bioeth 2013;34:275-91. https://doi.org/10.1007/s11017-013-9266-0.
López-López JA, Davies SR, Caldwell DM, Churchill R, Peters TJ, Tallon D, et al. The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis. Psychol Med 2019;49:1937-47. https://doi.org/10.1017/S003329171900120X.
National Institute for Health and Care Excellence . Depression in Adults: Recognition and Management 2009.
Guyatt GH, Oxman AD, Santesso N, Helfand M, Vist G, Kunz R, et al. GRADE guidelines. J Clin Epidemiol 2013;66:158-72. https://doi.org/10.1016/j.jclinepi.2012.01.012.
Daly J. Evidence-based Medicine and the Search for a Science of Clinical Care. Berkeley, CA: University of California Press; 2005.
Howick J. The Philosophy of Evidence-Based Medicine. Oxford: Wiley-Blackwell; 2011.
Group . EBMW. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-5. https://doi.org/10.1001/jama.1992.03490170092032.
Howick J. Exploring the asymmetrical relationship between the power of finance bias and evidence. Perspect Biol Med 2019;62:159-87. https://doi.org/10.1353/pbm.2019.0009.
Cuijpers P, Karyotaki E, Eckshtain D, Ng MY, Corteselli KA, Noma H, et al. Psychotherapy for depression across different age groups: a systematic review and meta-analysis. JAMA Psychiatry 2020;77:694-702. https://doi.org/10.1001/jamapsychiatry.2020.0164.
Ünlü Ince B, Riper H, van ‘t Hof E, Cuijpers P. The effects of psychotherapy on depression among racial-ethnic minority groups: a metaregression analysis. Psychiatr Serv 2014;65:612-17. https://doi.org/10.1176/appi.ps.201300165.
French P, Morrison AP. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis: A Treatment Approach. Chichester: John Wiley & Sons Ltd; 2004.
Shawyer F, Farhall J, Mackinnon A, Trauer T, Sims E, Ratcliff K, et al. A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behav Res Ther 2012;50:110-21. https://doi.org/10.1016/j.brat.2011.11.007.
Beck AT. Cognitive Therapy of Depression. New York, NY; 1979.
Kendall P, Choudary M, Hudson J, Webb A. The CAT Project Manual. Ardmore, PA: Workbook Publishing; 2002.
Hay P, Trefiglio R. Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev 2001;2001. https://doi.org/10.1002/14651858.CD003385.

Appendix 1 Sensitivity check papers

Amick HR, Gartlehner G, Gaynes BN, Forneris C, Asher GN, Morgan LC, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ 2015;351:h6019.

Beynon S, Soares-Weiser K, Woolacott N, Duffy S, Geddes JR. Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials. Br J Psychiatry 2008;192:5–11.

Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlof E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther 2018;47:1–18.

Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med 2008;31:169–77.

de Arellano MA, Lyman DR, Jobe-Shields L, George P, Dougherty RH, Daniels AS, et al. Trauma-focused cognitive–behavioral therapy for children and adolescents: assessing the evidence. Psychiatr Serv 2014;65:591–602.

Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 2008;165:179–87.

Farah WH, Alsawas M, Mainou M, Alahdab F, Farah MH, Ahmed AT, et al. Non-pharmacological treatment of depression: a systematic review and evidence map. Evid Based Med 2016;21:214–21.

Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG. Psychological treatments for fibromyalgia: a meta-analysis. Pain 2010;151:280–95.

Hesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioural therapy for tinnitus distress. Clin Psychol Rev 2011;31:545–53.

Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008;69:621–32.

Hundt NE, Barrera TL, Robinson A, Cully JA. A systematic review of cognitive behavioral therapy for depression in veterans. Mil Med 2014;179:942–9.

James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2013;6:CD004690.

Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev 2012;4:CD008712.

Kavanagh J, Oliver S, Lorenc T, Caird J, Tucker H, Harden A, et al. School-based cognitive–behavioural interventions: a systematic review of effects and inequalities. Health Sociol Rev 2009;18:61–78.

Kim JH. [A meta-analysis of effects of job stress management interventions (SMIs).] Taehan Kanho Hakhoe Chi 2007;37:529–39.

Leichsenring F, Leibing E. The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 2003;160:1223–32.

Okajima I, Komada Y, Inoue Y. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythm 2011;9:24–34.

Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 2015;3:CD011565.

Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2014;1:CD009125.

O'Toole MS, Zachariae R, Renna ME, Mennin DS, Applebaum A. Cognitive behavioral therapies for informal caregivers of patients with cancer and cancer survivors: a systematic review and meta-analysis. Psycho-Oncology 2017;26:428–37.

Pallesen S, Mitsem M, Kvale G, Johnsen BH, Molde H. Outcome of psychological treatments of pathological gambling: a review and meta-analysis. Addiction 2005;100:1412–22.

Pearson FS, Lipton DS, Cleland CM, Yee DS. The effects of behavioral/cognitive-behavioral programs on recidivism. Crime Delinq 2002;48:476–96.

Peng XD, Huang CQ, Chen LJ, Lu ZC. Cognitive behavioural therapy and reminiscence techniques for the treatment of depression in the elderly: a systematic review. J Int Med Res 2009;37:975–82.

Pineros-Leano M, Liechty JM, Piedra LM. Latino immigrants, depressive symptoms, and cognitive behavioral therapy: a systematic review. J Affect Disord 2017;208:567–76.

Powers MB, Vedel E, Emmelkamp PM. Behavioral couples therapy (BCT) for alcohol and drug use disorders: a meta-analysis. Clin Psychol Rev 2008;28:952–62.

Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2001;189:278–87.

Richmond H, Hall AM, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N, et al. The effectiveness of cognitive behavioural treatment for non-specific low back pain: a systematic review and meta-analysis. PLOS One 2015;10:e0134192.

Santacruz I, Orgiles M, Rosa AI, Sanchez-Meca J, Mendez X, Olivares J. [Generalized anxiety, separation anxiety and school phobia: the predominance of cognitive–behavioural therapy.] Psicologia Conductual 2002;10:503–21.

Shinohara K, Honyashiki M, Imai H, Hunot V, Caldwell DM, Davies P, et al. Behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2013;10:CD008696.

Smith SM, Sonego S, Ketcheson L, Larson JL. A review of the effectiveness of psychological interventions used for anxiety and depression in chronic obstructive pulmonary disease. BMJ Open Respir Res 2014;1:e000042.

Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 2011;31:839–49.

Soo S, Moayyedi P, Deeks J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2004;1:CD002301.

Taylor S, Asmundson GJG, Coons MJ. Current directions in the treatment of hypochondriasis. J Cogn Psychother 2005;19:285–304.

Thompson-Brenner HJ. Implications for the Treatment of Bulimia Nervosa: A Meta-analysis of Efficacy Trials and a Naturalistic Study of Treatment in the Community. PhD thesis. Ann Arbor, MI: University of Michigan; 2002.

van Dessel N, den Boeft M, van der Wouden JC, Kleinstauber M, Leone SS, Terluin B, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev 2014;11:CD011142.

van Straten A, Geraedts A, Verdonck-de Leeuw I, Andersson G, Cuijpers P. Psychological treatment of depressive symptoms in patients with medical disorders: a meta-analysis. J Psychosom Res 2010;69:23–32.

Appendix 2 Detailed search strategies for review

MEDLINE

Database and platform

Ovid MEDLINE^® Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE^® Daily and Ovid MEDLINE^®, 1946 to present.

Search filter

Scottish Intercollegiate Guidelines Network systematic review search filter for MEDLINE (via Ovid) [www.sign.ac.uk/search-filters.html (accessed February 2019)].

Date search was conducted

Original: 25 April 2018 (for publication years 1992 to present) (2967 references).

Updated: 30 January 2019 (for publication years 2018–19) (359 references).

Search strategy

(cognitive adj2 behavio?r adj3 (therap$ or theor$ or intervention$ or train$ or treatment$ or psychotherap$ or programme$ or program$ or method$ or approach$)).ti,ab,kw.
(cognitive adj2 behavio?ral adj3 (therap$ or theor$ or intervention$ or train$ or treatment$ or psychotherap$ or programme$ or program$ or method$ or approach$)).ti,ab,kw.
CBT.ti,ab,kw.
Cognitive Therapy/
or/1-4
Meta-Analysis as Topic/
meta analy$.tw.
metaanaly$.tw.
Meta-Analysis/
(systematic adj (review$1 or overview$1)).tw.
exp Review Literature as Topic/
or/6-11
cochrane.ab.
embase.ab.
(psychlit or psyclit).ab.
(psychinfo or psycinfo).ab.
(cinahl or cinhal).ab.
science citation index.ab.
bids.ab.
cancerlit.ab.
or/13-20
reference list$.ab.
bibliograph$.ab.
hand-search$.ab.
relevant journals.ab.
manual search$.ab.
or/22-26
selection criteria.ab.
data extraction.ab.
28 or 29
Review/
30 and 31
Comment/
Letter/
Editorial/
animal/
human/
36 and 37
36 not 38
or/33-35,39
12 or 21 or 27 or 32
41 not 40
5 and 42
limit 43 to yr = ‘1992-2018’.

EMBASE

Database and platform

Embase, 1974–2018, week 17 (via Ovid).

Search filter

The SIGN systematic review filter for EMBASE (via Ovid) [www.sign.ac.uk/search-filters.html (accessed February 2019)].

Date search was conducted

Original: 25 April 2018 (for publication years 1992 to present) (4862 references).

Update: 30 January 2019 (for publication years 2018–19) (192 references).

Search strategy

(cognitive adj2 behavio?r adj3 (therap$ or theor$ or intervention$ or train$ or treatment$ or psychotherap$ or programme$ or program$ or method$ or approach$)).ti,ab,kw.
(cognitive adj2 behavio?ral adj3 (therap$ or theor$ or intervention$ or train$ or treatment$ or psychotherap$ or programme$ or program$ or method$ or approach$)).ti,ab,kw.
CBT.ti,ab,kw.
Cognitive Therapy/
exp Cognitive Behavioral Therapy/
or/1-5
exp Meta Analysis/
((meta adj analy$) or metaanalys$).tw.
(systematic adj (review$1 or overview$1)).tw.
or/7-9
cancerlit.ab.
cochrane.ab.
embase.ab.
(psychlit or psyclit).ab.
(psychinfo or psycinfo).ab.
(cinahl or cinhal).ab.
science citation index.ab.
bids.ab.
or/11-18
reference list$.ab.
bibliograph$.ab.
hand-search$.ab.
relevant journals.ab.
manual search$.ab.
or/20-24
selection criteria.ab.
data extraction.ab.
26 or 27
review.pt.
28 and 29
Letter.pt.
Editorial.pt.
animal/
human/
33 and 34
33 not 35
or/31-32,36
10 or 19 or 25 or 30
38 not 37
6 and 39
limit 40 to yr = ‘1992-2018’.

Cumulative Index to Nursing and Allied Health Literature

Database and platform

CINAHL (via EBSCOhost).

Search filter

The SIGN systematic review filter for CINAHL (via EBSCOhost) [www.sign.ac.uk/search-filters.html (accessed February 2019)].

Date search was conducted

Original: 25 April 2018 (for publication years 1992 to present) (1062 references).

Update: 30 January 2019 (for publication years 2018–19) (174 references).

Search strategy

(TI (cognitive N2 behaviour N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB (cognitive N2 behaviour N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI (cognitive N2 behavior N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB (cognitive N2 behavior N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI (cognitive N2 behavioural N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB (cognitive N2 behavioural N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI cognitive N2 behavioral N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB cognitive N2 behavioral N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI ‘CBT’) OR (AB ‘CBT’)
(MH ‘Cognitive Therapy’) OR (SU ‘Cognitive Therapy’)
S1 OR S2 OR S3 OR S4 OR S5 OR S6
(MH Meta Analysis)
(TX ‘meta analys*’)
(TX ‘metaanaly*’)
(MH ‘Literature Review+’)
(TX systematic N1 (review or overview))
S8 OR S9 OR S10 OR S11 OR S12
(PT ‘Commentary’)
(PT ‘Letter’)
(PT ‘Editorial’)
(MH Animals)
S14 OR S15 OR S16 OR S17
S13 NOT S18
S7 AND S19
PY 1992-2018
S20 AND S21

PsycINFO

Database and platform:

PsycINFO, 1967 to April week 2 2018 (via Ovid).

Search filter

McMaster Hedges Maximises Specificity Systematic Review filter for PsycINFO (via Ovid) (modified) [https://hiru.mcmaster.ca/hiru/HIRU_Hedges_PsycINFO_Strategies.aspx#Reviews (accessed February 2019)].

Date search was conducted

Original: 27 April 2018 (for publication years 1992 to present) (2190 references).

Update: 30 January 2019 (for publication years 2018–19) (150 references).

Search strategy

(cognitive adj2 behavio?r adj3 (therap$ or theor$ or intervention$ or train$ or treatment$ or psychotherap$ or programme$ or program$ or method$ or approach$)).ti,ab.
(cognitive adj2 behavio?ral adj3 (therap$ or theor$ or intervention$ or train$ or treatment$ or psychotherap$ or programme$ or program$ or method$ or approach$)).ti,ab.
CBT.ti,ab.
Cognitive Behavior Therapy/
or/1-4
meta-analy$.tw.
systematic review.md.
meta analysis.md.
search:.tw.
or/6-9
5 and 10
limit 11 to yr = ‘1992-2018’

Notes

The McMaster Hedges Maximises Specificity Systematic Review filter for PsycINFO was modified in the following way:

Changed ‘meta-analysis.tw.’ to ‘meta-analy$.tw.’
Added ‘systematic review.md.’ and ‘meta analysis.md.’

This was to account for known missing papers with ‘meta-analyses’ or ‘meta-analytic’ in the abstract and for papers that do not use ‘search’ (e.g. where ‘retrieval’ or ‘databases surveyed’ is used). If the papers are systematic reviews or reviews, they should be assigned the methodology heading (‘.md.’).

Cochrane Database of Systematic Reviews

Database and platform

Cochrane Database of Systematic Reviews [via The Cochrane Library: http://cochranelibrary-wiley.com/cochranelibrary/search/ (accessed May 2020)].

Date search was conducted

Original: 26 April 2018 (for publication years 1992 to present) (176 references).

Update: 30 January 2019 (for publication years 2018–19) (20 references).

Search strategy

(cognitive next/2 behaviour* next/3 therap*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 theor*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 intervention*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 train*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 treatment*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 psychotherap*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 programme*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 program*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 method*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behaviour* next/3 approach*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 therap*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 theor*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 intervention*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 train*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 treatment*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 psychotherap*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 programme*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 program*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 method*):ti,ab,kw in Cochrane Reviews (Reviews only)
(cognitive next/2 behavior* next/3 approach*):ti,ab,kw in Cochrane Reviews (Reviews only)
‘CBT’:ti,ab,kw in Cochrane Reviews (Reviews only)
[mh ‘Cognitive Therapy’] in Cochrane Reviews (Reviews only)
#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22
#23 Publication Year from 1992 to 2018

Database of Abstracts of Reviews of Effects

Database and platform

Database of Abstracts of Reviews of Effect [via The Cochrane Library: https://cochranelibrary-wiley.com/cochranelibrary/search/ (accessed May 2020)].

Date search was conducted

Original: 26 April 2018 (for publication years 1992 to present) (610 references).

Update: no updated search on DARE as no longer updated.

Search strategy

cognitive next/2 behaviour* next/3 therap*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 theor*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 intervention*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 train*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 treatment*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 psychotherap*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 programme*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 program*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 method*:ti,ab,kw in Other Reviews
cognitive next/2 behaviour* next/3 approach*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 therap*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 theor*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 intervention*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 train*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 treatment*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 psychotherap*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 programme*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 program*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 method*:ti,ab,kw in Other Reviews
cognitive next/2 behavior* next/3 approach*:ti,ab,kw in Other Reviews
‘CBT’:ti,ab,kw in Other Reviews
[mh ‘Cognitive Therapy’] in Other Reviews
#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22
#23 Publication Year from 1992 to 2018.

Child Development and Adolescent Studies

Database and platform

Child Development and Adolescent Studies (via EBSCOhost).

Date search was conducted

Original: 25 April 2018 (for publication years 1992 to present) (177 references).

Update: 30 January 2019 (for publication years 2018–19) (21 references).

Search strategy

(TI (cognitive N2 behaviour N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB (cognitive N2 behaviour N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AS (cognitive N2 behaviour N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI (cognitive N2 behavior N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB (cognitive N2 behavior N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AS (cognitive N2 behavior N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI (cognitive N2 behavioural N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB (cognitive N2 behavioural N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AS (cognitive N2 behavioural N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI cognitive N2 behavioral N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AB cognitive N2 behavioral N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*)) OR (AS cognitive N2 behavioral N3 (therap* or theor* or intervention* or train* or treatment* or psychotherap* or programme* or program* or method* or approach*))
(TI ‘CBT’) OR (AB ‘CBT’) OR (DE ‘CBT’)
(DE ‘Cognitive Therapy’) OR (SU ‘Cognitive Therapy’)
(DE ‘Cognitive-behavioral therapy’) OR (DE ‘Cognitive behavioral therapy’) OR (DE ‘Cognitive-behavioural therapy’) OR (DE ‘Cognitive behavioural therapy’) OR (DE ‘Cognitive-behavior therapy’) OR (DE ‘Cognitive behavior therapy’) OR (DE ‘Cognitive-behaviour therapy’) OR (DE ‘Cognitive behaviour therapy’)
(DE ‘BEHAVIOR therapy’) OR (SU ‘BEHAVIOR therapy’) OR (DE ‘BEHAVIOUR therapy’) OR (SU ‘BEHAVIOUR therapy’) OR (DE ‘BEHAVIORAL therapy’) OR (SU ‘BEHAVIORAL therapy’) OR (DE ‘BEHAVIOURAL therapy’) OR (SU ‘BEHAVIOURAL therapy’)
S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8
(DE ‘SYSTEMATIC reviews (Medical research)’) OR (DE ‘systematic review’) OR (SU ‘SYSTEMATIC reviews (Medical research)’) OR (DE ‘review’)
(DE ‘META-analysis’) OR (SU ‘META-analysis’)
(DE ‘Literature Review’)
(TX ‘metaanaly*’)
(TX ‘meta analy*’)
(TX systematic N3 (review or overview))
S10 OR S11 OR S12 OR S13 OR S14 OR S15
S9 AND S16
DT 1992-2018
S17 AND S18.

OpenGrey

Database and platform

OpenGrey [via www.opengrey.eu/ (accessed February 2019)].

Date search was conducted

Original: 26 April 2018 (295 references).

Update: 30 January 2019 (0 references).

Search strategy

‘cognitive behavioral’ OR ‘cognitive behavioural’ OR ‘cognitive behavior’ OR ‘cognitive behaviour’ OR ‘CBT’.

Appendix 3 Data extraction form for mapping

ID, identification; N, no; NR, not reported; PANSS, Positive and Negative Syndrome Scale; PDF, Portable Document Format; RoB, risk of bias; Y, yes.
Data extraction	Notes
Review ID (surname, year)
Reviewer completing form
Date completed
Reference citation (first author, title, journal, volume, issue)
Published in last 5 years (Y/N)
Aim of the review
Design of included studies [RCT n = [participants n = ]]
Any risk-of-bias tool employed (Y/N) [Detail]	RoB not just quality assessment tool. Report the actual tool used in ‘details’
Primary health problem	Report ICD-11 for every health problem reported
Secondary health problem
Severity (mild, moderate, severe, NR)	Select one or many or ‘unclear’
Age categories [number of RCTs]	Select one or many of children, adolescents, adults, older adults or ‘not reported’ or ‘unclear’
Other characteristics reported: (1) gender, (2) ethnicity, (3) other specific/unique information	Report top-level information on (1) gender (2) ethnicity and (3) if available other information (but do not need to search)
Where recruited [number of RCTs]	Report as the review has reported: clinic, university, internet, etc
When delivered [number of RCTs]	Drop-down list [(1) preventative (2) preventative for relapse (3) early intervention (4) standard treatment (5) mixed (6) not reported (7) other (standard treatment is the norm, the others are if review specifies a target)]
Countries included [number of RCTs]
CBT high/low/combined: description of CBT	High intensity: formal psychotherapy delivered by relatively specialist psychological therapist Low intensity: guided self-help – books, internet, structured exercise, brief interventions can be with relevantly trained individual
CBT overall: number of sessions, duration and frequency	As much as is available in the review. Can synthesise ourselves but only at this top level
CBT content description 1 [number of RCTs/total RCTs]	Report high-intensity intervention first then low intensity
CBT description 2 [number of RCTs/total]	Complete for every type of CBT category the review includes
CBT description 3 [number of RCTs/total]
CBT description 4 [number of RCTs/total]
CBT description 5 [number of RCTs/total]
Control description 1 [number of RCTs]	If review synthesises all non-active/active together, then extract as such; if reported as separate control groups, then we can extract as such and then later we will combine
Control description 2 [number of RCTs]
Control description 3 [number of RCTs]
Control description 4 [number of RCTs]
Control description 5 [number of RCTs]
Other details	Only most pertinent information if required
HRQoL category	Choose (1) category, (2) category but no data available, (3) not measured. If HRQoL emerges at individual RCT level, then we extract (but only for HRQoL)
How measured [name(s) of instruments/method]	Specific name of outcome
When measured [pegged time point?]	Short (majority < 12 months), long (majority ≥ 12 months) or ‘unclear’ [if the review reports where the follow-up time points are pegged to, i.e. post randomisation, post intervention, then report]
Number of RCTs [number of participants]	Number of RCTs [number of participants]
Meta-analysis [Y/N]	If no meta-analysis, please report the direction of results (i.e. in favour or not in favour of CBT)
Depression category	Choose (1) category, (2) category but no data available, (3) not measured
How measured [name(s) of instruments/method]	Specific name of outcome
When measured [pegged time point?]	Short (majority < 12 months), long (majority ≥ 12 months) or ‘unclear’ [if the review reports where the follow-up time points are pegged to, i.e. post randomisation, post intervention, then report]
Number of RCTs [number of participants]	Number of RCTs [number of participants]
Meta-analysis [Y/N]	If no meta-analysis, please report the direction of results (i.e. in favour or not in favour of CBT)
Anxiety category	Choose (1) category (2) category but no data available (3) not measured
How measured [name(s) of instruments/method]	Specific name of outcome
When measured [pegged time point?]	Short (majority < 12 months), long (majority ≥ 12 months) or ‘unclear’ [if the review reports where the follow-up time points are pegged to, i.e. post randomisation, post intervention, then report]
Number of RCTs [number of participants]	Number of RCTs [number of participants]
Meta-analysis [Y/N]	If no meta-analysis, please report the direction of results (i.e. in favour or not in favour of CBT)
Physical/physiological category	Choose (1) category, (2) category but no data available, (3) not measured
How measured [name(s) of instruments/method]	Specific name of outcome
When measured [pegged time point?]	Short (majority < 12 months), long (majority ≥ 12 months) or ‘unclear’ [if the review reports where the follow-up time points are pegged to, i.e. post randomisation, post intervention, then report]
Number of RCTs [number of participants]	Number of RCTs [number of participants]
Meta-analysis [Y/N]	If no meta-analysis, please report the direction of results (i.e. in favour or not in favour of CBT)
Psychosis category	Choose (1) category, (2) category but no data available, (3) not measured
How measured [name(s) of instruments/method]	Specific name of outcome
When measured [pegged time point?]	Short (majority < 12 months), long (majority ≥ 12 months) or ‘unclear’ [if the review reports where the follow-up time points are pegged to, i.e. post randomisation, post intervention, then report]
Number of RCTs [number of participants]	Number of RCTs [number of participants]
Meta-analysis [Y/N]	If no meta-analysis, please report the direction of results (i.e. in favour or not in favour of CBT)
All other outcomes reported in review	List format e.g. (1) PANSS psychosis
Overall	See AMSTAR-2 PDF21
Mechanism data	Extraction of entire section ‘How the intervention might work’ (for Cochrane reviews), or similar (other reviews), and/or direct data: namely changes to beliefs such as self-efficacy or hypotheses for mechanisms such as presented in the discussions
Acceptability
Satisfaction
Adverse effects
Economic analyses

Appendix 4 The AMSTAR-2 checklist

Reproduced from Shea et al. 4 with permission. Copyright © 2017, BMJ Publishing Group Ltd. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.

(PDF download)

Appendix 5 Data extraction form for the panoramic meta-analysis

MD, mean difference; S/MD, standardised or mean difference.
Meta-analysis details
HRQoL
GRADE or equivalent
Intervention vs. control group
Age group
When measured
Name of outcome instrument	Specific name of instrument on which meta-analysis was conducted
Number of RCTs
Continuous SMD or MD [S/MD post or S/MD of change] (± favours intervention or not)
Number of participants
S/MD (effect size) and type [95% CI]	Hedges or Cohen (± favours intervention or not)
I ²
Fixed or random effects
Reference
Depression
GRADE or equivalent
Intervention vs. control group
Age group
Name of outcome instrument
When measured
Number of RCTs
Binary OR or RR (± favours intervention or not)
Number of participants
Number of events
OR/RR [95% CI]
I ²
Fixed or random effects
Continuous SMD or MD [S/MD post or S/MD of change] (± favours intervention or not)
Number of participants
S/MD (effect size) and type [95% CI]
I ²
Fixed or random effects
Reference
Anxiety
GRADE or equivalent
Intervention vs. control group
Age group
Name of outcome instrument
When measured
Number of RCTs
Binary OR or RR (± favours intervention or not)
Number of participants
Number of events
OR/RR [95% CI]
I ²
Fixed or random effects
Continuous SMD or MD [S/MD post or S/MD of change] (± favours intervention or not)
Number of participants
S/MD (effect size) and type [95% CI]
I ²
Fixed or random effects
Reference
Physical/physiological
GRADE or equivalent
Intervention vs. control group
Age group
When measured
Name of outcome instrument
Number of RCTs
Binary OR or RR (± favours intervention or not)
Number of participants
Number of events
OR/RR [95% CI]
I ²
Fixed or random effects
Continuous SMD or MD [S/MD post or S/MD of change] (± favours intervention or not)
Number of participants
S/MD (effect size) and type [95% CI]
I ²
Fixed or random effects
Reference
Psychosis
GRADE or equivalent
Intervention vs. control group
Age group
Name of outcome instrument
When measured
Number of RCTs
Binary OR or RR (± favours intervention or not)
Number of participants
Number of events
OR/RR [95% CI]
I ²
Fixed or random effects
Continuous SMD or MD (± favours intervention or not)
Number of participants
S/MD (effect size) and type [95% CI]
I ²
Fixed or random effects
Reference

Appendix 6 References to studies excluded at the full-text screening stage, with reasons for exclusion

Studies excluded because no English full text or translation available (n = 237)

Abdel-Baki A, Nicole L. [Schizophrenia and cognitive–behavioural therapy (CBT).] Can J Psychiatry 2001;46:511–21.

Aghaie E, Abedi A, Paghale SJ. [Meta-analysis of the effectiveness of cognitive–behavior interventions in the reduction 3 of test anxiety in Iran.] Iran J Psychiatry Clin Psychol 2012;18:3–12.

Ahmadnia E, Haseli A, Karamat A. [Therapeutic interventions conducted on improving women’s sexual satisfaction and function during reproductive ages in Iran: a systematic review.] J Mazandaran Univ Med Sci 2017;27:146–62.

Ahonen S, Kivela SL. [Effects of cognitive and behavioral treatments on primary insomnia in old age.] Duodecim 2010;126:794–802.

Albert U, Barbaro F, Aguglia A, Maina G, Bogetto F. [Combined treatments in obsessive–compulsive disorder: current knowledge and future prospects.] Riv Psichiatr 2012;47:255–68.

Algar MJM, Garcia PB. [Approach to anxiety in patients diagnosed with cancer.] Psicooncologia 2016;13:227–48.

Almeida Lima Junior N, Lopes Paes DG, Belchior Pontes GC, Gomes Sancho A, da Silva Rosa JL, Dias Faria ÁC. Possíveis impactos do transtorno de ansiedade social no processo de envelhecimento. Fisioterap Bras 2018;19:577–81.

Almeida AM, Lotufo Neto F. [Cognitive–behavioral therapy in prevention of depression relapses and recurrences: a review.] Rev Bras Psiquiatr 2003;25:239–44.

Ambresin G, De Roten Y, Despland JN. [Psychotherapy of depression in primary care.] Schweiz Arch Neurol Psychiatr 2016;167:147–54.

Andanson J, Pourre F, Maffre T, Raynaud JP. [Social skills training groups for children and adolescents with Asperger syndrome: a review.] Arch Pediatr 2011;18:589–96.

Arteriole N. [Cognitive–Behavioral Therapy in Bipolar Disorder.] PhD thesis. Caen: Université de Caen Normandie & Université de Caen UFR de médecine; 2013.

Auclair V, Harvey PO, Lepage M. [Cognitive behavioral therapy and the treatment of ADHD in adults.] Sante Ment Que 2016;41:291–311.

Bacaltchuk J, Hay P. [Treatment of bulimia nervosa: a synthesis of evidence.] Rev Bras Psiquiatr 1999;21:184–7.

Banti S, Borri C, Montagnani MS, Cargioli C, Belli S, Cotugno B, et al. [Premenstrual disphoric disorder: an update.] J Psychopathol 2012;18:261–72.

Barreto EMDP, Elkis H. [Evidences from the efficacy of the cognitive behavior therapy on schizophrenia.] Rev Psiquiatr Clin 2007;34:204–7.

Baum E, Maisel P, Dorr C, Donner-Banzhoff N. [Update of the DEGAM-guideline fatigue: new developments and recommendations.] Z Allgemeinmed 2012;88:133–7.

Beelmann A, Schneider N. [The effects of psychotherapy with children and adolescents. A review and meta-analysis of German-language research.] Z klin Psychol Psychotherap 2003;32:129–43.

Belanger L, Vallieres A, Morin CM. [Insomnia and the increased use of sleeping pills among the elderly: problems and alternative therapy.] Can Fam Physician 2006;52:968–73.

Bellino S, Zizza M, Di Lorenzo R, Paradiso E, Falakfarsa R, Fulcheri M, et al. [Combined therapy of major depressive disorder: a critical review.] Italian J Psychopathol 2002;8:401–16.

Bellver Perez A, Moreno P. [Psychosocial risks and psychological intervention in the transplanted bone marrow patients.] Psicooncologia 2009;6:65–81.

Blanca-Gutierrez JJ, Jimenez-Diaz MDC, Escalera-Franco LF. [Effective interventions to reduce absenteeism among hospital nurses.] Gac Sanit 2013;27:545–51.

Block I, Loeber S. [Evidence-based psychotherapy of addictive disorders.] Nervenarzt 2018;89:283–9.

Bomba J. [Research on psychotherapy effectiveness in treatment of mental and behavioural disorders in children and adolescents.] Psychoterapia 2010:37–47.

Bornas X, Rodrigo T, Barcelo F, Toledo M. [New technologies in cognitive-behavioral therapy: a review.] Int J Clin Health Psychol 2002;2:533–41.

Boschi M, Santandrea S, Vanti C. [Efficacy of cognitive behavioural therapy in non-specific neck pain: a systematic review.] Sci Riabil 2010;12:5–15.

Bottlender M, Kohler J, Soyka M. [The effectiveness of psychosocial treatment approaches for alcohol dependence – a review.] Fortschr Neurol Psychiatr 2006;74:19–31.

Boudebesse C, Henry C. [Emotional hyper-reactivity and sleep disturbances in remitted patients with bipolar disorders.] Encephale 2012;38:S173–S8.

Brandao T, Mena Matos P. [Efficacy of psychological group interventions for women with breast cancer: a systematic review.] Rev Port Saude Publica 2015;33:98–106.

Brown RC. [Psychotherapeutic interventions for suicidal adolescents – a systematic review of the current literature.] Z Kind Jugendpsychiatr Psychotherap 2017;45:499–508.

Bruun Wyller V, Bjorneklett A, Brubakk O, Festvag L, Follestad I, Malt U, et al. [Diagnosis and Treatment of Chronic Fatigue Syndrome/Myalgic Encephalopathy (CFS/ME).] Report from Knowledge Centre No. 9. Oslo: National Knowledge Centre for Health Services at the Norwegian Institute of Public Health (NIPH); 2006.

Calzolari L, Fioravanti G. [A comparison between acceptance and commitment therapy and cognitive behavioural therapy: a review of literature.] Psicoter Cogn Comportamental 2016;22:103–17.

Caselli G, Manfredi C, Ruggiero GM, Sassaroli S. [Cognitive behavioural therapy for anxiety disorders: a review of efficacy studies.] Psicoter Cogn Comportamental 2016;22:81–101.

Castelein S, Knegtering H, Van Meijel B, Van Der Gaag M. [Dutch guideline on Schizophrenia 2012: basic care within the areas of psychosocial interventions and nursing care.] Tijdschr Psychiatr 2013;55:707–14.

Cavadas LF, Ribeiro L. [Management of adult secondary insomnia in primary health care.] Acta Med Port 2011;24:135–44.

Copanitsanou P, Sourtzi P. [The effect of educational interventions for the reduction of nursing staff’s occupational stress: systematic review.] Nosileftiki 2016;55:250–62.

Cuijpers P, Dekker J. [Psychological treatment of depression; a systematic review of meta-analyses.] Nederlands Tijdschr Geneesk 2005;149:1892–7.

Daga G, Quaranta M, Notaro G, Urani C, Amianto F, Fassino S. [Family therapy and eating disorders in young female patients: state of the art.] Ital J Psychopathol 2011;17:40–7.

Dahm KT, Landmark B, Kirkehei I, Reinar LM. [The Effects of School Health Services for Children and Young People’s Health and Growing Up Conditions.] Report from Knowledge Centre No. 17. Oslo: National Knowledge Centre for Health Services at the Norwegian Institute of Public Health (NIPH); 2010.

Dahm KT, Smedslund G, Havelsrud K, Hafstad E, Reinar LM. [Psychological Interventions for Children and Youth with Serious Somatic Illness in Primary Care.] Report from Knowledge Centre No.10. Oslo: National Knowledge Centre for Health Services at the Norwegian Institute of Public Health (NIPH); 2014.

de Almeida AM, Lotufo Neto F. [Cognitive–behavioral therapy in prevention of depression relapses and recurrences: a review.] Rev Bras Psiquiatr 2003;25:239–44.

de Carvalho MR, Nardi AE, Range B. [Comparison between cognitive, behavioral and cognitive–behavioral approaches in the treatment of panic disorder.] Rev Psiquiatr Clin 2008;35:66–73.

de Cerqueira ACR, Nardi AE. [Depression and multiple sclerosis: on overview.] Rev Bras Neurol 2011;47:11–6.

de Haan E, Huyser C, Boer F. [Obsessive–compulsive disorder in children and adolescents.] Tijdschr Psychiatr 2005;47:229–38.

de Haan L, Bakker JM. [Effectivity of individual psychotherapy in schizophrenia. A review of recent studies.] Tijdschr Psychiatr 2000;42:751–8.

Deffieux X, Billecocq S, Demoulin G, Rivain AL, Trichot C, Thubert T. [Pelvic floor rehabilitation for female urinary incontinence: mechanisms of action.] Progr Urol 2013;23:491–501.

Ding Y. [A review of the psychological characteristics and intervention of patients with malignant tumor before and atter treatment.] J Clin Rehabil Tissue Eng Res 2007;11:7951–4.

Dingemans AE, Bruna MJ, Van Furth EF. [Binge eating disorder. A review.] Tijdschr Psychiatr 2001;43:321–31.

Doerr JP, Hajak G, Riemann D. [Pharmacotherapy of primary insomnia – efficacy, effectiveness and safety of various therapeutic options.] Psycho Neuro 2008;34:86–93.

dos Reis E, Camargo Novelli MMP, Fernandes Guerra RL. Intervenções realizadas com grupos de cuidadores de idosos com síndrome demencial: revisão sistemática. Cad Bras Terap Ocup 2018;26:646–57.

Driessen E, Cuijpers P, Hollon SD, Van HL, Dekker JJM. [The efficacy of psychological treatments for depression: a review of recent research findings.] Tijdschr Psychiatr 2014;56:455–62.

Ducasse D, Denis H. [Pathological nighttime fears in children: clinical specificities and effective therapeutics.] Encephale 2015;41:323–31.

Duchesne M, Appolinario JC, Range BP, Freitas S, Papelbaum M, Coutinho W. [Evidence of cognitive–behavioral therapy in the treatment of obese patients with binge eating disorder.] Rev Psiquiatr Rio Grande Sul 2007;29:80–92.

박 수 인, 김 연 지, 오 의. 만성적인 신체질환을 가진 환자의 우울 감소를 위한 전화기반 인지행동치료의 효과: 메타분석. J Kor Acad Psychiatr Ment Health Nurs 2018;27:227–39.

김지현, 오복자. 수면장애가 있는 중장년 환자에게 적용한 비약물적 중재의 효과: 메타분석. Kor Adult Nurs 2016;28:13–29.

Elisha D, Karny N, Styr BB. [Psychotherapy – outcome studies and guidelines for evidence-based care policy in Israel.] Harefuah 2011;150:269–74, 302.

Espanol Armengol N, Mijan De La Torre A. [Eating disorders in obesity.] Rev Esp Obes 2006;4:317–27.

Fagiolo D, Berardelli I. [Use of cognitive–behavioural techniques in the treatment of headaches: a systematic review of the last 10-years’ literature.] Med Psicosomat 2007;52:117–24.

Faller H, Herschbach P. [Psychooncological interventions – how successful are they?] Nervenheilkunde 2011;30:133–7.

Fan RM, Yang L. [Progress in clinical treatment of insomnia.] Chin J Clin Rehabil 2006;10:149–51.

Fernandes PA, de Carvalho MR. [Neurobiological changes after cognitive–behavioral therapy of obsessive–compulsive disorder.] Psicologia: Teoria e Pesquisa 2016;32:1–9.

Fischer-Terworth C, Probst P, Glanzmann PG, Knorr CC. [Psychological interventions in dementia: an evaluative review.] Z Psychiatr Psycholog Psychotherap 2009;57:195–206.

Flores-Valdez IH, Leon-Santos MP, Vera-Hernandez E, del Rocio Hernandez Pozo M. [Psychological interventions on stress management and reduction for hypertensive patients: a review of their effectiveness.] Psychologia: Avances de la Disciplina 2013;7:25–44.

Fodor KE, Bitter I. [Psychological interventions following trauma to prevent posttraumatic stress disorder: a systematic review of the literature.] Orvosi Hetilap 2015;156:1321–4.

Foldes-Busque G, Marchand A, Landry P. [Early detection and treatment of panic disorder with or without agoraphobia.] Can Fam Physician 2007;53:1686–93.

Fond G, Franc N. [Treating specific childhood phobia in a single session? A systematic review of the literature.] Encephale 2013;39:109–14.

Fritsche G, Kroner-Herwig B, Kropp P, Niederberger U, Haag G. [Psychological therapy of migraine: systematic review.] Schmerz 2013;27:263–74.

Fu L, Wu MB, Hu Y. [Influence of cognitive behavioural therapy on depression, medication adherence and quality of life in people living with HIV/AIDS (PLHIV): a systematic review.] Chin J Evid Based Med 2014;14:734–42.

Gärtner-Tschacher N. [The effectiveness of combined active physiotherapy and cognitive, behavioural or cognitive–behavioural therapy approaches in patients with musculoskeletal pain.] Manuelle Therapie 2005;9:11–34.

Gai X-S, Lan G-R, Liu X-P. [A meta-analytic review on treatment effects of attention deficit/hyperactivity disorder children in China.] Acta Psychol Sin 2009;40:1190–6.

Gajdos P, Rigo A. [Irritable bowel syndrome: comorbid psychiatric disorders and psychological treatment options.] Orvosi Hetilap 2018;159:2115–21.

Galindo-Vazquez O, Perez-Barrientos H, Alvarado-Aguilar S, Rojas-Castillo E, Alvarez-Avitia MA, Aguilar-Ponce JL. [Cognitive behavioral therapy effects in cancer patients: a review.] Gaceta Mexicana de Oncologia 2013;12:108–15.

Garcia-Perez L, Valdivia-Salas S. [Acceptance and commitment therapy for social anxiety disorder: a systematic review.] Behav Psychol 2018;26:37–92.

Garcia-Torres F, Alos FJ, Perez-Duenas C. [Posttraumatic stress disorder in cancer survivors: a review of the psychological treatments available.] Psicooncologia 2015;12:293–301.

Garcia-Vera MP, Moreno N, Sanz J, Gutierrez S, Gesteira C, Zapardiel A, et al. [Efficacy and clinical utility (effectiveness) of treatments for adult victims of terrorist attacks: a systematic review.] Behavioral Psychology/Psicologia Conductual: Revista Internacional Clinica y de la Salud 2015;23:215–44.

Garcia-Vera MP, Sanz J. [Analysis of the situation of treatments for smoking cessation based on cognitive–behavioral therapy and nicotine patches.] Psicooncologia 2006;3:269–89.

Gellato C. [Eye Movement Desensitization and Reprocessing and Cognitive–Behavioral Therapy in the Treatment of Adult’s Post Traumatic Syndrome Disorder.] PhD thesis. Marseille: Université d’Aix-Marseille II; 2009.

Gomes JB, Matte BC, Vivan A, Viana A, Bortoncello CF, Salum GA, et al. [Cognitive behavioral therapy with family intervention for children and adolescents with obsessive compulsive disorder: a systematic review.] Rev Psiquiatr Rio Grande Sul 2011;33:121–7.

Gomez Puente JM, Martinez-Marcos M. [Overweight and obesity: effectiveness of interventions in adults.] Enfermeria Clin 2018;28:65–74.

Gonzalez Larrabe I, Torre Mollinedo F, Telletxea Benguria S, Arizaga Maguregi A. [Update in the multidisciplinary treatment of fibromyalgia.] Dolor 2008;23:194–206.

Groschwitz RC, Plener PL. [Psychotherapeutic interventions for non-suicidal self-injury.] Nervenheilkunde 2013;32:30–6.

Gunthner A, Batra A. [Prevention of burnout by stress management.] Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2012;55:183–9.

Guzman GAR, Lemus CAD, Garcia RR, Agraz FP. [Cognitive behavioral therapy for binge eating disorder: a review.] Psiquiatria 2005;21.

Haidl TK, Rosen M, Ruhrmann S, Klosterkotter J. [Social anxiety in individuals with clinical high-risk state for psychosis.] Fortschritte der Neurologie-Psychiatrie 2018;87:284–97.

Hauser W, Bernardy K. [Psychotherapeutic procedures for fibromyalgia syndrome.] Z Rheumatol 2015;74:584–90.

Hautzinger M, Meyer TD. [Psychotherapy for bipolar disorder: a systematic review of controlled studies.] Nervenarzt 2007;78:1248–60.

Hautzinger M, Wetzel H, Scheurich A, Mainz Univ, Saarland Univ, Rostock Univ, et al. [Serotonin 1A-agonist and Cognitive Behavior Therapy in Relapse Prevention of Alcoholics. Evaluation of Efficacy of Different Treatment Modalities and their Combination.] 2001.

Hautzinger M. [Behavioural therapy with affective and neurological disorders in the elderly.] Verhaltenstherapie & Verhaltensmedizin 2002;23:195–212.

Heckrath VC, Dohmen P. [On the empirical foundation of the highly significant superiority of the cognitive–behavior compared with the psychoanalytically oriented psychotherapies.] Z Psychosomat Med Psychoanal 1997;43:179–201.

Hendriks GJ, Keijsers GPJ, Kampman M, Verbraak MJPM, Broekman TG, Hoogduin CAL, et al. [Treatment of anxiety disorders in the elderly.] Tijdschrift voor Psychiatrie 2011;53:589–95.

Herr L, Mingebach T, Becker K, Christiansen H, Kamp-Becker I. [A systematic review of the effectiveness of parent-based interventions for children aged two to twelve years.] Kindheit Entwicklung: Z Klin Kinderpsychol 2015;24:6–19.

Hess M, Wirtz S, Allroggen M, Scheithauer H. [Intervention and therapy for perpetrators and victims of bullying: a systematic review.] Prax Kinderpsychol Kinderpsychiatr 2017;66:740–55.

Hilbert A, Brahler E. [Interpersonal psychotherapy for eating disorders: a systematic and practical review.] Verhaltenstherapie 2012;22:149–57.

Hirjak D, Bechdolf A, Thomann PA, Thiemann U, Wolf RC. [Prevention of psychosis.] Nervenheilkunde 2012;31:923–32.

Hua Y, Dai J. [Studies on occupational stress intervention in workplaces abroad: a systematic review.] Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2015;33:759–64.

Huang F-F, Li Z-J, Han H-Y, Xiong H-F, Ma Y. [Cognitive behavioral therapy combined with pharmacotherapy for obsessive compulsive disorder: a meta-analysis.] Chin Ment Health J 2013;27:643–9.

한수연, 황지혜, 김초희, 장혜영, 방경숙. 소아암 환자의 형제자매 중재에 관한 연구논문의 체계적 문헌고찰. Child Health Nurs Res 2017;23:394–404.

Isolan L, Pheula G, Manfro GG. [Treatment of social anxiety disorder in children and adolescents.] Rev Psiquiatr Clin 2007;34:125–32.

Jakle C, Basler HD. [Change of cognition in psychological pain therapy: a meta-analysis of the cognitive–behavioral mode.] Z klin Psychol Psychotherap 2000;29:127–39.

Jank R, Pieh C. [Efficacy and evidence base of group psychotherapy for depressive disorders.] Psychotherapie Forum 2016;21:62–71.

Jelonkiewicz I. [Psychotherapy of gambling – how to effectively treat gamblers? The effectivenes of applied therapeutic methods.] Psychoterapia 2014;2:31–41.

Juge C, Tubert-Jeannin S. [Effects of hypnosis in dental care.] Presse Medicale 2013;42:e114–e24.

Kamaradova D, Prasko J, Grambal A, Diveky T, Latalova K, Silhan P. [Pharmacoresistance in patients with panic disorder.] Psychiatrie 2012;16:150–6.

Kapfhammer H-P. [The relationship between depression, anxiety and heart disease – a psychosomatic challenge.] Psychiatr Danub 2011;23:412–25.

Kapusta ND, Fegert JM, Haring C, Plener PL. [Psychotherapeutic interventions for suicidal adolescents.] Psychotherapeut 2014;59:16–23.

Karjalainen P, Santalahti P, Sihvo S. [Are programs supporting parenthood skills effective in the prevention and reduction of conduct disorders and problems of childhood?] Duodecim 2016;132:967–74.

Kim JH. [A meta-analysis of effects of job stress management interventions (SMIs).] Taehan Kanho Hakhoe Chi 2007;37:529–39.

Kim Y, Park I, Park JS. [Meta-analysis of effects on adolescent smoking cessation programs in Korea.] Taehan Kanho Hakhoe Chi 2008;38:204–16.

Kirk I, Leiknes KA, Laru L, Hammerstrom KT, Bramness JG, Grawe RW, et al. [Dual Diagnoses – Severe Mental Illness and Substance Use Disorder. Part 2 – Effect of Psychosocial Interventions.] Report from Knowledge Centre No. 25. Oslo: National Knowledge Centre for Health Services at the Norwegian Institute of Public Health (NIPH); 2008.

Kirste U, Haugstad GK, Leganger S, Blomhoff S, Malt UF. [Chronic pelvic pain in women.] Tidsskr Nor Laegeforen 2002;122:1223–7.

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Studies excluded because no cognitive–behavioural therapy randomised controlled trial summary (n = 520)

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Brooks AT, Wallen GR. Sleep disturbances in individuals with alcohol-related disorders: a review of cognitive–behavioral therapy for insomnia (CBT-I) and associated non-pharmacological therapies. Subst Abuse 2014;8:55–62. https://doi.org/10.4137/SART.S18446

Brown RC, Witt A, Fegert JM, Keller F, Rassenhofer M, Plener PL. Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychol Med 2017;47:1893–905. https://doi.org/10.1017/S0033291717000496

Browne C, Smith IC. Psychological interventions for anger and aggression in people with intellectual disabilities in forensic services. Aggress Violent Behav 2018;39:1–14.

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Brunwasser SM, Gillham JE, Kim ES. A meta-analytic review of the Penn Resiliency Program’s effect on depressive symptoms. J Consult Clin Psychol 2009;77:1042–54. https://doi.org/10.1037/a0017671

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Carolan S, Harris PR, Cavanagh K. Improving employee well-being and effectiveness: systematic review and meta-analysis of web-based psychological interventions delivered in the workplace. J Med Internet Res 2017;19:e271. https://doi.org/10.2196/jmir.7583

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Chambers CT, Taddio A, Uman LS, McMurtry CM, HELPinKIDS Team. Psychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review. Clin Ther 2009;31(Suppl. 2):77–103. https://doi.org/10.1016/j.clinthera.2009.07.023

Chambers D, Bagnall AM, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med 2006;99:506–20.

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Chan EK-H. Efficacy of Cognitive–Behavioral, Pharmacological, and Combined Treatments of Depression: A Meta-analysis. PhD thesis. Calgary, AB: University of Calgary; 2006.

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Turner DT, McGlanaghy E, Cuijpers P, van der Gaag M, Karyotaki E, MacBeth A. A meta-analysis of social skills training and related interventions for psychosis. Schizophr Bull 2018;44:475–91. https://doi.org/10.1093/schbul/sbx146

Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2013;10:CD005179. https://doi.org/10.1002/14651858.CD005179.pub3

Ung D, Selles R, Small BJ, Storch EA. A systematic review and meta-analysis of cognitive–behavioral therapy for anxiety in youth with high-functioning autism spectrum disorders. Child Psychiatry Hum Dev 2015;46:533–47. https://doi.org/10.1007/s10578-014-0494-y

Unwin G, Tsimopoulou I, Kroese BS, Azmi S. Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: a review of the literature. Res Dev Disabil 2016;51–52:60–75. https://doi.org/10.1016/j.ridd.2015.12.010

Vallarino M, Henry C, Etain B, Gehue LJ, Macneil C, Scott EM, et al. An evidence map of psychosocial interventions for the earliest stages of bipolar disorder. Lancet Psychiatry 2015;2:548–63. https://doi.org/10.1016/S2215-0366(15)00156-X

Vally Z, Maggott C. Evaluating the outcome of cultural adaptations of cognitive–behavioural therapy for adult depression: a meta-analysis of treatment studies in developing countries. Int J Adv Counsel 2015;37:293–304.

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van Koulil S, Effting M, Kraaimaat FW, van Lankveld W, van Helmond T, Cats H, et al. Cognitive–behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann Rheum Dis 2007;66:571–81.

van Straten A, Geraedts A, Verdonck-de Leeuw I, Andersson G, Cuijpers P. Psychological treatment of depressive symptoms in patients with medical disorders: a meta-analysis. J Psychosom Res 2010;69:23–32. https://doi.org/10.1016/j.jpsychores.2010.01.019

van Straten A, van der Zweerde T, Kleiboer A, Cuijpers P, Morin CM, Lancee J. Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis. Sleep Med Rev 2018;38:3–16.

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van Zoonen K, Buntrock C, Ebert DD, Smit F, Reynolds CF, Beekman AT, Cuijpers P. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. Int J Epidemiol 2014;43:318–29. https://doi.org/10.1093/ije/dyt175

Vasa RA, Carroll LM, Nozzolillo AA, Mahajan R, Mazurek MO, Bennett AE, et al. A systematic review of treatments for anxiety in youth with autism spectrum disorders. J Autism Dev Disord 2014;44:3215–29. https://doi.org/10.1007/s10803-014-2184-9

Verdejo-Garcia A, Alcazar-Corcoles MA, Albein-Urios N. Neuropsychological interventions for decision-making in addiction: a systematic review. NeuropsycholRev 2018;26:26.

Vereenooghe L, Langdon PE. Psychological therapies for people with intellectual disabilities: a systematic review and meta-analysis. Res Dev Disabil 2013;34:4085–102. https://doi.org/10.1016/j.ridd.2013.08.030

Visser E, Gosens T, Den Oudsten BL, De Vries J. The course, prediction, and treatment of acute and posttraumatic stress in trauma patients: a systematic review. J Trauma Acute Care Surg 2017;82:1158–83. https://doi.org/10.1097/TA.0000000000001447

von der Embse N, Barterian J, Segool N. Test anxiety interventions for children and adolescents: a systematic review of treatment studies from 2000–2010. Psychol Schools 2013;50:57–71.

Wadephul F, Jones C, Jomeen J. The impact of antenatal psychological group interventions on psychological well-being: a systematic review of the qualitative and quantitative evidence. Healthcare 2016;4:E32. https://doi.org/10.3390/healthcare4020032

Walczak M, Ollendick T, Ryan S, Esbjørn BH. Does comorbidity predict poorer treatment outcome in pediatric anxiety disorders? An updated 10-year review. Clin Psychol Rev 2018;60:45–61.

Waldron B, Casserly LM, O’Sullivan C. Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury: what works for whom? Neuropsychol Rehabil 2013;23:64–101. https://doi.org/10.1080/09602011.2012.724196

Waldron HB, Turner CW. Evidence-based psychosocial treatments for adolescent substance abuse. J Clin Child Adolesc Psychol 2008;37:238–61. https://doi.org/10.1080/15374410701820133

Wan Mohd Yunus WMA, Musiat P, Brown JSL. Systematic review of universal and targeted workplace interventions for depression. Occup Environ Med 2018;75:66–75. https://doi.org/10.1136/oemed-2017-104532

Wang L, Chang Y, Kennedy SA, Hong PJ, Chow N, Couban RJ, et al. Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials. Br J Anaesth 2018;120:1304–14.

Wang MY, Wang SY, Tsai PS. Cognitive behavioural therapy for primary insomnia: a systematic review. J Adv Nurs 2005;50:553–64.

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Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull 2006;132:132–49.

Weitlauf AS, McPheeters ML, Peters B, Sathe N, Travis R, Aiello R, et al. Therapies for Children with Autism Spectrum Disorder: Behavioural Interventions Update. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

Werner-Seidler A, Johnston L, Christensen H. Digitally-delivered cognitive–behavioural therapy for youth insomnia: a systematic review. Internet Interv 2018;11:71–8. https://doi.org/10.1016/j.invent.2018.01.007

Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics 2003;111:e1–11. https://doi.org/10.1542/peds.111.1.e1

Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramírez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA 2001;286:1360–8.

Williams S, Dale J. The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 2006;94:372–90.

Wilson DB, Bouffard LA, Mackenzie DL. A quantitative review of structured, group-oriented, cognitive–behavioral programs for offenders. Crim Justice Behav 2005;32:172–204.

Wolpert M, Dalzell K, Ullman R, Garland L, Cortina M, Hayes D, et al. Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness. Lancet Psychiatry 2019;6:46–60.

Wu Y, Lang Z, Zhang H. Efficacy of cognitive–behavioral therapy in pediatric obsessive–compulsive disorder: a meta-analysis. Med Sci Monit 2016;22:1646–53.

Yang B, Xu J, Xue Q, Wei T, Xu J, Ye C, et al. Non-pharmacological interventions for improving sleep quality in patients on dialysis: systematic review and meta-analysis. Sleep Med Rev 2015;23:68–82. https://doi.org/10.1016/j.smrv.2014.11.005

Yang S, Sajatovic M, Walter BL. Psychosocial interventions for depression and anxiety in Parkinson’s disease. J Geriatr Psychiatry Neurol 2012;25:113–21. https://doi.org/10.1177/0891988712445096

Yatham S, Sivathasan S, Yoon R, Da Silva T, Ravindran AV, Levitt SE. Depression and anxiety disorders in child and adolescent populations in low and middle income countries: a review. Ann Glob Health 2017;83:87.

Ye YY, Chen NK, Chen J, Liu J, Lin L, Liu YZ, et al. Internet-based cognitive–behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open 2016;6:e010707. https://doi.org/10.1136/bmjopen-2015-010707

Ye YY, Zhang YF, Chen J, Liu J, Li XJ, Liu YZ, et al. Internet-based cognitive behavioral therapy for insomnia (ICBT-i) improves comorbid anxiety and depression-a meta-analysis of randomized controlled trials. PLOS ONE 2015;10:e0142258. https://doi.org/10.1371/journal.pone.0142258

Yeh ML, Chung YC, Hsu MYF, Hsu CC. Quantifying psychological distress among cancer patients in interventions and scales: a systematic review topical collection on cancer pain. Curr Pain Headache Rep 2014;18:399.

Ying L, Wu LH, Loke AY. The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review. J Assist Reprod Genet 2016;33:689–701. https://doi.org/10.1007/s10815-016-0690-8

Yohannes AM, Caton S. Management of depression in older people with osteoarthritis: a systematic review. Aging Ment Health 2010;14:637–51. https://doi.org/10.1080/13607860903483094

Yohannes AM, Junkes-Cunha M, Smith J, Vestbo J. Management of dyspnea and anxiety in chronic obstructive pulmonary disease: a critical review. J Am Med Dir Assoc 2017;18:1096.e1–1096.e17.

Yoon IA, Slade K, Fazel S. Outcomes of psychological therapies for prisoners with mental health problems: a systematic review and meta-analysis. J Consult Clin Psychol 2017;85:783–802. https://doi.org/10.1037/ccp0000214

Zantvoord JB, Diehle J, Lindauer RJ. Using neurobiological measures to predict and assess treatment outcome of psychotherapy in posttraumatic stress disorder: systematic review. Psychother Psychosom 2013;82:142–51. https://doi.org/10.1159/000343258

Zhou SG, Hou YF, Liu D, Zhang XY. Effect of cognitive behavioral therapy versus interpersonal psychotherapy in patients with major depressive disorder: a meta-analysis of randomized controlled trials. Chin Med J 2017;130:2844–51. https://doi.org/10.4103/0366-6999.219149

Zhou X, Hetrick SE, Cuijpers P, Qin B, Barth J, Whittington CJ, et al. Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: a systematic review and network meta-analysis. World Psychiatry 2015;14:207–22. https://doi.org/10.1002/wps.20217

Zimmermann G, Favrod J, Trieu VH, Pomini V. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005;77:1–9.

Zimmermann P, Muhlig S, Sonntag D, Buhringer G, Wittchen HU. Review on psychotherapeutic interventions for cannabis disorders. Sucht 2004;50:334–42.

Studies excluded because of broad definition of cognitive–behavioural therapy (n = 119)

Álvarez-Jiménez M, Hetrick SE, González-Blanch C, Gleeson JF, McGorry PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2008;193:101–7. https://doi.org/10.1192/bjp.bp.107.042853

Amick HR, Gartlehner G, Gaynes BN, Forneris C, Asher GN, Morgan LC, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ 2015;351:h6019. https://doi.org/10.1136/bmj.h6019

Andersson G, Nordgren LB, Buhrman M, Carlbring P. Psychological treatments for depression delivered via the internet and supported by a clinician: an update. Rev Psicopatol Psicol Clin 2014;19:217–25.

Arnberg A, Ost LG. CBT for children with depressive symptoms: a meta-analysis. Cogn Behav Ther 2014;43:275–88. https://doi.org/10.1080/16506073.2014.947316

Barlow J, Smailagic N, Huband N, Roloff V, Bennett C. Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev 2014;5:CD002020. https://doi.org/10.1002/14651858.CD002020.pub4

Barrera TL, Mott JM, Hofstein RF, Teng EJ. A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder. Clin Psychol Rev 2013;33:24–32. https://doi.org/10.1016/j.cpr.2012.09.005

Battagliese G, Caccetta M, Luppino OI, Baglioni C, Cardi V, Mancini F, Buonanno C. Cognitive–behavioral therapy for externalizing disorders: a meta-analysis of treatment effectiveness. Behav Res Ther 2015;75:60–71. https://doi.org/10.1016/j.brat.2015.10.008

Bennett K, Manassis K, Walter SD, Cheung A, Wilansky-Traynor P, Diaz-Granados N, et al. Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis. Depress Anxiety 2013;30:829–41. https://doi.org/10.1002/da.22099

Bighelli I, Huhn M, Schneider-Thoma J, Krause M, Reitmeir C, Wallis S, et al. Response rates in patients with schizophrenia and positive symptoms receiving cognitive behavioural therapy: a systematic review and single-group meta-analysis. BMC Psychiatry 2018;18:380. https://doi.org/10.1186/s12888-018-1964-8

Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev 2013;12:CD003388. https://doi.org/10.1002/14651858.CD003388.pub4

Burns AM, Erickson DH, Brenner CA. Cognitive–behavioral therapy for medication-resistant psychosis: a meta-analytic review. Psychiatr Serv 2014;65:874–80. https://doi.org/10.1176/appi.ps.201300213

Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, et al. Manifestations and management of chronic insomnia in adults. Evid Rep Technol Assess 2005;125:1–10.

Chung KF, Lee CT, Yeung WF, Chan MS, Chung EW, Lin WL. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract 2018;35:365–75. https://doi.org/10.1093/fampra/cmx122

Chung KF, Lee CT, Yeung WF, Chan MS, Chung EW, Lin WL. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract 2017;29:29.

Cooper K, Gregory JD, Walker I, Lambe S, Salkovskis PM. Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behav Cogn Psychother 2017;45:110–23. https://doi.org/10.1017/S1352465816000527

Crepaz N, Passin WF, Herbst JH, Rama SM, Malow RM, Purcell DW, Wolitski RJ, HIV/AIDS Prevention Research Synthesis Team. Meta-analysis of cognitive–behavioral interventions on HIV-positive persons’ mental health and immune functioning. Health Psychol 2008;27:4–14. https://doi.org/10.1037/0278-6133.27.1.4

Cristea IA, Stefan S, Karyotaki E, David D, Hollon SD, Cuijpers P. The effects of cognitive behavioral therapy are not systematically falling: a revision of Johnsen and Friborg (2015). Psychol Bull 2017;143:326–40.

Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJ. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 2016;15:245–58. https://doi.org/10.1002/wps.20346

Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G. Psychological treatment of generalized anxiety disorder: a meta-analysis. Clin Psychol Rev 2014;34:130–40. https://doi.org/10.1016/j.cpr.2014.01.002

Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med 2008;31:169–77. https://doi.org/10.1007/s10865-007-9144-1

Cuijpers P, Straten A, Warmerdam L. Are individual and group treatments equally effective in the treatment of depression in adults: a meta-analysis. Eur J Psychiatry 2008;22:38–51.

Cuijpers P, van Straten A, Warmerdam L, Andersson G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety 2009;26:279–88. https://doi.org/10.1002/da.20519

Cuijpers P, van Straten A, Smit F, Mihalopoulos C, Beekman A. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. Am J Psychiatry 2008;165:1272–80. https://doi.org/10.1176/appi.ajp.2008.07091422

De Los Reyes A. Identifying Evidence-based Interventions Using the Range of Possible Changes Model: A Meta-analytic Illustration. PhD thesis. New Haven, CT: Yale University; 2008.

Dickens C, Cherrington A, Adeyemi I, Roughley K, Bower P, Garrett C, et al. Characteristics of psychological interventions that improve depression in people with coronary heart disease: a systematic review and meta-regression. Psychosom Med 2013;75:211–21. https://doi.org/10.1097/PSY.0b013e31827ac009

Diehle J, Schmitt K, Daams JG, Boer F, Lindauer RJ. Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: a meta-analysis. J Trauma Stress 2014;27:257–64. https://doi.org/10.1002/jts.21924

Dissanayake RK, Bertouch JV. Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: a systematic review. Int J Rheum Dis 2010;13:324–34. https://doi.org/10.1111/j.1756-185X.2010.01563.x

Dorrepaal E, Thomaes K, Hoogendoorn AW, Veltman DJ, Draijer N, van Balkom AJ. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review. Eur J Psychotraumatol 2014;5:23613. https://doi.org/10.3402/ejpt.v5.23613

Eccleston C, Palermo TM, Fisher E, Law E. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2012;8:CD009660. https://doi.org/10.1002/14651858.CD009660.pub2

Feng CY, Chu H, Chen CH, Chang YS, Chen TH, Chou YH, et al. The effect of cognitive behavioral group therapy for depression: a meta-analysis 2000-2010. Worldviews Evid Based Nurs 2012;9:2–17.

Fentz HN, Arendt M, O’Toole MS, Hoffart A, Hougaard E. The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis. Behav Res Ther 2014;60:23–33. https://doi.org/10.1016/j.brat.2014.06.003

Filges T, Jorgensen A-MK. Cognitive–behavioral therapies for young people in outpatient treatment for nonopioid drug use. Res Soc Work Pract 2018;28:363–85.

Flint J, Cuijpers P, Horder J, Koole S, Munafo M. Is there an excess of significant findings in published studies of psychotherapy for depression? Psychol Med 2015;45:439–46.

Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas IK, Oldervoll L, et al. Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psycho-Oncology 2011;20:909–18. https://doi.org/10.1002/pon.1844

Forti-Buratti MA, Saikia R, Wilkinson EL, Ramchandani PG. Psychological treatments for depression in pre-adolescent children (12 years and younger): systematic review and meta-analysis of randomised controlled trials. Eur Child Adolesc Psychiatry 2016;25:1045–54. https://doi.org/10.1007/s00787-016-0834-5

Furukawa TA, Noma H, Caldwell DM, Honyashiki M, Shinohara K, Imai H, et al. Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatr Scand 2014;130:181–92. https://doi.org/10.1111/acps.12275

Furukawa TA, Watanabe N, Omori IM, Churchill R. Can pill placebo augment cognitive–behavior therapy for panic disorder? BMC Psychiatry 2007;7:73.

Furukawa TA, Weitz ES, Tanaka S, Hollon SD, Hofmann SG, Andersson G, et al. Initial severity of depression and efficacy of cognitive–behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials. Br J Psychiatry 2017;210:190–6. https://doi.org/10.1192/bjp.bp.116.187773

Galsworthy-Francis L, Allan S. Cognitive Behavioural Therapy for anorexia nervosa: a systematic review. Clin Psychol Rev 2014;34:54–72. https://doi.org/10.1016/j.cpr.2013.11.001

Garg S, Garg D, Turin TC, Chowdhury MF. Web-based interventions for chronic back pain: a systematic review. J Med Internet Res 2016;18:e139. https://doi.org/10.2196/jmir.4932

Gartlehner G, Gaynes BN, Amick HR, Asher G, Morgan LC, Coker-Schwimmer E, et al. Nonpharmacological Versus Pharmacological Treatments for Adult Patients with Major Depressive Disorder. Comparative Effectiveness Review No. 161. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

Ghahramanlou M. Cognitive Behavioral Treatment Efficacy for Anxiety Disorders: A Meta-analytic Review. PhD thesis. New Jersey: Fairleigh Dickinson University; 2003.

Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med 2017;110:404–10. https://doi.org/10.1177/0141076817731904

Gould RL, Coulson MC, Howard RJ. Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc 2012;60:1817–30. https://doi.org/10.1111/j.1532-5415.2012.04166.x

Gracie DJ, Irvine AJ, Sood R, Mikocka-Walus A, Hamlin PJ, Ford AC. Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017;2:189–99.

Haby MM, Donnelly M, Corry J, Vos T. Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: a meta-regression of factors that may predict outcome. Aust N Z J Psychiatry 2006;40:9–19.

Harrington R, Whittaker J, Shoebridge P, Campbell F. Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. BMJ 1998;316:1559–63.

Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Hazell P, et al. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2016;5:CD012189. https://doi.org/10.1002/14651858.CD012189

Hesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clin Psychol Rev 2011;31:545–53. https://doi.org/10.1016/j.cpr.2010.12.006

Ho FY, Chan CS, Tang KN. Cognitive–behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: a meta-analysis of randomized controlled trials. Clin Psychol Rev 2016;43:90–102. https://doi.org/10.1016/j.cpr.2015.09.005

Ho FY, Chung KF, Yeung WF, Ng TH, Kwan KS, Yung KP, Cheng SK. Self-help cognitive–behavioral therapy for insomnia: a meta-analysis of randomized controlled trials. Sleep Med Rev 2015;19:17–28. https://doi.org/10.1016/j.smrv.2014.06.010

Hockenhull JC, Whittington R, Leitner M, Barr W, McGuire J, Cherry MG, et al. A systematic review of prevention and intervention strategies for populations at high risk of engaging in violent behaviour: update 2002–8. Health Technol Assess 2012;16(3). https://doi.org/10.3310/hta16030

Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008;69:621–32.

Honyashiki M, Furukawa TA, Noma H, Tanaka S, Chen P, Ichikawa K, et al. Specificity of CBT for depression: a contribution from multiple treatments meta-analyses. Cogn Ther Res 2014;38:249–60.

Hopkinson MD, Reavell J, Lane DA, Mallikarjun P. Cognitive behavioral therapy for depression, anxiety, and stress in caregivers of dementia patients: a systematic review and meta-analysis. Gerontologist 2018;24:24.

Hunot V, Churchill R, Silva de Lima M, Teixeira V. Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev 2007;1:CD001848. https://doi.org/10.1002/14651858.CD001848.pub4

Iniesta-Sepúlveda M, Rosa-Alcázar AI, Sánchez-Meca J, Parada-Navas JL, Rosa-Alcázar Á. Cognitive–behavioral high parental involvement treatments for pediatric obsessive–compulsive disorder: a meta-analysis. J Anxiety Disord 2017;49:53–64.

Ishikawa SI, Okajima I, Matsuoka H, Sakano Y. Cognitive behavioural therapy for anxiety disorders in children and adolescents: a meta-analysis. Child Adolesc Ment Health 2007;12:164–72. https://doi.org/10.1111/j.1475-3588.2006.00433.x

Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2015;5:CD008729. https://doi.org/10.1002/14651858.CD008729.pub2

Jauhar S, McKenna PJ, Radua J, Fung E, Salvador R, Laws KR. Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry 2014;204:20–9. https://doi.org/10.1192/bjp.bp.112.116285

Jonas DE, Cusack K, Forneris CA, Wilkins TM, Sonis J, Middleton JC, et al. Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD). Rockville, MD: Agency for Healthcare Research and Quality; 2013.

Jónsson H, Hougaard E. Group cognitive behavioural therapy for obsessive–compulsive disorder: a systematic review and meta-analysis. Acta Psychiatr Scand 2009;119:98–106. https://doi.org/10.1111/j.1600-0447.2008.01270.x

Kaddour L, Kishita N, Schaller A. A meta-analysis of low-intensity cognitive behavioral therapy-based interventions for dementia caregivers [published online ahead of print November 12 2018]. Int Psychogeriatr 2018. https://doi.org/10.1017/S1041610218001436

Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technol Assess 2002;6(22). https://doi.org/10.3310/hta6220

Kampmann IL, Emmelkamp PM, Morina N. Meta-analysis of technology-assisted interventions for social anxiety disorder. J Anxiety Disord 2016;42:71–84. https://doi.org/10.1016/j.janxdis.2016.06.007

Keles S, Idsoe T. A meta-analysis of group cognitive behavioral therapy (CBT) interventions for adolescents with depression. J Adolesc 2018;67:129–39.

Kishita N, Hammond L, Dietrich CM, Mioshi E. Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. Int Psychogeriatr 2018;30:1679–96. https://doi.org/10.1017/S1041610218000947

Kwon OY, Ahn HS, Kim HJ, Park KW. Effectiveness of cognitive behavioral therapy for caregivers of people with dementia: a systematic review and meta-analysis. J Clin Neurol 2017;13:394–404. https://doi.org/10.3988/jcn.2017.13.4.394

Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: a systematic review and meta-analysis. Clin Psychol Rev 2017;51:142–52.

Le LK, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders: a systematic review and meta-analysis. Clin Psychol Rev 2017;53:46–58.

Lee M, Ryoo JH, Chung M, Anderson JG, Rose K, Williams IC. Effective interventions for depressive symptoms among caregivers of people with dementia: a systematic review and meta-analysis [published online ahead of print January 12 2019]. Dementia 2019. https://doi.org/10.1177/1471301218822640

Liu J, Gill NS, Teodorczuk A, Li ZJ, Sun J. The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: a meta-analysis of randomized controlled trials. J Affect Disord 2019;245:98–112.

Lo K, Waterland J, Todd P, Gupta T, Bearman M, Hassed C, Keating JL. Group interventions to promote mental health in health professional education: a systematic review and meta-analysis of randomised controlled trials. Adv Health Sci Educ Theory Pract 2018;23:413–47. https://doi.org/10.1007/s10459-017-9770-5

Lutgens D, Gariepy G, Malla A. Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. Br J Psychiatry 2017;210:324–32. https://doi.org/10.1192/bjp.bp.116.197103

Maag JW, Swearer SM, Toland MD. Cognitive–Behavioral Interventions for Depression in Children and Adolescents: Meta-analysis, Promising Programs, and Implications for School Personnel. York: Centre for Reviews and Dissemination, University of York; 2009.

Maddock JE. Statistical Power and Effect Size in the Field of Health Psychology. PhD thesis. Kingston, RI: University of Rhode Island; 2000.

Martinez Devesa P, Waddell A, Perera R, Theodoulou M. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2007;1:CD005233.

Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2010;8:CD005233.

Mello PG, Silva GR, Donat JC, Kristensen CH. An update on the efficacy of cognitive–behavioral therapy, cognitive therapy, and exposure therapy for posttraumatic stress disorder. Int J Psychiatry Med 2013;46:339–57. https://doi.org/10.2190/PM.46.4.b

Menon V, Rajan TM, Kuppili PP, Sarkar S. Cognitive behavior therapy for medically unexplained symptoms: a systematic review and meta-analysis of published controlled trials. Indian J Psychol Med 2017;39:399–406. https://doi.org/10.4103/IJPSYM.IJPSYM_17_17

Montero-Marin J, Garcia-Campayo J, López-Montoyo A, Zabaleta-Del-Olmo E, Cuijpers P. Is cognitive–behavioural therapy more effective than relaxation therapy in the treatment of anxiety disorders? A meta-analysis. Psychol Med 2018;48:1427–36. https://doi.org/10.1017/S0033291717003099

Morina N, Koerssen R, Pollet TV. Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clin Psychol Rev 2016;47:41–54. https://doi.org/10.1016/j.cpr.2016.05.006

Muresan V, Montgomery GH, David D. Emotional outcomes and mechanisms of change in online cognitive–behavioral interventions: a quantitative meta-analysis of clinical controlled studies. J Technol HumServ 2012;30:1–13.

Nardi B, Laurenzi S, Di Nicolò M, Bellantuono C. Is the cognitive–behavioral therapy an effective intervention to prevent the postnatal depression? A critical review. Int J Psychiatry Med 2012;43:211–25. https://doi.org/10.2190/PM.43.3.b

Nenova M, Morris L, Paul L, Li Y, Applebaum A, DuHamel K. Psychosocial interventions with cognitive-behavioral components for the treatment of cancer-related traumatic stress symptoms: a review of randomized controlled trials. J Cogn Psychother 2013;27:258–84. https://doi.org/10.1891/0889-8391.27.3.258

Newton-Howes G, Wood R. Cognitive behavioural therapy and the psychopathology of schizophrenia: systematic review and meta-analysis. Psychol Psychother 2013;86:127–38. https://doi.org/10.1111/j.2044-8341.2011.02048.x

Ng QX, Venkatanarayanan N, Kumar L. A systematic review and meta-analysis of the efficacy of cognitive behavioral therapy for the management of pediatric migraine. Headache 2017;57:349–62. https://doi.org/10.1111/head.13016

Nosè M, Ballette F, Bighelli I, Turrini G, Purgato M, Tol W, et al. Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: systematic review and meta-analysis. PLOS ONE 2017;12:e0171030. https://doi.org/10.1371/journal.pone.0171030

Nüesch E, Häuser W, Bernardy K, Barth J, Jüni P. Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Ann Rheum Dis 2013;72:955–62. https://doi.org/10.1136/annrheumdis-2011-201249

Okajima I, Inoue Y. Efficacy of cognitive behavioral therapy for comorbid insomnia: a meta-analysis. Sleep Biol Rhythm 2018;16:21–35.

Olatunji BO, Kauffman BY, Meltzer S, Davis ML, Smits JA, Powers MB. Cognitive–behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behav Res Ther 2014;58:65–74. https://doi.org/10.1016/j.brat.2014.05.002

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Philipp R, Kriston L, Lanio J, Kuhne F, Harter M, Moritz S, et al. Effectiveness of metacognitive interventions for mental disorders in adults – a systematic review and meta-analysis (METACOG). Clin Psychol Psychother 2018;19:19.

Phyo AZZ, Demaneuf T, De Livera AM, Jelinek GA, Brown CR, Marck CH, et al. The efficacy of psychological interventions for managing fatigue in people with multiple sclerosis: a systematic review and meta-analysis. Front Neurol 2018;9:149. https://doi.org/10.3389/fneur.2018.00149

Pijnenborg GH, van Donkersgoed RJ, David AS, Aleman A. Changes in insight during treatment for psychotic disorders: a meta-analysis. Schizophr Res 2013;144:109–17. https://doi.org/10.1016/j.schres.2012.11.018

Pozza A, Andersson G, Antonelli P, Dèttore D. Computer-delivered cognitive–behavioural treatments for obsessive compulsive disorder: preliminary meta-analysis of randomized and non-randomized effectiveness trials. Cogn Behav Ther 2014;7:e16.

Pozza A, Dèttore D. Drop-out and efficacy of group versus individual cognitive behavioural therapy: what works best for obsessive–compulsive disorder? A systematic review and meta-analysis of direct comparisons. Psychiatry Res 2017;258:24–36.

Reynolds S, Wilson C, Austin J, Hooper L. Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 2012;32:251–62. https://doi.org/10.1016/j.cpr.2012.01.005

Saddichha S, Al-Desouki M, Lamia A, Linden IA, Krausz M. Online interventions for depression and anxiety – a systematic review. Health Psychol Behav Med 2014;2:841–81. https://doi.org/10.1080/21642850.2014.945934

Santoft F, Axelsson E, Öst LG, Hedman-Lagerlöf M, Fust J, Hedman-Lagerlöf E. Cognitive behaviour therapy for depression in primary care: systematic review and meta-analysis. Psychol Med 2019;49:1266–74. https://doi.org/10.1017/S0033291718004208

Shinohara K, Honyashiki M, Imai H, Hunot V, Caldwell DM, Davies P, et al. Behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2013;10:CD008696. https://doi.org/10.1002/14651858.CD008696.pub2

Sijbrandij M, Kunovski I, Cuijpers P. Effectiveness of internet-delivered cognitive behavioral therapy for posttraumatic stress disorder: a systematic review and meta-analysis. Depress Anxiety 2016;33:783–91. https://doi.org/10.1002/da.22533

Smeets KC, Leeijen AA, van der Molen MJ, Scheepers FE, Buitelaar JK, Rommelse NN. Treatment moderators of cognitive behavior therapy to reduce aggressive behavior: a meta-analysis. Eur Child Adolesc Psychiatry 2015;24:255–64. https://doi.org/10.1007/s00787-014-0592-1

Spielmans GI, Benish SG, Marin C, Bowman WM, Menster M, Wheeler AJ. Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons. Clin Psychol Rev 2013;33:460–9. https://doi.org/10.1016/j.cpr.2013.01.008

Stafford MR, Jackson H, Mayo-Wilson E, Morrison AP, Kendall T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013;346:f185. https://doi.org/10.1136/bmj.f185

Stephens S, Ford E, Paudyal P, Smith H. Effectiveness of psychological interventions for postnatal depression in primary care: a meta-analysis. Ann Fam Med 2016;14:463–72. https://doi.org/10.1370/afm.1967

Tirado-Muñoz J, Gilchrist G, Farré M, Hegarty K, Torrens M. The efficacy of cognitive behavioural therapy and advocacy interventions for women who have experienced intimate partner violence: a systematic review and meta-analysis. Ann Med 2014;46:567–86. https://doi.org/10.3109/07853890.2014.941918

van Bronswijk S, Moopen N, Beijers L, Ruhe HG, Peeters F. Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression. Psychol Med 2019;49:366–79. https://doi.org/10.1017/S003329171800199X

van den Akker LE, Beckerman H, Collette EH, Eijssen IC, Dekker J, de Groot V. Effectiveness of cognitive behavioral therapy for the treatment of fatigue in patients with multiple sclerosis: a systematic review and meta-analysis. J Psychosom Res 2016;90:33–42.

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Williams ACC, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2020;8:CD007407. https://doi.org/10.1002/14651858.CD007407.pub4

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Zhang M, Huang L, Feng Z, Shao L, Chen L. Effects of cognitive behavioral therapy on quality of life and stress for breast cancer survivors: a meta-analysis. Minerva Med 2017;108:84–93. https://doi.org/10.23736/S0026-4806.16.04528-6

Studies excluded because outcomes not relevant (n = 125)

Abreu Costa M, D’Alo de Oliveira GS, Tatton-Ramos T, Manfro GG, Salum GA. Anxiety and stress-related disorders and mindfulness-based interventions: a systematic review and multilevel meta-analysis and meta-regression of multiple outcomes. Mindfulness 2018;10:996–1005.

Alammehrjerdi Z, Ezard N, Dolan K. Methamphetamine dependence in methadone treatment services in Iran: the first literature review of a new health concern. Asian J Psychiatr 2018;31:49–55.

Anderson N, Heywood-Everett S, Siddiqi N, Wright J, Meredith J, McMillan D. Faith-adapted psychological therapies for depression and anxiety: systematic review and meta-analysis. J Affect Disord 2015;176:183–96. https://doi.org/10.1016/j.jad.2015.01.019

Applebaum AJ, Breitbart W. Care for the cancer caregiver: a systematic review. Palliat Support Care 2013;11:231–52. https://doi.org/10.1017/S1478951512000594

Ashman L, Duggan L. Interventions for learning disabled sex offenders. Cochrane Database Syst Rev 2008;1:CD003682. https://doi.org/10.1002/14651858.CD003682.pub2

Babcock JC, Green CE, Robie C. Does batterers’ treatment work? A meta-analytic review of domestic violence treatment. Clin Psychol Rev 2004;23:1023–53.

Benbow AA, Anderson PL. A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. J Anxiety Disord 2019;61:18–26.

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Bhui K, Aslam RW, Palinski A, McCabe R, Johnson MR, Weich S, et al. Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness. Health Technol Assess 2015;19(31). https://doi.org/10.3310/hta19310

Brendel KE, Maynard BR. Child–parent interventions for childhood anxiety disorders: a systematic review and meta-analysis. Res Soc Work Pract 2014;24:287–95.

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Clements KM, Hydery T, Tesell MA, Greenwood BC, Angelini MC. A systematic review of community-based interventions to improve oral chronic disease medication regimen adherence among individuals with substance use disorder. Drug Alcohol Depend 2018;188:141–52.

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Cuijpers P, Smit F, Bohlmeijer E, Hollon SD, Andersson G. Efficacy of cognitive–behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry 2010;196:173–8. https://doi.org/10.1192/bjp.bp.109.066001

Cuijpers P, Weitz E, Twisk J, Kuehner C, Cristea I, David D, et al. Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: an ‘individual patient data’ meta-analysis. Depress Anxiety 2014;31:941–51.

da Silva JA, Siegmund G, Bredemeier J. Crisis interventions in online psychological counseling. Trends Psychiatry Psychother 2015;37:171–82. https://doi.org/10.1590/2237-6089-2014-0026

Darker CD, Sweeney BP, Barry JM, Farrell MF, Donnelly-Swift E. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev 2015;5:CD009652. https://doi.org/10.1002/14651858.CD009652.pub2

De Crescenzo F, Ciabattini M, D’Alò GL, De Giorgi R, Del Giovane C, Cassar C, et al. Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: a systematic review and network meta-analysis. PLOS Med 2018;15:e1002715. https://doi.org/10.1371/journal.pmed.1002715

De Giorgi R, Cassar C, Loreto D’alò G, Ciabattini M, Minozzi S, Economou A, et al. Psychosocial interventions in stimulant use disorders: a systematic review and qualitative synthesis of randomized controlled trials. Riv Psichiatr 2018;53:233–55. https://doi.org/10.1708/3000.30003

Dennis JA, Khan O, Ferriter M, Huband N, Powney MJ, Duggan C. Psychological interventions for adults who have sexually offended or are at risk of offending. Cochrane Database Syst Rev 2012;12:CD007507. https://doi.org/10.1002/14651858.CD007507.pub2

Depont F, Berenbaum F, Filippi J, Le Maitre M, Nataf H, Paul C, et al. Interventions to improve adherence in patients with immune-mediated inflammatory disorders: a systematic review. PLOS ONE 2015;10:e0145076. https://doi.org/10.1371/journal.pone.0145076

Dou C, Rebane J, Bardal S. Interventions to improve benzodiazepine tapering success in the elderly: a systematic review. Aging Ment Health 2019;23:411–16. https://doi.org/10.1080/13607863.2017.1423030

Dumont M, Thériault J, Briand C, Dumais A, Potvin S. Psychosocial approaches for individuals with schizophrenia in correctional and forensic psychiatric settings: a rapid review. J Forensic Pract 2018;20:152–66.

Ebrahim S. Psychotherapy for depression in claimants receiving wage replacement benefits: review of the evidence. J Insur Med 2014;44:53–7.

Eskildsen A, Hougaard E, Rosenberg NK. Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioural therapy for social phobia: a systematic review. Nord J Psychiatry 2010;64:94–105. https://doi.org/10.3109/08039480903426929

Evans K, Spiby H, Morrell JC. Non-pharmacological interventions to reduce the symptoms of mild to moderate anxiety in pregnant women. A systematic review and narrative synthesis of women’s views on the acceptability of and satisfaction with interventions. Arch Womens Ment Health 2020;23:11–28.

Fisher H, Gardner FE, Montgomery P. Cognitive-behavioural interventions for preventing youth gang involvement for children and young people (7–16). Cochrane Database Syst Rev 2008;2:CD007008. https://doi.org/10.1002/14651858.CD007008.pub2

Fjermestad KW, Mowatt Haugland BS, Heiervang E, Ost LG. Relationship factors and outcome in child anxiety treatment studies. Clin Child Psychol Psychiatry 2009;14:195–214. https://doi.org/10.1177/1359104508100885

Franklin G, Carson AJ, Welch KA. Cognitive behavioural therapy for depression: systematic review of imaging studies. Acta Neuropsychiatr 2016;28:61–74. https://doi.org/10.1017/neu.2015.41

Gallagher M, McLeod HJ, McMillan TM. A systematic review of recommended modifications of CBT for people with cognitive impairments following brain injury. Neuropsychol Rehabil 2019;29:1–21. https://doi.org/10.1080/09602011.2016.1258367

Gilchrist G, Munoz JT, Easton CJ. Should we reconsider anger management when addressing physical intimate partner violence perpetration by alcohol abusing males? A systematic review. Aggress Violent Behav 2015;25:124–32.

Gilinsky A, Swanson V, Power K. Interventions delivered during antenatal care to reduce alcohol consumption during pregnancy: a systematic review. Addict Res Theory 2011;19:235–50.

Ginsburg GS, Kingery JN, Drake KL, Grados MA. Predictors of treatment response in pediatric obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 2008;47:868–78.

Gray H, Howe T. Physiotherapists’ assessment and management of psychosocial factors (Yellow and Blue Flags) in individuals with back pain. Phys Ther Rev 2013;18:379–.94

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Heber E, Ebert DD, Lehr D, Cuijpers P, Berking M, Nobis S, Riper H. The benefit of web- and computer-based interventions for stress: a systematic review and meta-analysis. J Med Internet Res 2017;19:e32. https://doi.org/10.2196/jmir.5774

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Heron-Speirs HA, Harvey ST, Baken DM. Moderators of psycho-oncology therapy effectiveness: meta-analysis of therapy characteristics. J Psychosoc Oncol 2013;31:617–41. https://doi.org/10.1080/07347332.2013.835022

Hesser H, Weise C, Rief W, Andersson G. The effect of waiting: a meta-analysis of wait-list control groups in trials for tinnitus distress. J Psychosom Res 2011;70:378–84. https://doi.org/10.1016/j.jpsychores.2010.12.006

Ho BP, Stephenson J, Carter M. Cognitive–behavioural approach for children with autism spectrum disorder: a literature review. J Intellect Dev Disabil 2015;40:213–29.

Ho M, Jensen ME, Burrows T, Neve M, Garnett SP, Baur L, et al. Best practice dietetic management of overweight and obese children and adolescents: a 2010 update of a systematic review. JBI Database of Syst Rev Implement Rep 2013;11:190–293.

Hodgkinson B, Evans D, O’Donnell A, Walsh K. Comparing the Effectiveness of Individual Therapy and Group Therapy in the Treatment of Depression: Systematic Review. Systematic Review 3. Adelaide, SA: Joanna Briggs Institute for Evidence Based Nursing and Midwifery; 1999.

Hogue A, Henderson CE, Becker SJ, Knight DK. Evidence base on outpatient behavioral treatments for adolescent substance use, 2014–2017: outcomes, treatment delivery, and promising horizons. J Clin Child Adolesc Psychol 2018;47:499–526. https://doi.org/10.1080/15374416.2018.1466307

Honagodu AR, Krishna M, Sundarachar R, Lepping P. Group psychotherapies for depression in persons with HIV: a systematic review. Indian J Psychiatry 2013;55:323–30. https://doi.org/10.4103/0019-5545.120541

Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, Conrod J, Rozario S. A systematic review of cognitive behavioral therapy and behavioral activation apps for depression. PLOS ONE 2016;11:e0154248. https://doi.org/10.1371/journal.pone.0154248

Hundt NE, Mignogna J, Underhill C, Cully JA. The relationship between use of CBT skills and depression treatment outcome: a theoretical and methodological review of the literature. Behav Ther 2013;44:12–26.

Ince P, Haddock G, Tai S. A systematic review of the implementation of recommended psychological interventions for schizophrenia: rates, barriers, and improvement strategies. Psychol Psychother 2016;89:324–50. https://doi.org/10.1111/papt.12084

Jonsson H, Kristensen M, Arendt M. Intensive cognitive behavioural therapy for obsessive–compulsive disorder: a systematic review and meta-analysis. J Obsess Compuls Relat Disord 2015;6:83–96.

Joyce S, Shand F, Tighe J, Laurent SJ, Bryant RA, Harvey SB. Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open 2018;8:e017858. https://doi.org/10.1136/bmjopen-2017-017858

Kaltenthaler E, Sutcliffe P, Parry G, Beverley C, Rees A, Ferriter M. The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review. Psychol Med 2008;38:1521–30. https://doi.org/10.1017/S0033291707002607

Karyotaki E, Kemmeren L, Riper H, Twisk J, Hoogendoorn A, Kleiboer A, et al. Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis. Psychol Med 2018;48:2456–66. https://doi.org/10.1017/S0033291718000648

Kazantzis N, Whittington C, Zelencich L, Kyrios M, Norton PJ, Hofmann SG. Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behav Ther 2016;47:755–72.

Khan A, Tansel A, White DL, Kayani WT, Bano S, Lindsay J, et al. Efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: a systematic review. Clin Gastroenterol Hepatol 2016;14:191–202.e1-4. https://doi.org/10.1016/j.cgh.2015.07.047

Klimas J, Tobin H, Field CA, O’Gorman CS, Glynn LG, Keenan E, et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2014;12:CD009269. https://doi.org/10.1002/14651858.CD009269.pub3

Koffel E, Bramoweth AD, Ulmer CS. Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med 2018;33:955–62. https://doi.org/10.1007/s11606-018-4390-1

Kregel J, Coppieters I, DePauw R, Malfliet A, Danneels L, Nijs J, et al. Does conservative treatment change the brain in patients with chronic musculoskeletal pain? A Systematic Review. Pain Physician 2017;20:139–54.

Kurtz MM. Neurocognition as a predictor of response to evidence-based psychosocial interventions in schizophrenia: what is the state of the evidence? Clin Psychol Rev 2011;31:663–72.

Lam LT, Lam MK. eHealth intervention for problematic internet use (PIU). Curr Psychiatry Rep 2016;18:107. https://doi.org/10.1007/s11920-016-0747-5

Lavielle M, Puyraimond-Zemmour D, Romand X, Gossec L, Senbel E, Pouplin S, et al. Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review. RMD Open 2018;4:e000684. https://doi.org/10.1136/rmdopen-2018-000684

Law EF, Fisher E, Fales J, Noel M, Eccleston C. Systematic review and meta-analysis of parent and family-based interventions for children and adolescents with chronic medical conditions. J Pediatr Psychol 2014;39:866–86. https://doi.org/10.1093/jpepsy/jsu032

Lee EB, An W, Levin ME, Twohig MP. An initial meta-analysis of acceptance and commitment therapy for treating substance use disorders. Drug Alcohol Depend 2015;155:1–7. https://doi.org/10.1016/j.drugalcdep.2015.08.004

Linardon J, Hindle A, Brennan L. Dropout from cognitive-behavioral therapy for eating disorders: a meta-analysis of randomized, controlled trials. Int J Eat Disord 2018;51:381–91. https://doi.org/10.1002/eat.22850

Linardon J, de la Piedad Garcia X, Brennan L. Predictors, moderators, and mediators of treatment outcome following manualised cognitive–behavioural therapy for eating disorders: a systematic review. Eur Eat Disord Rev 2017;25:3–12. https://doi.org/10.1002/erv.2492

Lundkvist-Houndoumadi I, Hougaard E, Thastum M. Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders. Nord J Psychiatry 2014;68:524–35. https://doi.org/10.3109/08039488.2014.903295

Markel C. Child-focused psychosocial interventions for childrenand adolescents with attention-deficit hyperactivity disorder (ADHD): a systematic review and meta-analysis. PhD thesis. Toronto, ON: University of Toronto; 2018.

Martire LM. The ‘relative’ efficacy of involving family in psychosocial interventions for chronic illness: are there added benefits to patients and family members? Fam Syst Health 2005;23:312–28.

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Matteson ML, Russell C. Interventions to improve hemodialysis adherence: a systematic review of randomized-controlled trials. Hemodial Int 2010;14:370–82. https://doi.org/10.1111/j.1542-4758.2010.00462.x

Matthews EE, Arnedt JT, McCarthy MS, Cuddihy LJ, Aloia MS. Adherence to cognitive behavioral therapy for insomnia: a systematic review. Sleep Med Rev 2013;17:453–64. https://doi.org/10.1016/j.smrv.2013.01.001

Mbuagbaw L, Sivaramalingam B, Navarro T, Hobson N, Keepanasseril A, Wilczynski NJ, Haynes RB, Patient Adherence Review (PAR) Team. Interventions for enhancing adherence to antiretroviral therapy (ART): a systematic review of high quality studies. AIDS Patient Care STDS 2015;29:248–66. https://doi.org/10.1089/apc.2014.0308

McLean SM, Burton M, Bradley L, Littlewood C. Interventions for enhancing adherence with physiotherapy: a systematic review. Man Ther 2010;15:514–21. https://doi.org/10.1016/j.math.2010.05.012

Melendez-Torres GJ, Bonell C. Systematic review of cognitive behavioural interventions for HIV risk reduction in substance-using men who have sex with men. Int J STD AIDS 2014;25:627–35. https://doi.org/10.1177/0956462413515638

Montgomery EC, Kunik ME, Wilson N, Stanley MA, Weiss B. Can paraprofessionals deliver cognitive–behavioral therapy to treat anxiety and depressive symptoms? Bull Menninger Clin 2010;74:45–62.

Mukhtar F, Oei TP. A review on assessment and treatment for depression in malaysia. Depress Res Treat 2011;2011:123642. https://doi.org/10.1155/2011/123642

Naeem F, Farooq S, Kingdon D. Cognitive behavioural therapy (brief versus standard duration) for schizophrenia. Cochrane Database Syst Rev 2015;10:CD010646. https://doi.org/10.1002/14651858.CD010646.pub3

Nascimento SS, Oliveira LR, DeSantana JM. Correlations between brain changes and pain management after cognitive and meditative therapies: a systematic review of neuroimaging studies. Complement Ther Med 2018;39:137–45.

Nesset MB, Lara-Cabrera ML, Dalsbø TK, Pedersen SA, Bjørngaard JH, Palmstierna T. Cognitive behavioural group therapy for male perpetrators of intimate partner violence: a systematic review. BMC Psychiatry 2019;19:11. https://doi.org/10.1186/s12888-019-2010-1

Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, et al. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev 2014;12:CD006237. https://doi.org/10.1002/14651858.CD006237.pub3

O’Keeffe J, Conway R, McGuire B. A systematic review examining factors predicting favourable outcome in cognitive behavioural interventions for psychosis. Schizophr Res 2017;183:22–30.

Ougrin D, Tranah T, Stahl D, Moran P, Asarnow JR. Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2015;54:97–107.e2. https://doi.org/10.1016/j.jaac.2014.10.009

Brazier J, Tumur I, Holmes M, Ferriter M, Parry G, Dent-Brown K, Paisley S. Psychological therapies including dialectical behaviour therapy for borderline personality disorder: a systematic review and preliminary economic evaluation. Health Technol Assess 2006;10(35). https://doi.org/10.3310/hta10350

Perkins DO. Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry 2002;63:1121–8. https://doi.org/10.4088/jcp.v63n1206

Petry NM, Armentano C. Prevalence, assessment, and treatment of pathological gambling: a review. Psychiatr Serv 1999;50:1021–7. https://doi.org/10.1176/ps.50.8.1021

Pihlaja S, Stenberg JH, Joutsenniemi K, Mehik H, Ritola V, Joffe G. Therapeutic alliance in guided internet therapy programs for depression and anxiety disorders – a systematic review. Internet Interv 2018;11:1–10. https://doi.org/10.1016/j.invent.2017.11.005

Pompoli A, Furukawa TA, Efthimiou O, Imai H, Tajika A, Salanti G. Dismantling cognitive–behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med 2018;48:1945–53. https://doi.org/10.1017/S0033291717003919

Porter E, Chambless DL. A systematic review of predictors and moderators of improvement in cognitive–behavioral therapy for panic disorder and agoraphobia. Clin Psychol Rev 2015;42:179–92. https://doi.org/10.1016/j.cpr.2015.09.004

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Potier F, Degryse JM, de Saint-Hubert M. Impact of caregiving for older people and pro-inflammatory biomarkers among caregivers: a systematic review. Aging Clin Exp Res 2018;30:119–32. https://doi.org/10.1007/s40520-017-0765-0

Powers MB, Vedel E, Emmelkamp PM. Behavioral couples therapy (BCT) for alcohol and drug use disorders: a meta-analysis. Clin Psychol Rev 2008;28:952–62. https://doi.org/10.1016/j.cpr.2008.02.002

Rapley HA, Loades ME. A systematic review exploring therapist competence, adherence, and therapy outcomes in individual CBT for children and young people. Psychother Res 2019;29:1010–19. https://doi.org/10.1080/10503307.2018.1464681

Rathbun AM, Reed GW, Harrold LR. The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology 2013;52:1785–94. https://doi.org/10.1093/rheumatology/kes356

Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract 2009;25:424–41.

Riblet NBV, Shiner B, Young-Xu Y, Watts BV. Strategies to prevent death by suicide: meta-analysis of randomised controlled trials. Br J Psychiatry 2017;210:396–402. https://doi.org/10.1192/bjp.bp.116.187799

Rohden AI, Benchaya MC, Camargo RS, Moreira TC, Barros HMT, Ferigolo M. Dropout prevalence and associated factors in randomized clinical trials of adolescents treated for depression: systematic review and meta-analysis. Clin Ther 2017;39:971–92.e4.

Room J, Hannink E, Dawes H, Barker K. What interventions are used to improve exercise adherence in older people and what behavioural techniques are they based on? A systematic review. BMJ Open 2017;7:e019221. https://doi.org/10.1136/bmjopen-2017-019221

Rudge S, Feigenbaum JD, Fonagy P. Mechanisms of change in dialectical behaviour therapy and cognitive behaviour therapy for borderline personality disorder: a critical review of the literature. J Ment Health 2020;29:92–102.

Rueda S, Park-Wyllie LY, Bayoumi AM, Tynan AM, Antoniou TA, Rourke SB, Glazier RH. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev 2006;3:CD001442. https://doi.org/10.1002/14651858.CD001442.pub2

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Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database Syst Rev 2010;1:CD001822. https://doi.org/10.1002/14651858.CD001822.pub2

Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev 2013;8:CD001822. https://doi.org/10.1002/14651858.CD001822.pub3

Schütze R, Rees C, Smith A, Slater H, Campbell JM, O’Sullivan P. How can we best reduce pain catastrophizing in adults with chronic noncancer pain? A systematic review and meta-analysis. J Pain 2018;19:233–56.

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Smits JA, Berry AC, Tart CD, Powers MB. The efficacy of cognitive–behavioral interventions for reducing anxiety sensitivity: a meta-analytic review. Behav Res Ther 2008;46:1047–54. https://doi.org/10.1016/j.brat.2008.06.010

Smits JA, Julian K, Rosenfield D, Powers MB. Threat reappraisal as a mediator of symptom change in cognitive–behavioral treatment of anxiety disorders: a systematic review. J Consult Clin Psychol 2012;80:624–35. https://doi.org/10.1037/a0028957

Spinhoven P, Klein N, Kennis M, Cramer AOJ, Siegle G, Cuijpers P, et al. The effects of cognitive–behavior therapy for depression on repetitive negative thinking: a meta-analysis. Behav Res Ther 2018;106:71–85.

Storebø OJ, Skoog M, Damm D, Thomsen PH, Simonsen E, Gluud C. Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2011;12:CD008223. https://doi.org/10.1002/14651858.CD008223.pub2

Stott J, Charlesworth G, Scior K. Measures of readiness for cognitive behavioural therapy in people with intellectual disability: a systematic review. Res Dev Disabil 2017;60:37–51.

Surley L, Dagnan D. A review of the frequency and nature of adaptations to cognitive behavioural therapy for adults with intellectual disabilities. J Appl Res Intellect Disabil 2019;32:219–37. https://doi.org/10.1111/jar.12534

Thulin U, Svirsky L, Serlachius E, Andersson G, Ost LG. The effect of parent involvement in the treatment of anxiety disorders in children: a meta-analysis. Cogn Behav Ther 2014;43:185–200. https://doi.org/10.1080/16506073.2014.923928

Thurgood SL, McNeill A, Clark-Carter D, Brose LS. A systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery. Nicotine Tob Res 2016;18:993–1001. https://doi.org/10.1093/ntr/ntv127

Turner C, O’Gorman B, Nair A, O’Kearney R. Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: a systematic review. Psychiatry Res 2018;261:50–60.

Vallury KD, Jones M, Oosterbroek C. Computerized cognitive behavior therapy for anxiety and depression in rural areas: a systematic review. J Med Internet Res 2015;17:e139. https://doi.org/10.2196/jmir.4145

van Ballegooijen W, Cuijpers P, van Straten A, Karyotaki E, Andersson G, Smit JH, Riper H. Adherence to internet-based and face-to-face cognitive behavioural therapy for depression: a meta-analysis. PLOS ONE 2014;9:e100674. https://doi.org/10.1371/journal.pone.0100674

van der Put CE, Assink M, Gubbels J, Boekhout van Solinge NF. Identifying effective components of child maltreatment interventions: a meta-analysis. Clin Child Fam Psychol Rev 2018;21:171–202. https://doi.org/10.1007/s10567-017-0250-5

Vázquez Rivera S, Gómez Magariños S, González-Blanch C. [Effects on the brain of effective psychological treatments for anxiety disorders: a systematic review.] Actas Esp Psiquiatr 2010;38:239–48.

Vigerland S, Lenhard F, Bonnert M, Lalouni M, Hedman E, Ahlen J, et al. Internet-delivered cognitive behavior therapy for children and adolescents: a systematic review and meta-analysis. Clin Psychol Rev 2016;50:1–10.

Vujanovic AA, Farris SG, Bartlett BA, Lyons RC, Haller M, Colvonen PJ, Norman SB. Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: a systematic review. Clin Psychol Rev 2018;62:37–55.

Waller R, Gilbody S. Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence. Psychol Med 2009;39:705–12. https://doi.org/10.1017/S0033291708004224

Williamson JPA. Assessing the Suitability of Cognitive–Behavioural Therapy for Specialised Client Populations and Clinical Practice Reports. PhD thesis. Birmingham; University of Birmingham; 2011.

Windgassen S, Moss-Morris R, Chilcot J, Sibelli A, Goldsmith K, Chalder T. The journey between brain and gut: a systematic review of psychological mechanisms of treatment effect in irritable bowel syndrome. Br J Health Psychol 2017;22:701–36. https://doi.org/10.1111/bjhp.12250

Windsor LC, Jemal A, Alessi EJ. Cognitive behavioral therapy: a meta-analysis of race and substance use outcomes. Cultur Divers Ethnic Minor Psychol 2015;21:300–13. https://doi.org/10.1037/a0037929

Wray TB, Grin B, Dorfman L, Glynn TR, Kahler CW, Marshall BD, et al. Systematic review of interventions to reduce problematic alcohol use in men who have sex with men. Drug Alcohol Rev 2016;35:148–57. https://doi.org/10.1111/dar.12271

Xu Z, Huang F, Kösters M, Rüsch N. Challenging mental health related stigma in China: systematic review and meta-analysis. II. Interventions among people with mental illness. Psychiatry Res 2017;255:457–64.

Studies excluded because economic evaluation only (n = 13)

Bereza BG, Machado M, Einarson TR. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther 2009;31:1279–308. https://doi.org/10.1016/j.clinthera.2009.06.004

Bosmans JE, van Schaik DJF, de Bruijne MC, van Hout HPJ, van Marwijk HWJ, van Tulder MW, et al. Are psychological treatments for depression in primary care cost-effective? J Ment Health Policy Econ 2008;11:3–15.

Dieng M, Cust AE, Kasparian NA, Mann GJ, Morton RL. Economic evaluations of psychosocial interventions in cancer: a systematic review. Psychooncology 2016;25:1380–92. https://doi.org/10.1002/pon.4075

Gajic-Veljanoski O, Sanyal C, McMartin K, Xie X, Walter M, Higgins C, et al. Economic evaluations of commonly used structured psychotherapies for major depressive disorder and generalized anxiety disorder: a systematic review. Can Psychol 2018;59:301–14.

Heuzenroeder L, Donnelly M, Haby MM, Mihalopoulos C, Rossell R, Carter R, et al. Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Aust N Z J Psychiatry 2004;38:602–12. https://doi.org/10.1080/j.1440-1614.2004.01423.x

Karyotaki E, Tordrup D, Buntrock C, Bertollini R, Cuijpers P. Economic evidence for the clinical management of major depressive disorder: a systematic review and quality appraisal of economic evaluations alongside randomised controlled trials. Epidemiol Psychiatr Sci 2017;26:501–16. https://doi.org/10.1017/S2045796016000421

Konnopka A, Schaefert R, Heinrich S, Kaufmann C, Luppa M, Herzog W, König HH. Economics of medically unexplained symptoms: a systematic review of the literature. Psychother Psychosom 2012;81:265–75. https://doi.org/10.1159/000337349

Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW. Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review. Eur Spine J 2011;20:1024–38. https://doi.org/10.1007/s00586-010-1676-3

Mavranezouli I, Mayo-Wilson E, Dias S, Kew K, Clark DM, Ades AE, Pilling S. The cost effectiveness of psychological and pharmacological interventions for social anxiety disorder: a model-based economic analysis. PLOS ONE 2015;10:e0140704. https://doi.org/10.1371/journal.pone.0140704

Ophuis RH, Lokkerbol J, Heemskerk SC, van Balkom AJ, Hiligsmann M, Evers SM. Cost-effectiveness of interventions for treating anxiety disorders: a systematic review. J Affect Disord 2017;210:1–13.

Sanyal C, Stolee P, Juzwishin D, Husereau D. Economic evaluations of eHealth technologies: a systematic review. PLOS ONE 2018;13:e0198112. https://doi.org/10.1371/journal.pone.0198112

Stevens M, Roberts H, Shiell A. Research review: economic evidence for interventions in children’s social care: revisiting the What Works for Children project. Child Fam Soc Work 2010;15:145–54.

van der Velde G, Yu H, Paulden M, Côté P, Varatharajan S, Shearer HM, et al. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J 2016;16:1582–97.

Studies excluded because abstracts/protocol/erratum (n = 278)

Adamus C, Pfammatter M. The effects of subjective recovery-oriented psychological interventions on schizophrenic disorders-a systematic review. Eur Arch Psychiatry Clin Neurosci 2017;267(Suppl. 1):S53.

Addington J, Devoe D. Meta-analytic review of treatment options for CHR youth. Early Interv Psychiatry 2018;12(Suppl. 1):10.

Aljudaibi S, Duane B. Non-pharmacological pain relief during orthodontic treatment. Evid Based Dent 2018;19:48–9. https://doi.org/10.1038/sj.ebd.6401305

Alwani S. Promoting mothers’ psychological health after fetal loss maternal mortality and morbidity is alarming and need extensive interventions. BJOG 2016;123(Suppl. 2):110.

Anagnostopoulou N, Kyriakopoulos M, Alba A. Psychological interventions in early onset psychosis: a systematic review. Eur Psychiatry 2018;48(Suppl. 1):S193.

Andrews L. Systematic review summary – psychosocial interventions to improve quality of life and emotional well-being for recently diagnosed cancer patients. Singap Nurs J 2013;40:47–9.

Angerer P, Li J. Evaluation of short-term and long-term effects of work stress interventions on CVD risk factors: focusing on the individual level. Eur J Prevent Cardiol 2017;24:13.

Anonymous. Useful treatments for fibromyalgia syndrome. J Fam Pract 2005;54:105.

Anonymous. Cognitive behavioral therapy helps ease tinnitus discomforts. Harvard Womens Health Watch 2007;14:2.

Anonymous. Computerised cognitive-behavioural therapy for depression: systematic review. Br J Psychiatry 2008;193:181–4. [Erratum published in Br J Psychiatry 2008;193:346.]

Anonymous. Cognitive behavioral therapy and psychoeducation reduce relapse in bipolar disorder. J Natl Med Assoc 2008;100:1108–9.

Anonymous. Early treatment for PTSD. J Natl Med Assoc 2009;101:742.

Anonymous. Effect of cognitive–behavioral therapy for anxiety disorders on quality of life: a meta analysis. J Consult Clin Psychol 2014;82:375–91. [Erratum published in J Consult Clin Psychol 2014;82:1228.]

Anonymous. ‘The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: a meta-analysis’: correction to Johnsen and Friborg (2015). Psychol Bull 2016;142:290.

Anonymous. Depression severity does not moderate differences between medication and CBT. Brown University Psychopharmacology Update 2016;27:4.

Anonymous. CBT results overstated. Ther Today 2016;27:5.

Anonymous. ‘Meta-analysis of cognitive–behavioral treatments for adult ADHD’: correction to Knouse, Teller, and Brooks (2017). J Consult Clin Psychol 2017;85:882.

Anonymous. Meta-analysis of cognitive–behavioral treatments for adult ADHD. J Consult Clin Psychol 2017;85:737–750 [Erratum published in J Consult Clin Psychol 2017;85:882.]

Anonymous. ‘Effect of cognitive–behavioral therapy for anxiety disorders on quality of life: a meta-analysis’: correction to Hofmann, Wu, and Boettcher (2014). J Consult Clin Psychol 2014;82:1228.

Arts M, Petrykiv S, Fennema J, De Jonge L. The role of psychiatry in the approach of neurocardiogenic syncope. Eur Psychiatry 2018;48(Suppl. 1):S218–S9.

Aydin C, Tibbo P, Ursuliak Z. Psychosocial interventions to reduce cannabis use in the early psychosis population. Early Interv Psychiatry 2012;6(Suppl. 1):115.

Baandrup L, Rasmussen JO, Klokker L, Austin S, Bjornshave T, Bliksted VF, et al. ‘Treatment of adult patients with schizophrenia and complex mental health needs – a national clinical guideline’: corrigendum. Nord J Psychiatry 2017;71:163.

Baglioni C, Hertenstein E, Bostanova Z, Rucker G, Riemann D, Feige B. A systematic review and network meta-analysis of complementary and alternative interventions for insomnia. J Sleep Res 2018;27(Suppl. 1):172.

Ballesio A, Aquino M, Feige B, Johann A, Kyle SD, Spiegelhalder K, et al. The impact of cognitive behavioral therapy for insomnia on fatigue symptoms: a systematic examination of randomized controlled trials. Sleep 2016;39(Suppl.):A211.

Ballesio A, Aquino MRJ, Feige B, Johann A, Kyle SD, Spiegelhalder K, et al. Network meta-analysis on the effectiveness of cognitive behavioral therapies for insomnia on daytime depression and fatigue. J Sleep Res 2016;25(Suppl. 1):90–1.

Barbato A. Effective strategies for health information, self-help and psychoeducation in bipolar disorder. Eur Psychiatry 2011;26(Suppl. 1):2214.

Barber B, Zhang H, Mitchell N, O’Connell DA, Harris JR, Seikaly H. Optimal interventions for depression after diagnosis of head and neck cancer: a systematic review. Otolaryngol Head Neck Surg 2014;151(Suppl. 1):P174.

Barrett D. Systematic review summary – media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Singap Nurs J 2015;42:39–40.

Basu A, Andrews G. Bandelow revisited: a conventional analysis of a meta-analysis of anxiety disorder treatments. Aust N Z J Psychiatry 2018;52(Suppl. 1):128.

Basu A, Andrews G, Cuijpers P, Craske M, McEvoy P, English C, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical healthcare: an updated meta-analysis. Aust N Z J Psychiatry 2017;51(Suppl. 1):117.

Bei B, Wiley JF, Trinder J, Member R. Beyond the mean: a systematic review on the correlates of daily sleep variability. Sleep 2015;1:A89.

Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme ME. Does CBT-I decrease concomitant anxiety? A meta-analytic review. Sleep Med 2011;12(Suppl. 1):S61.

Benz F, Knoop T, Ballesio A, Bacaro V, Johann A, Rucker G, et al. The efficacy of cognitive and behavior therapies for insomnia on daytime symptoms: a systematic review and network meta-analysis. J Sleep Res 2018;27(Suppl. 1):289.

Bertolin-Guillen JM, Bertolin-Colilla M. P.2.a.024 Effectiveness of mindfulness-based therapies as an alternative or adjuvant of antidepressants in the treatment of depression. Eur Neuropsychopharmacol 2011;21(Suppl. 3):S367–S8.

Bhattacharya R, Kelley G, Bhattacharjee S. Long-term follow-up effects of computerized or internet-based cognitive behavioral therapy for depression and anxiety: a metaanalysis. Value Health 2012;15:A82.

Bighelli I, Leucht S. Psychological interventions for positive symptoms in schizophrenia: a network meta-analysis. Schizophr Bull 2018;44(Suppl. 1):S305.

Blodgett JC, Maisel NC, Fuh IL, Wilbourne PL, Finney JW. How effective is continuing care for substance use disorders? A metaanalytic review. Alcohol Clin Exp Res 2012;36(Suppl. 1):156A.

Bos T. The efficacy of CBT-I on insomnia and depressive symptoms in comorbid adult patients: a systematic review and meta-analysis. Sleep 2018;41(Suppl. 1):A166–A7.

Bougea A, Spantideas N, Despoti A, Belegri S, Kleisarhakis M, Chrousos G. Proposed practical recommendations of stress management for headaches in children and adolescents. Eur J Neurol 2018;25(Suppl. 2):160.

Boyle JT, Muench A, Gencarelli A, Khader W, Perlis ML. How does intensive sleep retraining (ISR) compare to CBT-I? Sleep 2018;41(Suppl. 1):A155–A6.

Bradley R, Greene J, Russ E, Dutra L, Westen D. ‘A multidimensional meta-analysis of psychotherapy for PTSD’: correction. Am J Psychiatry 2006;163:330.

British Association for Counselling and Psychotherapy. CBT in schools: a new systematic review. Ther Today 2009;20:52.

Brotherton H, Hallmark C, Rogers H. The impact of stress management on immune response in breast cancer patients: a systematic review and meta-analysis of lymphocyte outcomes shortly after intervention. Psychooncology 2014;23(Suppl. 3):124.

Brown RF, Subnis U, Starkweather A, McCain N. The effect of psychosocial interventions for patients with cancer on psychoneuroimmunologic outcomes: a systematic review. Asia Pac J Clin Oncol 2012;8(Suppl. 3):145.

Bryden PA, Caldwell DM, Welton N, Churchill R, Baxter H, Lewis G, Skapinakis P. Network meta-analysis of the relative efficacy of pharmacological and psychological interventions in adults with obsessive compulsive disorder. Value Health 2014;17:A454–5. https://doi.org/10.1016/j.jval.2014.08.1241

Bucur M, Whale R. Systematic review of randomised interventions for patients at high risk of developing psychosis: 2012 update. Early Interv Psychiatry 2012;6(Suppl. 1):123.

Carpenter JS. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 NAMS position statement. Menopause 2016;23:1365.

Carson J. Mindful pain management. J Altern Complement Med 2016;22:A71.

Carson K, Jayasinghe H, Ali A, Singh K, Peters M, Esterman A, et al. TO 012. Culturally-tailored interventions for smoking cessation in indigenous populations: a Cochrane systematic review and meta-analysis. Respirology 2015;20(Suppl. 2):17.

Carson KV, Brinn MP, Peters M, Veale A, Esterman AJ, Smith BJ. Interventions for tobacco use cessation in indigenous populations: a Cochrane meta-analysis. Am J Respir Crit Care Med 2014;189:A1086.

Castelein S, Knegtering H. Treatment of negative symptoms: which psychosocial interventions are effective? Schizophr Bull 2011;37(Suppl. 1):261.

Cattelani R, Zettin M, Zoccolotti P. Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review. Neuropsychol Rev 2010;20:52–85. [Erratum published in Neuropsychol Rev 2011;21:224.]

Cheung JMY, Jarrin DC, Ballot O, Bharwani A, Morin CM. A systematic review of adaptive cognitive behavioral therapy for insomnia implemented in primary care settings. Sleep Med 2017;40(Suppl. 1):e59.

Chow KM, H Chan CW, Chan JC. Effects of psychoeducational interventions on sexual functioning, quality of life and psychological outcomes in patients with gynaecological cancer: a systematic review. JBI Libr Syst Rev 2012;10:4077–164. https://doi.org/10.11124/jbisrir-2012-406

Chung P, Khan F. Traumatic brain injury (TBI) diagnosis and treatment: a systematic review and update. Brain Injury 2014;28(5–6):744–5.

Chvatalova B. A comparison of the effectiveness of various psychotherapeutic approaches to first-episode psychosis in terms of recovery: a systematic review. Early Interv Psychiatry 2018;12(Suppl. 1):137.

Coffey BJ. 39.3 Update on pharmacological treatments in tics and tourette’s disorder. J Am Acad Child Adolesc Psychiatry 2016;55:S61.

Costa A, Melina F, Sansalone A, Iannacchero R. P004. Evidence based psychological treatments in pain management: a review of controlled and randomized trials about chronic headache, neuropathic pain and fibromyalgia. J Headache Pain 2015;16(Suppl. 1):A151.

Creasey N, Benger J, Wright I, Lyttle M. 0589 Non-pharmacological interventions to reduce psychological sequalae of mild traumatic brain injury in adults and children: a systematic review. Brain Injury 2016;30:709–10.

Creasey NJ, Lyttle M. Psychological interventions for patients of all ages with mild traumatic brain injury: a systematic review. Arch Dis Child 2016;101(Suppl. 1):A138–9.

Creed F, Rizzo M. W07-04-UK NICE guidelines for depression in people with a chronic physical illness. Eur Psychiatry 2011;26(Suppl. 1):2212.

Cullen K, Irvin E, Van Eerd D, Saunders R. Preventing work disability in workers with depression; a systematic review. Occup Environ Med 2018;75(Suppl. 2):A589.

Dahdah M, Driver S, Shafi S, Callender L, Collinsworth A, Brown R, et al. Development of evidence-based treatment guidelines for TBI rehabilitation care: the cognitive–behavioral treatment ARM. Arch Phys Med Rehabil 2016;97:e100–1.

Dancet E, Vermeulen N, Boivin J, Gameiro S. The effectiveness of psychosocial interventions that can be delivered by all staff members: a systematic review. Hum Reprod 2015;30(Suppl. 1):i61.

De Groot V, Beckerman H. Rehabilitation to treat MS-related fatigue: the TREFAMS research programme. Mult Scler 2016;22(Suppl. 3):40–1.

De Rooij A, Roorda L, Otten R, Dekker J, Steultjens M. Predictors of multidisciplinary rehabilitation outcome in fibromyalgia: a systematic review. Physiotherapy 2011;97(Suppl. 1):eS269–70.

De Vera MA, Galo J. FRI0212 What are the effects of interventions targetting medication adherence in rheumatic diseases: a systematic review. Ann Rheum Dis 2014;73(Suppl. 2):459.

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Sanjuan J, Liano V, Balaguer E, Aguilar EJ. Neuroimaging techniques and response to psychological intervention in psychotic patients: a systematic review. Schizophr Bull 2011;37(Suppl. 1):151–2.

Seda G, Sanchez-Ortuno MM, Welsh CH, Ann HC, Edinger JD. Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmares, sleep disturbance and post-traumatic stress. Sleep 2014;37(Suppl. 1):A276.

Sedlar N, Lainscak M, Farkas J. Psychological interventions to improve psychological outcomes in patients with heart failure: a systematic literature review. Eur J Heart Fail 2018;20(Suppl. 1):586.

Seppala A, Miettunen J, Hirvonen N, Isohanni M, Moilanen J, Koponen H, et al. What do we know about treatment-resistant schizophrenia? A systematic review. Eur Psychiatry 2016;33(Suppl.):S586.

Seppala J, Seppala A, Isohanni M, Miettunen J, Jaaskelainen E. Treatment-resistant and difficult-to treat schizophrenia as a challenge for clinical practices. Data from Finnish samples: Northern Finland birth cohort 1966 and Perfect-project. Eur Arch Psychiatry Clin Neurosci 2017;267(Suppl. 1):S16–17.

Sesel AL, Sharpe L, Naismith S. The efficacy of psychosocial interventions for people with multiple sclerosis: a meta-analysis of specific treatment effects. Mult Scler J 2017;23:NP1.

Shi Q, Xiang T, Liangren L, Zhenhua L, Lu Y, Qiang W. 946. Psychosocial interventions to improve the quality of life for men with prostate cancer: a Bayesian network meta-analysis of 31 randomised controlled trails. Eur Urol Suppl 2017;16:e1648.

Silva M, Figueiredo AR, Fornelos A, Macedo P, Nunes S. Psychotherapeutic interventions in Tinnitus. Eur Psychiatry 2016;33(Suppl.):S561.

Singh N, Dornadula I, Ramezani A, Sheth S, De Mesa C. Psychological preparation for neuromodulation: a systematic review. Neuromodulation 2018;21:e72.

Sjogren T, Avikainen L, Calleeuw N, Forsblom K, Keranen K, Lautamaki L, et al. Motor control exercise for non-specific low back pain: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy 2015;101(Suppl. 1):eS1405.

Sleight A. Rehabilitation interventions and coping techniques for chemotherapy-related cognitive dysfunction. Arch Phys Med Rehabil 2015;96:e115–e6.

Sleight A, Clark F. Chemotherapy-related cognitive dysfunction and the role of rehabilitation: a scoping review of the literature. Support Care Cancer 2015;23:S310–S1.

Smeets KC, Rommelse NNJ, Scheepers FE, Buitelaar JK. Responder and non-responder profiles of a cognitive behavior therapy to reduce aggression in adolescents. Eur Child Adolesc Psychiatry 2015;24:S50–S1.

Smith K. Network meta-analysis: a useful tool for comparing different psychological treatments for panic disorder?: Commentary on . . . Cochrane Corner. BJPsych Adv 2018;24:3–8.

Spiegel D, Krizanec S, Kraemer H, Jo B, Ershadi M, Neri E, et al. Meta-analysis of psychosocial treatment effects on cancer survival and sources of heterogeneity. Neuropsychopharmacology 2017;43(Suppl. 1):S331.

Ssegonja R, Nystrand C, Feldman I, Sarkadi A, Langenskiold S, Jonsson U. Indicated preventive interventions for depression in children and adolescents: a meta-analysis and meta-regression. Value Health 2018;21(Suppl. 1):S181.

Staugaard CF, Uhre V, Lonfeldt N, Pretzmann L, Vangkilde S, Plessen K, et al. Cognitive behavioral therapy for obsessive compulsive disorder in children and adolescents – preliminary results from a systematic review. Early Interv Psychiatry 2018;12(Suppl. 1):166.

Strauss N, Rabin J, Temel B, Philpotts L, Ostroff J, Park ER, et al. Smoking cessation interventions for Black and Hispanic cancer patients: a systematic review of tobacco trials. Psycho-Oncology 2017;26(Suppl. 1):87.

Stuhldreher N, Konnopka A, Wild B, Herzog W, Zipfel S, Lowe B, et al. Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. J Ment Health Policy Econ 2013;1:S33.

Sutherland R, O’Callaghan V, Henderson S, Nelson A, Jefford M, Zorbas H. Recommendations for the identification and management of fear of cancer recurrence in adult cancer survivors. Psychooncology 2014;23(Suppl. 3):109–10.

Swanson S, Dolce A, Marsh K, Summers J, Sheldon LK. Interventions to prevent and treat anxiety: a review of the evidence and implications for practice. Oncol Nurs Forum 2008;35:525.

Szeverenyi C, Kekecs Z, Elkins G, Csernatony Z, Varga K, Johnson A. Psychosocial interventions as adjuncts to orthopedic surgery: a systematic review and meta-analysis. Glob Adv Health Med 2018;7:258–9.

Teo SY, Loy FL. A physiotherapy clinical pathway for the management of chronic neck pain. Ann Acad Med Singap 2015;44(Suppl.):S304.

Thombs BD. Screening for depression in cardiac patients. J Psychosom Res 2010;68:670.

Tirado-Munoz J, Gilchrist G, Torrens M. Intimate partner violence among drug dependent women: state of the art. Heroin Addict Relat Clin Probl 2016;18(3 Suppl. 1):25–6.

Tolin DF. ‘Beating a dead dodo bird: Looking at signal vs. noise in cognitive–behavioral therapy for anxiety disorders’: corrigendum. Clin Psychol Sci Pract 2015;22:315–6.

Towbin K, DeLonga K. 21.1 Integrated treatment of refractory depression in youth: a review of medication, psychological treatments, and barriers to optimal care. J Am Acad Child Adolesc Psychiatry 2018;57:S31.

Trauer J, Qian M, Doyle J, Rajaratnum S, Cunnington D. 180 Efficacy of cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Sleep Biol Rhythm 2014;12(Suppl.):58.

Troy D, Arora J, Siefferman J. (370) Addressing attention deficits in the treatment of chronic pain: a systematic review. J Pain 2014;15:S68.

van Ameringen M, Patterson B. T92. The use of augmentation strategies in treatment resistant anxiety disorders: a systematic review and meta-analysis. Neuropsychopharmacology 2014;39:S350–1.

van Berkel DM, Van Den Heuvel S, Van Ravensberg D. Effects of specialized psychosomatic physical therapy in patients with stress related health problems: a systematic literature review. Physiotherapy 2011;97(Suppl. 1):eS1277–8.

van der Gaag M, Ising H. Latest developments of psychological psychosis prevention strategies in the Netherlands. Early Interv Psychiatry 2018;12(Suppl. 1):76.

van der Gaag M, Smit F, Bechdolf A, French P, Linszen DH, Yung A, et al. Preventing a first episode of psychosis: a meta-analysis. Schizophr Res 2014;153(Suppl. 1):S42.

van der Gaag M, Smit F, Bechdolf A, French P, Linszen DH, Yung AR, et al. Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials. Schizophr Bull 2013;39(Suppl. 1):S356.

van der Gaag M, Velthorst E, Smit F, Meyer C, Koeter M, Fett AK, et al. The battle for ameliorating negative symptoms has a restart. Early Interv Psychiatry 2014;8(Suppl. 1):23.

van der Gaag M, Velthorst E, Smit F, Meyer C, Koeter M, Fett AK, et al. Psychotherapy in people with negative symptoms. Eur Arch Psychiatry Clin Neurosci 2015;265(Suppl.):S40.

van Straten A, Van Der Zweerde T, Morin C, Lancee J. Cognitive and behavioural therapies in the treatment of insomnia: a systematic metaanalysis of all the literature. J Sleep Res 2018;27(Suppl. 1):167.

Vandepitte S, Van Den Noortgate N, Putman K, Verhaeghe S, Faes K, Annemans L. Effectiveness of supporting informal caregivers of people with dementia: a systematic review. Value Health 2015;18(7):A407–8.

Vasa RA. 8.5 Assessment and management of anxiety in youth with ASD. J Am Acad Child Adolesc Psychiatry 2018;57:S134–5.

Verberne D, Spauwen P, Van Heugten C. Neuropsychological interventions for treating neuropsychiatric consequences of acquired brain injury: a systematic review. Brain Injury 2017;31(6–7):797.

Vitinius F, Bassou S, Albus C. Psychotherapeutic and psychiatric interventions after bonemarrow/stemcell transplantation – a systematic review. J Psychosom Res 2011;70:621–2.

Vitinius F, Imlau C, Albus C. Psychosocial strain and therapeutic approaches of hereditary neurological diseases: a systematic review. J Psychosom Res 2013;74:560.

Vitinius F, Piontek K, Albus C. Psychosocial interventions to improve quality of life, depression and anxiety in lung transplant patients – a systematic review of randomized controlled trials. J Psychosom Res 2011;70:620.

Vollm B, Gibbon S, Khalifa N, Duggan C, Stoffers J, Huband N, et al. S08-01-Cochrane reviews of pharmacological and psychological interventions for antisocial personality disorder (ASPD). Eur Psychiatry 2010;25(Suppl. 1):90.

Walling AD. Which treatments are effective for reducing adolescent alcohol abuse? Am Fam Physician 2010;82:532–4.

Wang C, Bayes S. Effectiveness of acupuncture as an add-on treatment for women with postnatal depression: a systematic review. Women Birth 2018;31(Suppl. 1):S27.

Wang Z. Errors in Meta-analysis of trial comparing effectiveness and safety of cognitive behavioral therapy with pharmacotherapy for childhood anxiety disorders. JAMA Pediatr 2018;172:983–4. https://doi.org/10.1001/jamapediatrics.2018.2951

Wearden AJ, Russell C, Emsley R, Fairclough G, Kyle SD. Sleep and fatigue in chronic fatigue syndrome. Psychosom Med 2016;78:A24.

Webb M. A review of web-based applications used to support self-management of non-specific chronic low back pain. Br J Pain 2017;11(Suppl. 2):51–2.

Wendebourg MJ, Heesen C, Finlayson M, Meyer B, Pottgen J, Kopke S. Patient education for people with multiple sclerosis associated fatigue: a systematic review. Mult Scler 2016;22(Suppl. 3):700.

Whale R, Bucur M. Systematic review of randomised interventions for preonset phase psychosis. Early Interv Psychiatry 2010;4(Suppl. 1):116.

White D, Luther L. Efficacy of cognitive behavior therapy in early psychosis. Schizophr Bull 2017;43(Suppl. 1):S209.

Wiener J, Mehta S, Iruthayarajah J, Janssen S, Teasell R. The effectiveness of cognitive behavioural therapy for the management of post-stroke depressive symptoms. Arch Phys Med Rehabil 2017;98:e137.

Williams A, Eccleston C, Morley S. 1012 Systematic review and meta-analysis of psychological treatments for persistent pain in adults, excluding headache. Eur J Pain 2009;13(Suppl. 1):S284.

Williams A, Morley S. Systematic review and meta-analysis of psychological treatments for persistent pain in adults, excluding headache. J Pain 2009;10:S62.

Yoshinaga N, Nosaki A, Unozawa K, Hayashi Y, Shimizu E. A systematic review of cognitive behavioral therapy in nursing field in Japan. Asia Pac Psychiatry 2015;7(Suppl. 1):26.

Zafar Usmani A, Ni Cheng J, Smith BJ, Carson KV. A meta-analysis (Cochrane review) of pharmacological and psychological interventions for anxiety and depression in COPD. Respirology 2010;15(Suppl. 1):A19.

Zangi HA. The evidence for patient education in inflammatory arthritis. Ann Rheum Dis 2014;73(Suppl. 2):55–6.

Studies excluded because duplicates/superceded/withdrawn (n = 170)

Abbott RA, Martin AE, Newlove-Delgado TV, Bethel A, Whear RS, Thompson Coon J, Logan S. Recurrent abdominal pain in children: summary evidence from 3 systematic reviews of treatment effectiveness. J Pediatr Gastroenterol Nutr 2018;67:23–33. https://doi.org/10.1097/MPG.0000000000001922

Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev 2011;11:CD008456. https://doi.org/10.1002/14651858.CD008456.pub2

Akechi T, Okuyama T, Onishi J, Morita T, Furukawa TA. WITHDRAWN: Psychotherapy for depression among incurable cancer patients. Cochrane Database Syst Rev 2018;11:CD005537. https://doi.org/10.1002/14651858.CD005537.pub3

Alessi C, Vitiello MV. Insomnia (primary) in older people. BMJ Clin Evid 2011;2011:2302.

Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLOS ONE 2010;5:e13196. https://doi.org/10.1371/journal.pone.0013196

Anie KA, Green J. Psychological therapies for sickle cell disease and pain. Cochrane Database Syst Rev 2002;2:CD001916.

Anie KA, Green J. Psychological therapies for sickle cell disease and pain. Cochrane Database Syst Rev 2012;2:CD001916. https://doi.org/10.1002/14651858.CD001916.pub2

Apóstolo J, Bobrowicz-Campos E, Rodrigues M, Castro I, Cardoso D. The effectiveness of non-pharmacological interventions in older adults with depressive disorders: a systematic review. Int J Nurs Stud 2016;58:59–70.

Arroyo K, Lundahl B, Butters R, Vanderloo M, Wood DS. Short-term interventions for survivors of intimate partner violence: a systematic review and meta-analysis. Trauma Violence Abuse 2015;2.

Ashman L, Duggan L. Interventions for learning disabled sex offenders. Cochrane Database Syst Rev 2002;2:CD003682.

Auclair V, Harvey P-O, Lepage M. La thérapie cognitive-comportementale dans le traitement du TDAH chez l’adulte. Sante Mental Quebec 2016;41:291–311.

Bandelow B, Seidler-Brandler U, Becker A, Wedekind D, Rüther E. Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. World J Biol Psychiatry 2007;8:175–87.

Beelmann A, Losel F. El entrenamiento en habilidades sociales en la prevencion temprana de la delincuencia: los efectos en la conducta antisocial y la competencia social. Psicothema 2006;18:603–10.

Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme MÈ. Meta-analytic review of the impact of cognitive–behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev 2011;31:638–52. https://doi.org/10.1016/j.cpr.2011.02.004

Beltman MW, Oude Voshaar RC, Speckens AE. Cognitive–behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials Br J Psychiatry 2010;197:11–9.

Bender JL, Radhakrishnan A, Diorio C, Englesakis M, Jadad AR. Can pain be managed through the internet? A systematic review of randomized controlled trials. Pain 2011;152:1740–50. https://doi.org/10.1016/j.pain.2011.02.012

Bernardy K, Füber N, Köllner V, Häuser W. Efficacy of cognitive–behavioral therapies in fibromyalgia syndrome – a systematic review and metaanalysis of randomized controlled trials. J Rheumatol 2010;37:1991–2005. https://doi.org/10.3899/jrheum.100104

van Beugen S, Ferwerda M, Hoeve D, Rovers MM, Spillekom-van Koulil S, van Middendorp H, Evers AW. Internet-based cognitive behavioral therapy for patients with chronic somatic conditions: a meta-analytic review. J Med Internet Res 2014;16:e88. https://doi.org/10.2196/jmir.2777

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2005;2:CD003388. https://doi.org/10.1002/14651858.CD003388.pub2

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2007;3:CD003388. https://doi.org/10.1002/14651858.CD003388.pub3

Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S. Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Br J Psychiatry 2007;190:97–104.

Brasure M, MacDonald R, Fuchs E, Olson CM, Carlyle M, Diem S, et al. Management of Insomnia Disorder. Comparative Effectiveness Review No. 159. Report No: 15(16)-EHC027-EF. Rockville, MD: Agency for Healthcare Research and Quality (US); 2015.

Brennan L, Murphy KD, Shaw KA, McKenzie JE. WITHDRAWN: Psychological interventions for overweight or obesity. Cochrane Database Syst Rev 2014;5:CD003818. https://doi.org/10.1002/14651858.CD003818.pub3

Buchanan J, Zakrzewska J. Burning mouth syndrome. BMJ Clin Evid 2008;14:1301.

Buckley LA, Pettit T, Adams CE. Supportive therapy for schizophrenia. Cochrane Database Syst Rev 2007;18:CD004716.

Casacalenda N, Perry JC, Looper K. Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. Am J Psychiatry 2002;159:1354–60. https://doi.org/10.1176/appi.ajp.159.8.1354

Chang CW, Mu PF, Jou ST, Wong TT, Chen YC. The effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer: a systematic review. JBI Libr Syst Rev 2012;10:574–614. https://doi.org/10.11124/jbisrir-2012-60

Chi NC, Demiris G, Lewis FM, Walker AJ, Langer SL. Behavioral and educational interventions to support family caregivers in end-of-life care: a systematic review. Am J Hosp Palliat Care 2016;33:894–908.

Cleary M, Hunt G, Matheson S, Siegfried N, Walter G. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2008;1:CD001088. https://doi.org/10.1002/14651858.CD001088.pub2

Cormac I, Jones C, Campbell C. Cognitive behaviour therapy for schizophrenia. Cochrane Database Syst Rev 2002;1:CD000524.

Covin R, Ouimet AJ, Seeds PM, Dozois DJ. A meta-analysis of CBT for pathological worry among clients with GAD. J Anxiety Disord 2008;22:108–16.

Cuijpers P, van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med 2008;31:169–77. https://doi.org/10.1007/s10865-007-9144-1

Cuijpers P, van Straten A, Smit F. Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials. Int J Geriatr Psychiatry 2006;21:1139–49. https://doi.org/10.1002/gps.1620

Cuijpers P, van Straten A, Warmerdam L, Andersson G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety 2009;26:279–88. https://doi.org/10.1002/da.20519

de Arellano MA, Lyman DR, Jobe-Shields L, George P, Dougherty RH, Daniels AS, et al. Trauma-focused cognitive–behavioral therapy for children and adolescents: assessing the evidence. Psychiatr Serv 2014;65:591–602. https://doi.org/10.1176/appi.ps.201300255

Driessen E, Cuijpers P, Hollon SD, Van HL, Dekker JJ. [The efficacy of psychological treatments for depression: a review of recent research findings.] Tijdschr Psychiatr 2014;56:455–62.

Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2009;2:CD007407. https://doi.org/10.1002/14651858.CD007407.pub2

Edwards AG, Hailey S, Maxwell M. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev 2004;2:CD004253. https://doi.org/10.1002/14651858.CD004253.pub2

Edwards AG, Hulbert-Williams N, Neal RD. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev 2008;3:CD004253. https://doi.org/10.1002/14651858.CD004253.pub3

Elderton AJ. Posttraumatic Growth in Survivors of Interpersonal Violence in Adulthood. PhD thesis. Oxford: University of Oxford; 2013.

Ewing DL, Monsen JJ, Thompson EJ, Cartwright-Hatton S, Field A. A meta-analysis of transdiagnostic cognitive behavioural therapy in the treatment of child and young person anxiety disorders. Behav Cogn Psychother 2015;43:562–77. https://doi.org/10.1017/S1352465813001094

Ford AC, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol 2014;109:1350–65. https://doi.org/10.1038/ajg.2014.148

Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Behavioural and cognitive–behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev 2012;2:CD008225.

Galsworthy-Francis L. The Development and Exploration of the Experiences of Humiliation Scale (EHS) in an Eating Disordered Population. Leicester: University of Leicester; 2012.

Gandy M, Sharpe L, Perry KN. Cognitive behavior therapy for depression in people with epilepsy: a systematic review. Epilepsia 2013;54:1725–34. https://doi.org/10.1111/epi.12345

Gartlehner G, Gaynes BN, Amick HR, Asher GN, Morgan LC, Coker-Schwimmer E, et al. Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression: an evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med 2016;164:331–41. https://doi.org/10.7326/M15-1813

Gómez Puente JM, Martínez-Marcos M. Sobrepeso y obesidad: eficacia de las intervenciones en adultos. Enferm Clin 2018;28:65–74.

Goschwitz R, Plener P. Psychotherapeutic interventions for non-suicidal self-injury. Nervenheilkd Z Interdiszip Fortbild 2013;32:30–6.

Gregory VL. Cognitive–behavioral therapy for comorbid bipolar and substance use disorders: a systematic review of controlled trials. Ment Health Subst Use 2011;4:302–13.

Haniffa M, Lasserson TJ, Smith I. Interventions to improve compliance with continuous positive airway pressure for obstructive sleep apnoea. Cochrane Database Syst Rev 2004;4:CD003531. https://doi.org/10.1002/14651858.CD003531.pub2

Hay PJ, Bacaltchuk J. Psychotherapy for bulimia nervosa and binging. Cochrane Database Syst Rev 2000;2:CD000562.

Hay PJ, Bacaltchuk J. Psychotherapy for bulimia nervosa and binging. Cochrane Database Syst Rev 2001;3:CD000562.

Hay PJ, Bacaltchuk J. Psychotherapy for bulimia nervosa and binging. Cochrane Database Syst Rev 2003;1:CD000562. https://doi.org/10.1002/14651858.CD000562

Hay PJ, Bacaltchuk J. Bulimia nervosa. BMJ Clin Evid 2008;2008:1009.

Hay PJ, Bacaltchuk J, Stefano S. Psychotherapy for bulimia nervosa and binging. Cochrane Database Syst Rev 2004;3:CD000562. https://doi.org/10.1002/14651858.CD000562.pub2

Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008;2:CD000011. https://doi.org/10.1002/14651858.CD000011.pub3

Hazell P. Depression in children and adolescents. BMJ Clin Evid 2011;2011:1008.

Hetrick SE, Cox GR, Merry SN. Treatment-resistant depression in adolescents: is the addition of cognitive behavioral therapy of benefit? Psychol Res Behav Manag 2011;4:97–112.

Hetrick SE, Cox GR, Merry SN. Where to go from here? An exploratory meta-analysis of the most promising approaches to depression prevention programs for children and adolescents. Int J Environ Res Public Health 2015;12:4758–95. https://doi.org/10.3390/ijerph120504758

Hjorthøj C, Fohlmann A, Nordentoft M. Treatment of cannabis use disorders in people with schizophrenia spectrum disorders – a systematic review. Addict Behav 2009;34:520–5. https://doi.org/10.1016/j.addbeh.2009.02.001

Ho BPV, Carter M, Stephenson J. Anger management using a cognitive–behavioural approach for children with special education needs: a literature review and meta-analysis. Int J Disab Dev Educ 2010;57:245–65.

Hofmann SG, Sawyer AT, Korte KJ, Smits JA. Is it beneficial to add pharmacotherapy to cognitive–behavioral therapy when treating anxiety disorders? A meta-analytic review. Int J Cogn Ther 2009;2:160–75.

Hofmann SG, Smits JA. Cognitive–behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 2008;69:621–32.

Huang FF, Li ZJ, Han HY, Xiong HF, Ma Y, et al. Cognitive behavioral therapy combined with pharmacotherapy for obsessive compulsive disorder: a meta-analysis. Chin Ment Health J 2013;27:643–9.

Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C. WITHDRAWN: Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev 2014;2:CD003014. https://doi.org/10.1002/14651858.CD003014.pub3

Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 2006;25:3–14.

James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2005;4:CD004690. https://doi.org/10.1002/14651858.CD004690.pub2

James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2013;6:CD004690. https://doi.org/10.1002/14651858.CD004690.pub3

Jones C, Cormac I, Mota J, Campbell C. Cognitive behaviour therapy for schizophrenia. Cochrane Database Syst Rev 2000;2:CD000524.

Jones C, Cormac I, Silveira da Mota Neto JI, Campbell C. Cognitive behaviour therapy for schizophrenia. Cochrane Database Syst Rev 2004;4:CD000524.

Jones C, Hacker D, Meaden A, Cormac I, Irving CB. WITHDRAWN: Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev 2011;4:CD000524. https://doi.org/10.1002/14651858.CD000524.pub3

Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev 2012;4:CD008712. https://doi.org/10.1002/14651858.CD008712.pub2

Kaltenthaler E, Shackley P, Stevens K, Beverley C, Parry G, Chilcott J. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technol Assess 2002;6(22). https://doi.org/10.3310/hta6220

Kavanagh J, Oliver S, Lorenc T, Caird J, Tucker H, Harden A, et al. School-based cognitive–behavioural interventions: a systematic review of effects and inequalities. Health Sociol Rev 2009;18:61–78.

Kenworthy T, Adams CE, Bilby C, Brooks-Gordon B, Fenton M. WITHDRAWN: Psychological interventions for those who have sexually offended or are at risk of offending. Cochrane Database Syst Rev 2008;4:CD004858. https://doi.org/10.1002/14651858.CD004858.pub2

Kisely S, Campbell LA, Skerritt P. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev 2005;1:CD004101. https://doi.org/10.1002/14651858.CD004101.pub2

Kisely SR, Campbell LA, Skerritt P, Yelland MJ. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev 2010;1:CD004101. https://doi.org/10.1002/14651858.CD004101.pub3

Kisely SR, Campbell LA, Yelland MJ, Paydar A. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev 2012;6:CD004101. https://doi.org/10.1002/14651858.CD004101.pub4

Klimas J, Field CA, Cullen W, O’Gorman CS, Glynn LG, Keenan E, et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2012;11:CD009269. https://doi.org/10.1002/14651858.CD009269.pub2

Klimas J, Field CA, Cullen W, O’Gorman CS, Glynn LG, Keenan E, et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane Review. Syst Rev 2013;2:3. https://doi.org/10.1186/2046-4053-2-3

Köllner V, Häuser W, Klimczyk K, Kühn-Becker H, Settan M, Weigl M, Bernardy K, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. [Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline.] Schmerz 2012;26:291–6. https://doi.org/10.1007/s00482-012-1179-8

Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007;69:881–8.

Larkin D, Lopez V, Aromataris E. Non-pharmacological interventions for cancer-related fatigue in men treated for prostate cancer: a systematic review. JBI Libr Syst Rev 2012;10:3764–811.

Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2015;2:CD003200. https://doi.org/10.1002/14651858.CD003200.pub3

Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2016;12:CD003200.

Lewandowski LM, Gebing TA, Anthony JL, O’Brien WH. Meta-analysis of cognitive–behavioral treatment studies for bulimia. Clin Psychol Rev 1997;17:703–18.

Linde K, Sigterman K, Kriston L, Rücker G, Jamil S, Meissner K, Schneider A. Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam Med 2015;13:56–68. https://doi.org/10.1370/afm.1719

Lip GY, Lane DA, Millane TA, Tayebjee MH. Psychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev 2003;3:CD004394. https://doi.org/10.1002/14651858.CD004394

Liu HX, Liang QJ, Xiao P, Jiao HX, Gao Y, Ahmetjiang A. The effectiveness of cognitive–behavioural therapy for temporomandibular disorders: a systematic review. J Oral Rehabil 2012;39:55–62. https://doi.org/10.1111/j.1365-2842.2011.02239.x

Lockwood C, Page T, NursCert H, Conroy-Hiller T. Effectiveness of individual therapy and group therapy in the treatment of schizophrenia. JBI Libr Syst Rev 2004;2:1–44.

Macdonald G, Higgins JP, Ramchandani P, Valentine JC, Bronger LP, Klein P, et al. Cognitive–behavioural interventions for children who have been sexually abused. Cochrane Database Syst Rev 2012;5:CD001930. https://doi.org/10.1002/14651858.CD001930.pub3

Macdonald GM, Higgins JP, Ramchandani P. Cognitive–behavioural interventions for children who have been sexually abused. Cochrane Database Syst Rev 2006;4:CD001930. https://doi.org/10.1002/14651858.CD001930.pub2

Macea DD, Gajos K, Daglia Calil YA, Fregni F. The efficacy of Web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis. J Pain 2010;11:917–29. https://doi.org/10.1016/j.jpain.2010.06.005

Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev 2008;28:736–45.

Marshall M, Lockwood A. Early intervention for psychosis. Cochrane Database Syst Rev 2004;2:CD004718.

Marson AG, Maguire M, Ramaratnam S. Epilepsy. BMJ Clin Evid 2009;2009:1201.

Matthews EE, Arnedt JT, McCarthy MS, Cuddihy LJ, Aloia MS. Adherence to cognitive behavioral therapy for insomnia: a systematic review. Sleep Med Rev 2013;17:453–64. https://doi.org/10.1016/j.smrv.2013.01.001

Mayo-Wilson E. Media-delivered Behavioural and Cognitive Behavioural Therapy for Anxiety: A Systematic Review of Effectiveness and an Exploratory Study of Consumer Preferences. PhD thesis. Oxford: Oxford University; 2011.

Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev 2013;9:CD005330. https://doi.org/10.1002/14651858.CD005330.pub4

McDaid C, Trowman R, Golder S, Hawton K, Sowden A. Interventions for people bereaved through suicide: systematic review. Br J Psychiatry 2008;193:438–43. https://doi.org/10.1192/bjp.bp.107.040824

Meyer T, Hautzinger M. Cognitive behavioral therapy in addition to pharmacotherapy for manic depressive disorders: empirical results. Der Nervenarzt 2002;73:620–8.

Montgomery P, Dennis J. Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database Syst Rev 2002;2:CD003161.

Montgomery P, Dennis J. A systematic review of non-pharmacological therapies for sleep problems in later life. Sleep Med Rev 2004;8:47–62. https://doi.org/10.1016/S1087-0792(03)00026-1

Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep 1999;22:1134–56. https://doi.org/10.1093/sleep/22.8.1134

Ng TK, Wong DFK. The efficacy of cognitive behavioral therapy for Chinese people: a meta-analysis. Aust N Z J Psychiatry 2018;52:620–37. https://doi.org/10.1177/0004867417741555

Oakley-Browne MA, Adams P, Mobberley PM. Interventions for pathological gambling. Cochrane Database Syst Rev 2000;2:CD001521.

Oakley-Browne MA, Adams P, Mobberley PM. WITHDRAWN: Interventions for pathological gambling. Cochrane Database Syst Rev 2007;1:CD001521. https://doi.org/10.1002/14651858.CD001521.pub2

Oei TP, Dingle G. The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. J Affect Disord 2008;107:5–21.

O’Kearney R. Benefits of cognitive–behavioural therapy for children and youth with obsessive–compulsive disorder: re-examination of the evidence. Aust N Z J Psychiatry 2007;41:199–212.

Orgeta V, Qazi A, Spector A, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis. Br J Psychiatry 2015;207:293–8. https://doi.org/10.1192/bjp.bp.114.148130

Parsons AC, Shraim M, Inglis J, Aveyard P, Hajek P. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev 2009;1:CD006219. https://doi.org/10.1002/14651858.CD006219.pub2

Passarela CDM, Mendes DD, De Jesus Mari J. A systematic review to study the efficacy of cognitive behavioral therapy for sexually abused children and adolescents with posttraumatic stress disorder. Rev Psiquiatr Clin 2010;37:63–73.

Perveen T, Mahmood S, Gosadi I, Mehraj J, Sheikh SS. Long term effectiveness of cognitive behavior therapy for treatment of postpartum depression: a systematic review and meta-analysis. J Pak Med Stud 2013;3:198–204.

Pignone M, Gaynes BN, Rushton JL, Mulrow CD, Orleans CT, Whitener BL, et al. Screening for depression. Systematic Evidence Reviews, No. 6. Rockville, MD: Agency for Healthcare Research and Quality; 2002.

Pinquart M, Sörensen S. How effective are psychotherapeutic and other psychosocial interventions with older adults? J Ment Health Aging 2001;7:207–43.

Ponniah K, Magiati I, Hollon SD. An update on the efficacy of psychological therapies in the treatment of obsessive–compulsive disorder in adults. J Obsessive Compuls Relat Disord 2013;2:207–18. https://doi.org/10.1016/j.jocrd.2013.02.005

Pratt HD. Psychotherapy in the age of pharmacology. Int J Child Adolesc Health 2010;3:137–42.

Pratt HD. Psychotherapy in the Age of Pharmacology. In Merrick J, editor. Child and Adolescent Health Yearbook. New York, NY: Noval Science Publishers, Inc.; 2012. pp. 149–56.

Price JR, Couper J. Cognitive behaviour therapy for adults with chronic fatigue syndrome. Cochrane Database Syst Rev 2000;2:CD001027.

Ramaratnam S, Baker GA, Goldstein L. Psychological treatments for epilepsy. Cochrane Database Syst Rev 2001;4:CD002029.

Ramaratnam S, Baker GA, Goldstein L. Psychological treatments for epilepsy. Cochrane Database Syst Rev 2003;4:CD002029.

Ramaratnam S, Baker GA, Goldstein LH. Psychological treatments for epilepsy. Cochrane Database Syst Rev 2005;19:CD002029.

Ramaratnam S, Baker GA, Goldstein LH. Psychological treatments for epilepsy. Cochrane Database Syst Rev 2008;16:CD002029.

Ramaratnam S, Baker GA, Goldstein LH. Psychological treatments for epilepsy. Cochrane Database Syst Rev 2016;25:CD002029.

Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2012;200:832–9. https://doi.org/10.1097/NMD.0b013e31826dd9af

Reid SF, Chalder T, Cleare A, Hotopf M, Wessely S. Chronic fatigue syndrome. BMJ Clin Evid 2008;2008:1101.

Rimer J, Dwan K, Lawlor DA, Greig CA, McMurdo M, Morley W, et al. Exercise for depression. Cochrane Database Syst Rev 2012;7:CD004366.

Roberts NP, Roberts PA, Jones N, Bisson JI. Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin Psychol Rev 2015;38:25–38. https://doi.org/10.1016/j.cpr.2015.02.007

Schirmbeck F, Zink M. Cognitive behavioural therapy for obsessive-compulsive symptoms in schizophrenia. Cogn Behav Ther 2013;6:1–13.

Schmid G, Henningsen P, Dieterich M, Sattel H, Lahmann C. Psychotherapy in dizziness: a systematic review. J Neurol Neurosurg Psychiatry 2011;82:601–6.

Segal ZV, Whitney DK, Lam RW. Psychotherapy. Can J Psychiatry 2001;46:29S–37S.

Shaw K, O’Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev 2005;2:CD003818. https://doi.org/10.1002/14651858.CD003818.pub2

Silver N. Headache (chronic tension-type). BMJ Clin Evid 2007;2007:1205.

Sin J, Spain D. Psychological interventions for trauma in individuals who have psychosis: a systematic review and meta-analysis. Psychos Psychol Soc Integr Approach 2017;9:67–81.

Smedslund G, Dalsbø TK, Steiro AK, Winsvold A, Clench-Aas J. Cognitive behavioural therapy for men who physically abuse their female partner. Cochrane Database Syst Rev 2007;3:CD006048. https://doi.org/10.1002/14651858.CD006048.pub2

Soo S, Forman D, Delaney BC, Moayyedi P. A systematic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol 2004;99:1817–22. https://doi.org/10.1111/j.1572-0241.2004.30086.x

Soo S, Moayyedi P, Deeks J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2001;4:CD002301.

Soo S, Moayyedi P, Deeks J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2004;1:CD002301. https://doi.org/10.1002/14651858.CD002301.pub2

Soo S, Moayyedi P, Deeks J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2005;2:CD002301. https://doi.org/10.1002/14651858.CD002301.pub4

Soo S, Moayyedi P, Deeks JJ, Delaney B, Lewis M, Forman D. WITHDRAWN: Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2011;2:CD002301. https://doi.org/10.1002/14651858.CD002301.pub5

Soo S, Moayyedi P, Deeks Jonathan J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2011;16:CD002301.

Soomro GM. Obsessive compulsive disorder. BMJ Clin Evid 2007;2007:1004.

Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007;37:319–28.

Spence JD, Barnett PA, Linden W, Ramsden V, Taenzer P. Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ 1999;160(Suppl. 9):46–50.

Stratford HJ. Anxiety and Bipolar Spectrum Disorders: Psychological Treatments and Mental Imagery. PhD thesis. Oxford: University of Oxford; 2013.

Sumathipala A. What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med 2007;69:889–900.

Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E. Interventions for treating obesity in children. Cochrane Database Syst Rev 2003;3:CD001872. https://doi.org/10.1002/14651858.CD001872

Sztein DM, Koransky CE, Fegan L, Himelhoch S. Efficacy of cognitive behavioural therapy delivered over the internet for depressive symptoms: a systematic review and meta-analysis. J Telemed Telecare 2018;24:527–39. https://doi.org/10.1177/1357633X17717402

Liu TW, Ng GYF, Chung RCK, Ng SSM. Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis. Age Ageing 2018;47:520–7. https://doi.org/10.1093/ageing/afy010

Tatrow K, Montgomery GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 2006;29:17–27. https://doi.org/10.1007/s10865-005-9036-1

Thakur ER, Shapiro J, Chan J, Lumley MA, Cully JA, Bradford A, El-Serag HB. A systematic review of the effectiveness of psychological treatments for IBS in gastroenterology settings: promising but in need of further study. Dig Dis Sci 2018;63:2189–201. https://doi.org/10.1007/s10620-018-5095-3

Torchalla I, Strehlau V. The evidence base for interventions targeting individuals with work-related PTSD: a systematic review and recommendations. Behav Modif 2018;42:273–303. https://doi.org/10.1177/0145445517725048

Turner DT, van der Gaag M, Karyotaki E, Cuijpers P. Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. Am J Psychiatry 2014;171:523–38. https://doi.org/10.1176/appi.ajp.2013.13081159

Turner W, Macdonald GM, Dennis JA. Cognitive–behavioural training interventions for assisting foster carers in the management of difficult behaviour. Cochrane Database Syst Rev 2005;2:CD003760. https://doi.org/10.1002/14651858.CD003760.pub2

Turner W, Macdonald GM, Dennis JA. Cognitive–behavioural training interventions for assisting foster carers in the management of difficult behaviour. Cochrane Database Syst Rev 2007;1:CD003760. https://doi.org/10.1002/14651858.CD003760.pub3

Uman LS. Psychological interventions for needle-related procedural pain and distress in children and adolescents: A systematic review and quality analysis. PhD thesis. Halifax, NS: Dalhousie University; 2010.

Uman LS, Chambers CT, McGrath PJ, Kisely S. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2006;4:CD005179. https://doi.org/10.1002/14651858.CD005179.pub2

Uman LS, Chambers CT, McGrath PJ, Kisely S. A systematic review of randomized controlled trials examining psychological interventions for needle-related procedural pain and distress in children and adolescents: an abbreviated cochrane review. J Pediatr Psychol 2008;33:842–54. https://doi.org/10.1093/jpepsy/jsn031

van Balkom AJ, Bakker A, Spinhoven P, Blaauw BM, Smeenk S, Ruesink B. A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioral, and combination treatments. J Nerv Ment Dis 1997;185:510–16. https://doi.org/10.1097/00005053-199708000-00006

Veronese A, Hunot V, Cipriani A, Churchill R, Barbui C. Psychological therapies versus pharmacotherapy for obsessive compulsive disorder. Cochrane Database Syst Rev 2008;3:CD007319.

Vulink N, Denys D. Body dysmorphic disorder: an overview. Tijdschriftvoor Psychiatrie 2005;47:21–7.

Waddell C, Hua JM, Garland OM, Peters RD, McEwan K. Preventing mental disorders in children. Can J Public Health 2007;98:166–73.

Warren Z, Veenstra-VanderWeele J, Stone W, Bruzek JL, Nahmias AS, Foss-Feig JH, et al. Therapies for Children with Autism Spectrum Disorders. Comparative Effectiveness Review No. 26. Report No: 11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2011.

Windmill J, Fisher E, Eccleston C, Derry S, Stannard C, Knaggs R, Moore RA. Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane Database Syst Rev 2013;9:CD010323. https://doi.org/10.1002/14651858.CD010323.pub2

Yorke J, Fleming SL, Shuldham C. Psychological interventions for adults with asthma: a systematic review. Respir Med 2007;101:1–14.

Zakrzewska JM, Forssell H, Glenny AM. Interventions for the treatment of burning mouth syndrome: a systematic review. J Orofac Pain 2003;17:293–300.

Zakrzewska JM, Glenny AM, Forssell H. Interventions for the treatment of burning mouth syndrome. Cochrane Database Syst Rev 2001;3:CD002779.

Studies excluded as no cognitive–behavioural therapy in title/abstract/keywords or not relevant to the overview (n = 14)

Alharbi F, el-Guebaly N. Disulfiram: the survivor medication. Addict Disord Treat 2012;11:212–23.

Allen LA, Escobar JI, Lehrer PM, Gara MA, Woolfolk RL. Psychosocial treatments for multiple unexplained physical symptoms: a review of the literature. Psychosom Med 2002;64:939–50. https://doi.org/10.1097/01.psy.0000024231.11538.8f

Anderson EM, Lambert MJ. Short-term dynamically oriented psychotherapy: a review and meta-analysis. Clin Psychol Rev 1995;15:503–14.

Anonymous. Exam 2: efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: a systematic review. Clin Gastroenterol Hepatol 2016;14:e20.

Berglund M. A better widget? Three lessons for improving addiction treatment from a meta-analytical study. Addiction 2005;100:742–50.

Bloom K, Tam JA. Walk-in services for child and family mental health. J Syst Ther 2015;34:61–77.

Brown M, O’Neill N, van Woerden H, Eslambolchilar P, Jones M, John A. Gamification and adherence to web-based mental health interventions: a systematic review. JMIR Ment Health 2016;3:e39. https://doi.org/10.2196/mental.5710

Chakraborty K, Basu D, Vijaya Kumar KG. Internet addiction: consensus, controversies, and the way ahead. East Asian Arch Psychiatry 2010;20:123–32.

Clark GI, Rock AJ. Processes contributing to the maintenance of flying phobia: a narrative review. Front Psychol 2016;7:754. https://doi.org/10.3389/fpsyg.2016.00754

Daker-White G, Rogers A. What is the potential for social networks and support to enhance future telehealth interventions for people with a diagnosis of schizophrenia: a critical interpretive synthesis. BMC Psychiatry 2013;13:279. https://doi.org/10.1186/1471-244X-13-279

Edwards CJ, Cella M, Tarrier N, Wykes T. Investigating the empirical support for therapeutic targets proposed by the temporal experience of pleasure model in schizophrenia: a systematic review. Schizophr Res 2015;168:120–44. https://doi.org/10.1016/j.schres.2015.08.013

Folmer RL, Theodoroff SM, Martin WH, Shi Y. Experimental, controversial, and futuristic treatments for chronic tinnitus. J Am Acad Audiol 2014;25:106–25. https://doi.org/10.3766/jaaa.25.1.7

Marks R, Allegrante JP. Effectiveness of psychoeducational interventions in osteoarthritis. Crit Rev Phys Rehabil Med 2002;14:173–95.

Rozental A, Bennett S, Forsström D, Ebert DD, Shafran R, Andersson G, Carlbring P. Targeting procrastination using psychological treatments: a systematic review and meta-analysis. Front Psychol 2018;9:1588. https://doi.org/10.3389/fpsyg.2018.01588

Studies excluded as not able to obtain full text (n = 17)

Anders M, Christiansen H. Unaccompanied refugee minors: a systematic review of psychological interventions. Kindh Entwickl Z Klin Kinderpsychol 2016;25:216–30.

Åslund L, Arnberg F, Kanstrup M, Lekander M. Cognitive and behavioral interventions to improve sleep in school-age children and adolescents: a systematic review and meta-analysis. J Clin Sleep Med 2018;14:1937–47. https://doi.org/10.5664/jcsm.7498

Cardi V, Treasure J. Treatments in eating disorders: towards future directions. Minerva Psichiatrica 2010;51:191–206.

Chang CW, Mu PF, Jou ST, Wong TT, Chen YC. The effectiveness of non-pharmacological interventions on fatigue in children and adolescents with cancer: a systematic review. JBI Libr Syst Rev 2012;10:574–614. https://doi.org/10.11124/jbisrir-2012-60

Corbière M, Shen J. A systematic review of psychological return-to-work interventions for people with mental health problems and/or physical injuries. Can J Community Ment Health 2006;25:261–88.

de Wit N, Rubin G, Jones RH. Irritable bowel syndrome. BMJ Clin Evid 2007;2007:0410.

DiMauro J. Exposure therapy for posttraumatic stress disorder: a meta-analysis. Mil Psychol 2014;26:120–30.

Gherman A, David D. Are psychological interventions effective in diabetes care? A quantitative meta-analysis. Erdelyi Pszichologiai Szemle 2011;12:155–69.

Gratton S. Evaluation of a Computer-based CBT Package for Exam Anxiety. PhD thesis. Guildford: University of Surrey; 2007.

Heaton K. Men with Intellectual Disabilities who Display Sexually Abusive Behaviour. PhD thesis. Lancaster: Lancaster University; 2010.

Hedgpeth NL. Systematic Review of Psychosocial Interventions for Anxiety in Adult Cancer Patients. PhD thesis. DNPc; 2012.

Kinsella PJ. Paranoid Ideation after Traumatic Brain Injury: An Exploration of Related Factors. PhD thesis. Bangor: Bangor University; 2012.

Larkin D, Lopez V, Aromataris E. Non-pharmacological interventions for cancer-related fatigue in men treated for prostate cancer: a systematic review. JBI Libr Syst Rev 2012;10:3764–811.

Liu Z. The Effectiveness of Cognitive Behavioural Interventions for the Psychological Morbidity of Dementia Family Caregivers: A Systematic Review and Meta-analysis. PhD thesis. Hong Kong: The Chinese University of Hong Kong; 2017.

Nicoll M. Anger in Offenders with Intellectual Disabilities. PhD thesis. Sheffield: University of Sheffield; 2011.

Paskins RT, Brady AM, Schultz JC. Applied interventions in college settings to assist adult students with autism spectrum disorder: a systematic review of the literature. J Appl Rehabil Counsel 2018;49:39–45.

Pratt HD. Psychotherapy in the Age of Pharmacology. In Greydanus DE, Calles JL Jr, Patel DR, Nazeer A, Merrick J, editors. Clincial Aspects of Psychopharmacology in Childhood and Adolescence. 2nd edn. Hauppauge, NY: Nova Science Publishers; 2017. pp. 83–91.

Studies excluded because overviews of systematic reviews (n = 44)

Aguiluz J, Álvarez M, Pimentel E, Abarca C, Moore P. How to face a patient with benzodiazepine dependence in primary health care? Strategies for withdrawal. Medwave 2018;18:e7159. https://doi.org/10.5867/medwave.2018.01.7159

Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind–body medicine: state of the science, implications for practice. J Am Board Fam Pract 2003;16:131–47.

Barlow JH, Ellard DR. Psycho-educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base. Child Care Health Dev 2004;30:637–45.

Bennett K, Manassis K, Duda S, Bagnell A, Bernstein GA, Garland EJ, et al. Treating child and adolescent anxiety effectively: overview of systematic reviews. Clin Psychol Rev 2016;50:80–94.

Bhui KS, Dinos S, Stansfeld SA, White PD. A synthesis of the evidence for managing stress at work: a review of the reviews reporting on anxiety, depression, and absenteeism. J Environ Public Health 2012;2012:515874. https://doi.org/10.1155/2012/515874

Bidonde J, Menseses J. The Effect of Interventions for Children who have Experienced Violence in Close Relationships: An Overview of Reviews. Oslo: The Norwegian Institute of Public Health; 2017.

Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive–behavioral therapy: a review of meta-analyses. Clin Psychol Rev 2006;26:17–31.

Buysse DJ. Insomnia. JAMA 2013;309:706–16.

Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007;147:492–45. [Erratum published in Ann Intern Med 2008 Feb 5;148(3):247].

Cislak A, Safron M, Pratt M, Gaspar T, Luszczynska A. Family-related predictors of body weight and weight-related behaviours among children and adolescents: a systematic umbrella review. Child Care Health Dev 2012;38:321–31. https://doi.org/10.1111/j.1365-2214.2011.01285.x

Cox G, Hetrick S. Psychosocial interventions for self-harm, suicidal ideation and suicide attempt in children and young people: What? How? Who? And Where? Evid Based Ment Health 2017;20:35–40.

Crowe K, McKay D. Efficacy of cognitive–behavioral therapy for childhood anxiety and depression. J Anxiety Disord 2017;49:76–87.

Das JK, Salam RA, Lassi ZS, Khan MN, Mahmood W, Patel V, Bhutta ZA. Interventions for adolescent mental health: an overview of systematic reviews. J Adolesc Health 2016;59:S49–S60.

Dragioti E, Dimoliatis I, Fountoulakis KN, Evangelou E. A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy. Ann Gen Psychiatry 2015;14:25. https://doi.org/10.1186/s12991-015-0063-1

Dragioti E, Karathanos V, Gerdle B, Evangelou E. Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials. Acta Psychiatr Scand 2017;136:236–46. https://doi.org/10.1111/acps.12713

Driot D, Bismuth M, Maurel A, Soulie-Albouy J, Birebent J, Oustric S, et al. Management of first depression or generalized anxiety disorder episode in adults in primary care: a systematic meta review. La Presse Medicale 2017;46:1124–38.

Dufour S, Chamberland C. The effectiveness of selected interventions for previous maltreatment: enhancing the well-being of children who live at home. Child Fam Soc Work 2004;9:39–56.

Duncan M, Moschopoulou E, Herrington E, Deane J, Roylance R, Jones L, et al. Review of systematic reviews of non-pharmacological interventions to improve quality of life in cancer survivors. BMJ Open 2017;7:e015860. https://doi.org/10.1136/bmjopen-2017-015860

Eccleston C, Morley SJ, Williams AC. Psychological approaches to chronic pain management: evidence and challenges. Br J Anaesth 2013;111:59–63. https://doi.org/10.1093/bja/aet207

Enns J, Holmqvist M, Wener P, Halas G, Rothney J, Schultz A, et al. Mapping interventions that promote mental health in the general population: a scoping review of reviews. Prev Med 2016;87:70–80.

Farah WH, Alsawas M, Mainou M, Alahdab F, Farah MH, Ahmed AT, et al. Non-pharmacological treatment of depression: a systematic review and evidence map. Evid Based Med 2016;21:214–21. https://doi.org/10.1136/ebmed-2016-110522

Fishbain DA. Non-surgical chronic pain treatment outcome: a review. Int Rev Psychiatry 2000;12:170–80.

Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry 2011;11:131. https://doi.org/10.1186/1471-244X-11-131

Gartlehner G, Wagner G, Matyas N, Titscher V, Greimel J, Lux L, et al. Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews. BMJ Open 2017;7:e014912. https://doi.org/10.1136/bmjopen-2016-014912

Gustafsson C, Öjehagen A, Hansson L, Sandlund M, Nyström M, Glad J, et al. Effects of psychosocial interventions for people with intellectual disabilities and mental health problems: a survey of systematic reviews. Res Soc Work Pract 2009;19:281–90.

Health Quality Ontario. Psychotherapy for major depressive disorder and generalized anxiety disorder: a health technology assessment. Ont Health Technol Assess Ser 2017;17:1–167.

Health Quality Ontario. Cognitive behavioural therapy for psychosis: a health technology assessment. Ont Health Technol Assess Ser 2018;18:1–141.

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res 2012;36:427–40. https://doi.org/10.1007/s10608-012-9476-1

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Appendix 7 Summary tables of included systematic reviews grouped according to the conditions they targeted as per the ICD-11

TABLE 5 - Reviews in ICD-11 primary: 01 Certain infectious or parasitic diseases

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Uwimana and Louw465 2007	Human immunodeficiency virus	NA	Critically low	1 (NR)	Adults	NR	Group CBT	NA	Peer support counselling	NA	Short	✓	✓	✓	✗

TABLE 6 - Reviews in ICD-11 primary: 02 Neoplasms

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Berry et al.65 2017	Neoplasms	NA	Low	1 (118)	Adults	The Netherlands	Face-to-face CBT (couples therapy)	NA	NA	TAU	Short	✗	✓	✗	≤
Boutin73 2007	Malignant neoplasms of breast	NA	Critically low	2 (213)	Adults	NR	Individual CBT	NA	NR	NR	Short–long	✗	✓	✗	✗
Ernst et al.137 2006	Malignant neoplasms of breast	NA	Critically low	1 (92)	NR	NR	Therapist-led group CBT + standard oncological care	NA	NA	TAU	Long	✗	✗	✗	✓
Hines et al.209 2011	Malignant neoplasms	Cognitive dysfunction	Moderate	1 (40)	Adults	USA	Individual CBT+ telephone booster	NA	NA	WLC	Short	✓	✗	✗	✗
Juvet et al.238 2009	Malignant neoplasms of breast	NA	Moderate	1 (114)	Adults	Israel	Group CBT	NA	Relaxation + guided support	TAU	Short	≤	≤	≤	✓
Mirosevicet al.313 2019	Malignant neoplasms	NA	Critically low	4 (625)	Adults	NR	Group CBT	NA	NA	TAU	Long	✗	✗	✗	✓
Mustafa et al.322 2013	Malignant neoplasms of breast	NA	Moderate	1 (63)	Adults	Australia	Individual CBT	NA	NA	TAU	Short–long	≤	✓	✓	✓
Ye et al.513 2018	Malignant neoplasms of breast	NA	Low	10 (1939)	Adults	USA, China, Ireland, France, the Netherlands, Australia	Individual CBT	NA	Behavioural placebo, relaxation, drug	WLC, TAU	Short	✓	✓	✓	✓

TABLE 7 - Reviews in ICD-11 primary: 05 Endocrine, nutritional or metabolic diseases

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Amato Nesbit et al.41 2019	Diabetic peripheral neuropathy	NA	Critically low	1 (19)	Adults	NR	Individual CBT	NA	NA	Sham	Short	✗	✗	✗	✓
Elliot136 2012	Diabetes mellitus	Depression	Critically low	2 (158)	Adults	The Netherlands, USA	Group CBT, individual CBT	NA	Education, blood glucose awareness training	NA	Short–long	✗	✓	✗	✓
Uchendu and Blake463 2017	Diabetes mellitus	Depression, anxiety	Low	6 (NR)	Adults	The Netherlands, USA, Sweden	Group CBT, individual CBT	Telephone CBT	NA	TAU, NR	Long	✓	✓	✓	✓

Reviews in this ICD-11 primary classification 06 mental, behavioural or neurodevelopmental problems are presented at the secondary level of classification.

TABLE 8 - Reviews in ICD-11 secondary: neurodevelopmental disorders (6A00-06)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Goode et al.174 2018	ADHD	NA	Critically low	1 (119)	Children, adolescents	NR	NR	NA	NA	TAU	Short	✗	≤	≤	✓
Jensen et al.230 2016	ADHD	Anxiety, depression	Low	2 (85)	Adults	NR	Manualised group CBT or individual CBT	NA	NA	TAU	Short	≤	✓	✓	✓
Kemper et al.244 2018	ADHD	NA	High	1 (119)	Children, adolescents	NR	NR	NA	NA	TAU	Short	✗	✗	✗	✓
Lopez et al.286 2018	ADHD	NA	High	6 (277)	Adults	Sweden, Finland, Spain, Iceland, USA	Individual CBT	Internet-based CBT	Relaxation, education, cognitive training, drug	WLC	Short	✓	✓	✓	✓
Vidal-Estrada et al.481 2012	ADHD	NA	Critically low	3 (146)	Adults	NR	Individual CBT + medication	NA	Medication	NA	Short	✗	✓	✓	✓

TABLE 9 - Reviews in ICD-11 secondary: schizophrenia or other primary psychotic disorders (6A20-25)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported; TORCH, Treatment Of Resistant Command Hallucinations.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Álvarez-Jiménez et al.40 2011	Psychosis	NA	Moderate	1 (309)	Adults	NR	Manualised individual CBT	NA	Supportive counselling therapy	TAU	Long	✗	✗	✗	✓
Anagnostopoulou et al.43 2018	Psychosis	NA	Critically low	1 (30)	Adolescents	UK	Individual CBT	NA	Family therapy	TAU	Short	✗	✗	✗	✓
Armando et al.51 2015	Psychosis	NA	Critically low	1 (309)	Adolescents, adults	NR	NR	NA	Supportive counselling + TAU	TAU	Long	✗	✗	✗	✓
Bighelli et al.66 2018	Psychosis	NA	Moderate	2 (323)	Adults	UK, Norway	Individual CBT	NA	NA	WLC	Short	′	′	✗	✓
Bird et al.67 2010	Early-onset psychosis	NA	Moderate	3 (529)	Adults	NR	Group CBT, individual CBT	NA	NA	TAU	Long	✗	✗	✗	✓
Buckley et al.79 2015	Psychosis	NA	High	5 (349)	Adults	USA, UK, Italy	Individual CBT	NA	Supportive therapy	NA	Short	✗	✓	✗	✓
Davies et al.116 2018	Psychosis	NA	Moderate	6 (712)	Adolescents, adults	Canada, UK, Germany, Australia	Individual CBT (French and Morrison540 protocol)	NA	Drug	Needs-based intervention	Long	✗	✗	✗	✓
de Koning et al.121 2009	Attenuated psychosis syndrome	NA	Critically low	1 (128)	Adults	Germany	Comprehensive individual CBT	NA	Supportive counselling	NA	Long	✗	✗	✗	✓
Devoe et al.128 2018	Attenuated psychosis syndrome	NA	Moderate	3 (236)	Young adults	Canada, the Netherlands, Australia	Individual CBT + TAU, individual CBT + placebo	NA	Supportive therapy, supportive therapy + placebo drug	TAU + monitoring	Short	✗	✗	✗	✓
Devoe et al.127 2019	Psychosis	NA	Low	6 (843)	Young adults	Canada, the Netherlands, UK, Australia, New Zealand	Individual CBT, individual CBT +TAU, individual CBT + placebo, individual CBT + monitoring	NA	Supportive therapy, supportive therapy + placebo	TAU + monitoring	Long	✗	✗	✗	✓
Gaag et al.161 2014	Psychosis	NA	Moderate	9 (768)	Adults	UK, the Netherlands, Canada, Germany, Norway	Individually tailored case formulation + culturally adapted CBT	NA	Supportive counselling, social activity treatment	Attention placebo, TAU	Short	✗	✗	✗	✓
Hutton and Taylor219 2014	Psychosis	NA	Moderate	3 (324)	Adults	Canada, Australia, the Netherlands	Individual CBT	NA	Supportive therapy	Monitoring	Long	✓	✓	✓	✓
Jacobsen et al.226 2018	Psychosis	NA	Low	1 (90)	Adults	UK	NR	NA	NA	TAU	Long	✗	′	′	✓
Jones et al.234 2012	Psychosis	NA	Moderate	5 (378)	Adults	NR	Group CBT, individual CBT	NA	Supportive psychotherapy, family intervention, supportive counselling, enhanced supportive therapy, befriending, TAU	TAU	Long	✓	✓	✓	✓
Jones et al.235 2018	Psychosis	NA	High	14 (1561)	Adults	Scotland, Germany, UK, the Netherlands, Canada, USA, China	Group CBT, individual CBT	NA	Psychoeducation, family intervention, supportive psychotherapy, health education, group social skills training, supportive counselling, social activities therapy, befriending	NA	Short–long	✓	✓	✓	✓
Jones et al.236 2018	Psychosis	NA	High	12 (1827)	Adults	UK, Pakistan, China	Individual CBT	NA	NA	TAU	Long	✓	✓	✓	✓
Kennedy and Xyrichis245 2017	Psychosis	NA	Low	2 (105)	Adults	USA, Australia	Group CBT, TORCH541 individual CBT	NA	Supportive therapy, befriending	NA	Short	✗	✗	✗	✓
Kluwe-Schiavon et al.254 2013	Psychosis	NA	Critically low	1 (40)	Adults	NR	Individual CBT	NA	Cognitive remediation therapy	TAU	Short	≤	✗	✗	✓
Lawrence et al.269 2006	Psychosis	NA	Critically low	1 (88)	Adults	Australia, UK, Germany	Group CBT	NA	Psychoeducation	TAU, NR	Long	✗	✓	✓	✓
Laws et al.270 2018	Psychosis	NA	Critically low	9 (626)	Adults	NR	Group CBT, individual CBT	NA	Psychoeducation, befriending, drug	WLC, TAU	Short	✓	✗	✗	✓
Lockwood et al.283 2004	Psychosis	Social anxiety	Critically low	4 (825)	Adults	UK, NR	Group CBT, individual CBT	NA	Supportive counselling	WLC, TAU	Short–long	✓	✓	✓	✓
Mehl et al.304 2015	Delusional disorder	NA	Critically low	5 (842)	Adults	NR	Individual CBT for psychosis	NA	Supportive therapy, social activity therapy, family intervention	TAU	Short	✗	✗	✗	✓
Naeem et al.323 2016	Psychosis	NA	Critically low	7 (1128)	Adults	NR	Individual CBT for psychosis, group CBT for psychosis, culturally adapted individual CBT for psychosis	NA	Supportive counselling, befriending	TAU	Short–long	′	✓	′	✓
Rector and Beck380 2001	Psychosis	NA	Critically low	6 (341)	Adults	NR	NR	NA	Problem-solving, supportive therapy, informal support, befriending	TAU	Short	✗	✓	✗	✓
Sarin et al.394 2011	Psychosis	NA	Moderate	5 (623)	Adults	NR	Group CBT, individual CBT	NA	Other psychotherapy (family intervention, supportive therapy)	TAU	Short, NR	✗	✓	✓	′
Skelton et al.414 2015	Delusional disorder	NA	Moderate	1 (17)	Adults	NR	Individual CBT	NA	NA	Attention placebo	Short	≤	✓	✓	✓
Turner et al.458 2014	Psychosis	NA	Low	8 (497)	NR	NR	Group CBT, individual CBT	NA	Supportive counselling	NA	Short	✗	✗	✗	✓
van der Gaag et al.161 2014	Psychosis	NA	Low	9 (768)	Adults	UK, Norway, Germany, the Netherlands, Canada	Individual CBT	NA	Supportive counselling, social activity treatment	TAU, attention placebo	Short	✗	✗	✗	✓
Velthorst et al.476 2015	Psychosis	NA	Critically low	2 (238)	Adults	USA, Germany	Group CBT, individual CBT	NA	Cognitive remediation	TAU	Short	✗	✗	✗	✓
Wood et al.503 2016	Psychosis	NA	Low	1 (29)	Adults	UK	Individual CBT	NA	NA	TAU	Short	✗	✓	✗	✓
Zhao et al.518 2015	Psychosis	NA	High	1 (41)	Adults	Germany	Group CBT	NA	Group psychological programme	NA	Short	✓	≤	≤	✓

TABLE 10 - Reviews in ICD-11 secondary: mood disorders (6A60-80)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); HIV, human immunodeficiency virus; IBD, irritable bowel disorder; MS, multiple sclerosis; NA, not applicable; NR, not reported; PEP, Penn Enhancement Program; PRP, Penn Resiliency Program; RA, rheumatoid arthritis; RAP, Resourceful Adolescence Program; SSRI, selective serotonin reuptake inhibitor.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Ackermann and Williams33 2002	Premenstrual dysphoric disorder	NA	Critically low	1 (49)	NR	NR	Individual CBT	NA	NA	Placebo	NR	✗	✓	✗	✗
Ahern et al.36 2018	Depressive disorder	NA	Critically low	24 (2379)	Adults	Sweden, Australia, USA, Norway, UK, the Netherlands, Spain	NA	Internet-based CBT + therapist, internet-based CBT + administrative support	Individual CBT	WLC, TAU, attention control	Short	✗	✓	✗	✗
Akechi et al.37 2008	Depressive disorder	Metastatic breast cancer	High	1 (92)	Adults	NR	Group CBT	NA	NA	TAU	NR	≤	✓	✓	✗
Antoniades et al.48 2014	Depressive disorder	NA	Low	1 (63)	Adults	NR	NA	Culturally adapted internet-based CBT	NA	WLC	Short	✗	✓	✗	✗
Apóstolo et al.49 2015	Depressive disorder	NA	Moderate	1 (92)	Older adults	UK	Individual CBT + TAU (modified for older people)	NA	Talking control group	TAU	Short	✓	✓	✗	✗
Babowitch and Antshel55 2016	Depressive disorder	Substance abuse	Critically low	1 (40)	Adolescents	NR	Individual CBT, family CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Beltman et al.59 2010	Depressive disorder	Cancer, HIV, MS, RA, vascular disease, COPD, renal failure	Moderate	6 (725)	Adults	NR	Group CBT, individual CBT	NA	Other psychotherapy	WLC, TAU	Short	✗	✓	✗	✗
Bennett et al.61 2015	Subthreshold depression	Epilepsy, IBD	Low	2 (71)	Children, adolescents	Serbia and Montenegro, USA	Individual CBT	NA	NA	TAU (counselling, depression information leaflet)	Short–long	✓	✓	✗	✓
Briani et al.76 2018	Depressive disorder	Pain (knee osteoarthritis)	Low	1 (69)	Adults	NR	NA	Internet-based CBT	NA	TAU	Short	≤	✓	✗	✗
Butler et al.82 2018	Bipolar or related disorder	NA	Low	4 (405)	Adults	UK, USA, Germany, Canada	Individual CBT, individual CBT for insomnia	NA	Psychoeducation, supportive therapy	TAU	Short–long	✓	✓	✗	✓
Casacalenda et al.92 2002	Depressive disorder	NA	Critically low	1 (239)	Adults	NR	Individual CBT	NA	Imipramine (drug), interpersonal therapy	Placebo	Short	✗	✓	✗	✗
Clevenger et al.104 2018	Depressive disorder	NA	Critically low	1 (40)	Children, adolescents, adults	NR	Individual CBT + SSRI	NA	SSRI	NA	Long	✗	✓	✗	✗
Compton et al.106 2002	Depressive disorder	NA	Critically low	1 (57)	Children, adolescents	NR	Individual CBT	NA	Non-focused supportive intervention	NA	Long	✗	✓	✗	✗
Cuijpers et al.113 2009	Subthreshold depression	Subthreshold depression	Critically low	10 (1159)	Adolescent, adults	NR	Group CBT (coping with depression)	Guided self-help CBT (coping with depression)	Internet-based CBT	WLC, TAU	Short	✗	✓	✗	✗
Cuijpers et al.112 2013	Depressive disorder	NA	Low	9 (506)	Adults	USA, UK, Romania	Acute phase individual CBT + 3 or 4 booster (Beck542 protocol)	NA	Drug	NA	Short–long	✗	✓	✗	✗
Cuijpers et al.111 2017	Depressive disorder	Diabetes	Low	3 (200)	Adults	NR	Individual CBT	NA	Cognitive therapy, behavioural activation	NA	NR	✗	✓	✗	✗
Das et al.114 2019	Depressive disorder	Heart failure	Critically low	1 (60)	Adults	USA	NR	NA	Exercise	TAU	Short	✗	✓	✗	✗
de Mello et al.145 2005	Depressive disorder	NA	Critically low	3 (204)	Adults	NR	Individual CBT	NA	Interpersonal therapy	NA	Short	✗	✓	✗	✗
Dekker123 2008	Depressive disorder	Stroke, diabetes (type 2)	Critically low	2 (174)	NR	NR	Individual tailored CBT	NA	Diabetes education	Attention placebo, no intervention	Short	✗	✓	✗	✗
Demissie et al.124 2018	Bipolar or related disorder	NA	Low	2 (91)	Adults	Brazil	Group CBT	NA	NA	TAU	Short–long	✓	✓	✓	✓
Ebrahim et al.132 2012	Depressive disorder	NA	Low	8 (1400)	Adults	USA, Canada, Pakistan, Iran, the Netherlands	Mostly individualised face-to-face CBT	Internet-based CBT, CBT (delivered by female health workers)	Drug	No intervention, TAU	NR	✗	✓	✗	✗
Escobar and Gorey138 2018	Depressive disorder	NA	Low	5 (485)	Adults	USA	Group CBT, individual CBT	Telephone CBT	NA	TAU	Short	✗	✓	✗	✗
Fernie et al.146 2015	Depressive disorder	Epilepsy	Low	1 (59)	Adults	NR	Individual CBT	NA	NA	WLC	NR	✗	✓	✗	✗
Forman-Hoffman et al.153 2016	Depressive disorder	NA	Low	1 (123)	Children, adolescents	USA, NR	Individual CBT	NA	Drug, CBT + drug	Placebo	Short	✓	✓	✗	✗
Franco et al.156 2018	Depressive disorder	Diabetes	Critically low	2 (345)	Adults	NR	NA	Internet-based CBT	NA	WLC, TAU	Short	✓	′	✓	✓
Gertler et al.165 2015	Depressive disorder	Brain injury	High	2 (177)	Adults	USA	Individual CBT	NA	Supportive psychotherapy	WLC	Short	✓	✓	✗	✗
Griffiths et al.180 2010	Depressive disorder	NA	Low	5 (2166)	Adults	USA	NA	Internet-based CBT	NA	WLC, attention control, passive control	Short–long	✗	✓	≤	✗
Guidi et al.184 2016	Depressive disorder	NA	Moderate	1 (40)	Adults	NR	Individual CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Haibach et al.186 2014	Depressive disorder	Substance abuse	Critically low	1 (66)	Adults	USA	Integrated individual CBT	NA	12-step facilitation	NA	Long	✗	✓	✗	✓
Hall and Skelton190 2012	Depressive disorder	Caregivers (dementia)	Critically low	1 (42)	Adults	UK	CBT family intervention for caregivers	NA	NR	NR	Short	✗	✓	✗	✗
Hamers et al.191 2018	Depressive disorder	Intellectual disabilities	Low	1 (32)	Adults	NR	Manualised individual CBT	NA	NA	TAU	Short	✗	✓	✗	✗
Hart et al.196 2012	Depressive disorder	Cancer (mixed)	Low	1 (78)	Adults	USA	NA	Group CBT (delivered by social worker)	Crisis consultation and individual therapy	NA	Short	✗	✓	✗	✗
van Hees et al.202 2013	Depressive disorder	NA	Low	3 (333)	Adults	NR	Individual CBT	NA	Interpersonal therapy	NA	Short	✗	✓	✗	✗
Hennemann et al.204 2018	Depressive disorder	NA	Low	1 (84)	Adults	Sweden	NA	Internet-based CBT	NA	TAU	Long	✓	✓	✓	✗
Hetrick et al.205 2016	Depressive disorder	NA	Moderate	4 (1600)	Children, adolescents	Australia, New Zealand, USA	Manualised group CBT	Telephone CBT	NA	No intervention, TAU, attention placebo	Long	✗	✓	✓	✗
Hetrick et al.206 2011	Depressive disorder	NA	Moderate	2 (536)	Children, adolescents	UK, NR	Individual CBT + SSRI	NA	SSRI	NA	Short	✗	✓	✗	✗
Hides et al.207 2010	Depressive disorder	Substance abuse	Critically low	1 (66)	Adults	NR	NA	Group CBT	Group 12-step facilitation	NA	Short	✗	✓	✗	✓
Hundt et al.217 2014	Depressive disorder	Substance use disorder	Critically low	3 (357)	Older adults	NR	Group CBT	Telephone CBT	12-step facilitation	TAU	Short	✗	✓	✗	✗
Huntley et al.218 2012	Depressive disorder	NA	Moderate	3 (113)	Adults	UK	Group CBT + usual care	NA	NA	TAU	Short	✗	✓	✗	✗
Ijaz et al.220 2018	Treatment resistant depressive disorder	Treatment resistant	Moderate	1 (242)	Adults	UK	Individual CBT	NA	NA	TAU	Long	✓	✓	✗	✗
Jackson et al.224 2015	Depressive disorder	Epilepsy	Moderate	1 (30)	Adolescents	Serbia	Individual CBT	NA	NA	TAU	Short	✓	✓	≤	✗
Jeyanantham et al.231 2017	Depressive disorder	Heart failure	Moderate	5 (204)	Adults	USA	Face-to-face individual CBT ± telephone sessions (delivered by a therapist)	Face-to-face individual CBT (delivered by nurse) + telephone sessions	Exercise, CBT + exercise	TAU	Short	✓	✓	✗	✓
Jiang et al.232 2018	Depressive disorder	Heart failure	Low	5 (383)	Adults	Philippines, USA	Face-to-face group CBT and individual CBT (delivered by a therapist) ± telephone call	Face-to-face CBT (delivered by nurse) ± telephone call	NR	NR	Short	✓	✓	′	✓
Karyotaki et al.240 2017	Depressive disorder	NA	Moderate	13 (3876)	Adults	Switzerland, Australia, the Netherlands, UK, Germany, Spain	NA	Self-guided internet-based CBT	NA	TAU, WLC, attention placebo, no intervention	Short	✗	✓	✗	✗
Kavanagh et al.241 2009	Depressive disorder	NA	Critically low	2 (1153)	Adolescents	USA, Australia	Coping with depression	Coping with depression (delivered by teachers)	NA	No intervention	Short	✗	′	✓	✗
Kiosses et al.250 2011	Depressive disorder	NA	Critically low	1 (100)	Older adults	NR	NR	NA	Drug	NA	NR	≤	✓	≤	≤
Klein et al.253 2007	Depressive disorder	NA	Critically low	1 (88)	Adolescents	NR	Group CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Krishna et al.261 2015	Depressive disorder	NA	Moderate	1 (96)	Adults	The Netherlands	Group CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Lane et al.264 2013	Depressive disorder	Congenital heart disease	Moderate	0 (0)	Adolescents, adults	NR	NA	NA	NA	NA	NA	≤	≤	✗	≤
Li et al.277 2017	Depressive disorder	Diabetes	Low	3 (336)	Adults	NR	Group CBT/individual CBT (diabetes specific and generic)	NA	Diabetes education	TAU, WLC	Short	′	✓	✓	′
Li et al.278 2018	Depressive disorder	NA	Low	2 (468)	Adults	UK, Japan	Individual CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Linde et al.280 2015	Depressive disorder	NA	Moderate	7 (1273)	Adults	NR	Individual CBT	Telephone CBT, internet-based CBT	Drug, counselling	TAU	Short	✗	✓	✗	✗
Luckett et al.288 2011	Depressive disorder	Cancer (head and neck)	Moderate	1 (184)	Adults	USA	NA	Individual CBT (delivered by nurse)	NA	TAU	Short	≤	✓	≤	✗
Ma et al.289 2014	Depressive disorder	NA	Low	1 (208)	Children, adolescents	UK	Individual CBT	NA	Fluoxetine (drug)	NA	Short	✗	✓	✗	✗
Markowitz et al.296 2011	Depressive disorder	Diabetes	Critically low	1 (51)	Adults	NR	Individual CBT	NA	Education	NA	Short	✗	✓	✗	✓
Mewton and Andrews308 2016	Depressive disorder	Including suicide ideation	Critically low	2 (208)	Adults	NR	NR	Internet-based CBT	High-intensity CBT, interperson therapy, drug + clinical management	Placebo + clinical management	Short	✗	✓	✗	✗
Michaelis et al.309 2018	Depressive disorder	Epilepsy	Critically low	1 (NR)	Children	NR	Individual CBT	NR	NR	NR	Short	≤	✓	≤	≤
Moore et al.318 2017	Depressive disorder	NA	Low	5 (631)	Adults	Taiwan, England, Australia, Hong Kong, Sweden	Group CBT	NA	Guided internet-based CBT	WLC, TAU	Short–long	✓	✓	✗	✗
Napa et al.325 2017	Depressive disorder	Caregivers (psychosis)	Critically low	1 (21)	Adults	NR	Family CBT relapse prevention	NA	NA	TAU	Long	✗	✓	✗	✗
Noh334 2018	Depressive disorder	Homeless youth	Critically low	1 (27)	Adolescents, young adults	Republic of Korea	Group CBT	NA	NA	TAU	Short	✗	✓	✗	✗
Opoka and Lincoln344 2017	Depressive disorder	Psychosis	Critically low	1 (30)	Adults	NR	Individual CBT	NA	NA	TAU	Short	✗	✓	′	✓
Orgeta et al.347 2014	Depressive disorder	Dementia	Moderate	2 (82)	Older adults	UK, USA	Individual CBT	NA	NA	TAU	Short	✓	′	✓	✓
Osugo and Cooper350 2016	Depressive disorder	Intellectual disabilities	Critically low	1 (32)	Adults	NR	Individual CBT	NA	NA	TAU	Short	′	′	✓	✗
Oud et al.352 2019	Subthreshold depression	Subclinical depression or clinical depressive disorder	Low	4 (976)	Children, adolescents	USA, the Netherlands	Group CBT, individual CBT	Mixed CBT (group CBT/bibliotherapy CBT/online CBT)	NA	Placebo, online monitoring	Short	✓	✓	✗	✗
Pfeiffer et al.365 2011	Depressive disorder	NA	Low	7 (488)	Adults	NR	Group CBT	NA	Peer support interventions	NA	Short	✗	✓	✗	✗
Riper et al.383 2013	Depressive disorder	Alcohol misuse	Low	1 (164)	Adults	USA	Individual CBT for depression + TAU	NA	NA	TAU + placebo	Short	✗	✓	✓	✓
Robinson et al.386 2011	Depressive disorder	Including suicide ideation	Low	1 (90)	Adolescents, young adults	NR	Individual CBT	NA	NA	TAU	Short	✗	✓	✓	✓
Sharp et al.405 2013	Depressive disorder	Diabetes	Moderate	1 (167)	Adults	The Netherlands	NA	Computerised CBT (adapted from coping with depression)	NA	WLC	Short	≤	✓	✓	✓
Shi et al.407 2018	Depressive disorder	HIV	Low	4 (319)	NR	USA	Individual CBT	NA	Education on HIV medication adherence	TAU	Short–long	✗	✓	✓	✓
So et al.420 2013	Depressive disorder	NA	Moderate	5 (976)	Adults	Sweden, the Netherlands, Germany	NA	Internet-based CBT (unguided, guided)	NA	WLC, TAU	Short	′	✓	✗	✗
Soares-Weiser et al.421 2007	Bipolar or related disorder	NA	Moderate	1 (253)	Adults	UK	Individual CBT	NA	NA	TAU	Long	✗	✗	✗	✓
Ssegonja et al.427 2019	Subthreshold depression	Subsyndromal	Low	7 (3931)	Children, adolescents	Australia, USA, UK, the Netherlands	Group CBT (‘Friends’, ‘PRP’, ‘the resourceful adolescent’, ‘Friends for life’)	Group CBT (delivered by health-care professionals, teachers and psychologists)	Bibliotherapy, supportive expressive therapy	TAU, WLC, brochure, attention control	Long	✗	✓	✗	✗
Starkstein and Brockman428 2017	Depressive disorder	Parkinson’s disease	Critically low	1 (80)	Adults	NR	Individual CBT	NA	NA	Clinical monitoring	Short	✗	✓	✗	✗
Taylor and Montgomery444 2007	Depressive disorder	NA	Low	1 (30)	Adolescents	NR	Group CBT	NA	Relaxation	WLC	Short	✗	✓	✗	✗
Thomas et al.448 2006	Depressive disorder	MS	Moderate	3 (106)	Adults	NR	Group CBT, individual CBT	Telephone CBT	Drug	TAU, WLC	Short	≤	✓	✗	✓
Townsend et al.454 2010	Depressive disorder	NA	Moderate	1 (93)	Children, adolescents	USA	Group adolescent coping with depression	NA	Life skills tutoring	NA	Long	✗	✓	≤	✗
Twomey et al.462 2017 (Deprexis)	Depressive disorder	NA	Moderate	8 (2402)	Adults	USA, Germany, Switzerland	NA	Computerised CBT (Deprexis)	NA	WLC, TAU	Short	✗	✓	′	✗
Vandepitte et al.472 2016	Anxiety and depression	Caregivers (dementia)	Low	2 (292)	Adults	Spain	Group CBT	NA	NA	TAU	Short	✓	✓	✗	✗
Venning et al.477 2009	Depressive disorder	NA	Critically low	5 (2195)	Children, adolescents	USA, New Zealand, Australia	Group CBT [‘PEP’, ‘PRP’, ‘Problem-solving for Life’, ‘RAP-kiwi’, ‘the resourceful adolescent’)	NA	NA	TAU, NR	Long	✗	✓	✓	✗
Wang et al.485 2008	Depressive disorder	Diabetes	Critically low	1 (42)	Adults	NR	Individual CBT	NA	Diabetes self-management education	NA	Short	✗	✓	✗	✓
Wang et al.488 2017	Depressive disorder	Diabetes	Low	2 (368)	Adults	The Netherlands, Germany	NR	NA	Diabetes education	TAU	Long	✗	✓	✗	✗
Wang et al.486 2018	Depressive disorder	Post stroke	Critically low	22 (1911)	Adults	UK, China	Individual CBT ± drug	NA	Drug	Placebo, placebo or drug, attention control, TAU	Short	✗	✓	′	✗
Ward489 2007	Depressive disorder	Racial and ethnic minority women	Critically low	1 (267)	Adults	USA	NR	NA	Drug	TAU	Short	✓	✓	✗	✗
Wilson et al.501 2008	Depressive disorder	NA	Moderate	2 (148)	Older adults	USA	Individual CBT	NA	Focused visual imagery, education, psychodynamic therapy	NA	Short	✓	✓	✗	✗
Woltz et al.502 2012	Depressive disorder	Heart failure	Critically low	1 (74)	Adults	USA	Individual CBT	NA	Walking programme	Attention control	Short	✗	✓	✗	✗
Xiao et al.506 2017	Depressive disorder	Cancer (breast)	Low	1 (60)	Adults	USA	Individual CBT	NA	NA	No intervention	Short	✗	✓	✗	✗
Xie et al.507 2015	Depressive disorder	Parkinson’s disease	Moderate	6 (381)	Adults	UK, USA, China	Individual CBT + drug/monitoring, mixed individual CBT + telephone sessions	Bibliotherapy (self-help)	Drug, telephone support	Monitoring, no intervention	Short	✗	✓	✗	✓
Yang et al.510 2017	Depressive disorder	NA	Low	3 (93)	Children	NR	Group CBT	NA	NA	WLC, no intervention, placebo	Short	✗	✓	✗	✗
Ye et al.512 2016	Bipolar or related disorder	NA	Low	1 (76)	Adults	USA, Germany	Individual CBT	NA	Education, support therapy	NA	Short	✗	✓	✗	✓
Zhang et al.517 2018	Depressive disorder	NA	Critically low	3 (164)	Adults	NR	Individual CBT	Internet-based CBT	NA	Placebo	Long	✗	✓	✗	✗
Zhou et al.520 2014	Depressive disorder	NA	Low	1 (334)	Adolescents	NR	Individual CBT + drug	NA	Drug	NA	Short	✗	✓	✗	✗
Zhou et al.519 2016	Depressive disorder	NA	Low	3 (1066)	Adults	NR	NA	Internet-based CBT	NA	Attention control, WLC	Short–long	✓	✓	✓	✗

The reviews in Table 11 are labelled using the tertiary-level ICD-11 labels:

6B00 Generalised anxiety disorder
6B01 Panic disorder
6B02 Agoraphobia
6B03 Specific phobia
6B04 Social anxiety disorder
6B05 Separation anxiety disorder
6B06 Selective mutism.

TABLE 11 - Reviews in ICD-11 secondary: anxiety or fear-related problems (6B00-06)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; app, application; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); C.A.T., Cognitive–behavioural Therapy for Anxious Adolescents; EFT, emotional freedom technique; GAD, generalised anxiety disorder; IAFS, Intervention with Adolescents with Social Phobia; NA, not applicable; NR, not reported; PTSD, post-traumatic stress disorder; SAD, social anxiety disorder; SSRI, selective serotonin reuptake inhibitor.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Adelman et al.34 2014	GAD, SAD, panic, phobia	NA	Low	34 (2029)	Children, adults	NR	NA	Computerised CBT	High-intensity CBT	WLC	Short	✗	✗	✓	✗
Baardseth et al.54 2013	Anxiety	NA	Critically low	2 (123)	Adults	NR	NR	NA	Short-term dynamic psychotherapy, emotion-focused therapy	NR	NA	✗	✗	✓	✓
Bandelow et al.57 2007	GAD, SAD, panic	NA	Critically low	13 (NR)	NR	NR	NR	NA	Drug	NA	Short	✗	✗	✓	✗
Caldirola et al.84 2018	Panic	NA	Critically low	1 (150)	Adults	The Netherlands	Individual CBT, individual CBT + SSRI	NA	SSRI	NA	Long	✗	✗	✓	✗
Carpenter et al.89 2018	GAD, panic	NA	Moderate	1 (43)	Adults	NR	Individual CBT	NA	NA	Placebo (non-directive)	Short	✗	✗	✓	✗
Cartwright-Hatton et al.90 2004	Anxiety	NA	Critically low	10 (636)	Children, adolescents	USA, Australia	Group CBT, individual CBT	NA	NA	WLC	Short	✗	✗	✓	✗
Clond105 2016	Anxiety	NA	Critically low	1 (42)	Children, adolescents	USA	A brief form of individual CBT based on ‘Coping Cat’ and the C.A.T. Project543	NA	EFT	WLC	Short	✗	✗	✓	✗
Davis et al.118 2015	GAD, phobia, separation	NA	Critically low	1 (51)	Children, adolescents	NR	Group CBT	NA	NA	WLC	Long	✗	′	✓	✗
de Souza Moura et al.122 2015	Panic	NA	Critically low	1 (36)	Adults	NR	Individual CBT	NA	Physical exercise	NA	Long	✗	✗	✓	✗
Ewing et al.139 2015	Anxiety	NA	Moderate	20 (2099)	Children	NR	Trans-diagnostic individual CBT or group CBT	NA	NA	WLC	NC	✗	✗	✓	✗
Farrer et al.144 2013	SAD, exam anxiety	NA	Low	3 (300)	Adults	Australia, Spain, UK	NA	Internet-based CBT	Education	WLC	Short	✗	′	✓	✗
Foa et al.151 2002	GAD, panic	NA	Critically low	2 (425)	Adults	NR	Individual CBT	NA	Drug	Placebo	Short	✗	✗	✓	✗
Hall et al.189 2016	GAD	NA	Moderate	5 (242)	Older adults	NR	Group CBT, individual CBT	NA	Information only, enhanced usual care, supportive psychotherapy, drug, acceptance and commitment therapy	NA	Short	✗	✗	✓	✓
Hendriks et al.203 2008	GAD, panic, SAD, agoraphobia	NA	Low	7 (396)	Older adults	NR	Group CBT, individual CBT	NA	Supportive psychotherapy	WLC, TAU, discussion group	Short	✗	✓	✓	✗
James et al.227 2015	Anxiety	NA	Moderate	10 (707)	Children, adolescents	NR	Group CBT, school-based group CBT, clinic-based group CBT, modular CBT, individual CBT, ‘Facing your Fears’ programme, manualised group CBT	NA	Group CBT with parental advice, group support and attention, family-based CBT, family-based education support, social recreation programme, CBT without cognitive restructuring (IAFS)	TAU, WLC	Long	✗	✗	✓	✗
Jayakody et al.228 2014	Anxiety	NA	Low	0 (0)	Adults	NR	NA	NA	NA	NA	NA	≤	✗	≤	✗
Kishita and Laidlaw252 2017	GAD	NA	Critically low	7 (323)	Older adults	NR	Group CBT, individual CBT	NA	Supportive therapy, telephone calls, discussion groups	WLC	Short	✗	✗	✓	✗
Kreslins et al.259 2015	Anxiety	Autistic spectrum disorder	Moderate	7 (283)	Children, adolescents	NR	Group CBT, individual CBT, mixed individual CBT + group CBT	NA	NA	WLC, TAU	Short	✗	✗	✓	✗
Kreuze et al.260 2018	Mixed anxiety, SAD	NA	Low	13 (1073)	Children, adolescents	USA, Australia, Germany, UK	Group CBT, individual CBT	Audio CBT, partially guided CBT, computerised CBT	‘Test-busters’, computer-assisted education support and attention, education support	WLC, TAU, placebo	Short	✗	′	′	✓
Kumar and Malone262 2008	Panic	Alcohol dependence	Critically low	2 (122)	Adults	NR	Group CBT, individual CBT	NA	Exposure, alcohol treatment programme, internet self-help	NA	Long	≤	✓	✓	✓
Markowitz et al.295 2014	Panic	NA	Critically low	1 (91)	Adults	The Netherlands	Individual CBT	NA	Interpersonal therapy	NA	Short	✗	✗	✓	✓
Michail et al.310 2017	SAD	Psychosis	Moderate	1 (16)	Adults	Australia	Group CBT	NA	NA	WLC	Short	✓	✓	✓	✓
Oldham-Cooper and Loades342 2017	Anxiety	NA	Low	4 (257)	Children, adolescents	Australia, USA	Manualised individual CBT ‘Coping Cat’	NA	NA	WLC	Short	✗	✗	✓	✗
Opriş et al.346 2012	Phobia (flying)	NA	Critically low	1 (45)	Adults	NR	NR	NA	Behavioural therapy + virtual reality exposure	NA	Short	✗	✗	✓	✓
Østergaard349 2018	Selective mutism	NA	Critically low	1 (21)	Children	NR	Individual CBT (integrated behaviour therapy for selective mutism)	NA	NA	WLC	Short–long	✗	✗	✓	′
Pateraki and Morris358 2018	Anxiety	Asthma	Moderate	1 (94)	Children, adolescents, adults	UK	Individual CBT	NA	NA	TAU	Short	✗	✗	✓	✗
Perna and Caldirola361 2017	Panic (treatment resistant)	NA	Critically low	1 (58)	Adults	NR	Individual CBT	NA	SSRI	NA	Short	✗	✗	✓	✓
Perna et al.362 2011	Agoraphobia with panic	NA	Critically low	1 (49)	Older adults	NR	NR	NA	Drugs	WLC	Short	✗	✗	✓	✓
Podina et al.368 2016	Anxiety	NA	Critically low	8 (404)	Children, adolescents	NR	NA	Internet-based CBT	High-intensity CBT	WLC	Short	✗	✗	✓	✗
Pompoli et al.370 2016	Panic with or without agoraphobia	NA	Moderate	18 (1090)	Adults	NR	Group CBT, individual CBT	NA	NA	WLC	Short	✗	✗	✓	✓
Provencher et al.372 2011	Anxiety	Bipolar	Critically low	1 (108)	NR	NR	Individual CBT for PTSD	NA	NA	TAU	Short	✗	≤	✓	✓
Reinholt and Krogh381 2014	Anxiety	NA	Critically low	5 (1240)	Adults	NR	Trans-diagnostic group CBT and individual CBT	NA	NA	TAU, WLC	Short	✗	✗	✓	✗
Schade et al.395 2003	Anxiety	Substance abuse (alcohol)	Critically low	2 (206)	Adults	NR	Group CBT, individual CBT	NA	Substance abuse treatment	NA	Short	✗	✗	✓	✓
Schwartze et al.398 2017	Panic	NA	Low	1 (12)	Adults	NR	Group CBT	NA	Drug	NA	Short	✗	′	✓	✓
Singh and Gorey411 2018	SAD	NA	Critically low	1 (26)	Adults	NR	Individual CBT	NA	Mindfulness-based cognitive therapy	NA	Short	✗	✗	✓	✗
Singh and Servern410 2018	Anxiety	NA	Critically low	3 (326)	Adults, older adults	Romania, Sweden, Switzerland, Austria, Germany	NA	Internet-based CBT guided group, unguided and guided individual CBT	NA	WLC	Short	✓	✓	✓	✗
Stoll et al.433 2017	Anxiety	Chronic fatigue syndrome/ myalgic encephalomyelitis	Low	1 (112)	Children, adolescents	The Netherlands	NA	Internet-based CBT	NA	TAU	Short–long	✗	✗	✓	✓
Stratford et al.434 2015	Anxiety	Bipolar	Critically low	2 (149)	Adults	USA, Brazil	Group CBT and individual CBT for borderline personality disorder and PTSD	NA	NA	TAU	Short	✗	✗	✓	✗
Sukhodolsky et al.435 2013	Anxiety	Autism	Moderate	5 (224)	Children, adolescents	NR	Group CBT, individual CBT	NA	Social recreation	WLC, TAU	Short	✗	✗	✓	✗
Torous et al.453 2017	SAD	NA	Critically low	1 (52)	Adults	NR	NA	CBT app	Interpersonal therapy app	NA	Short	✗	≤	✓	✗
Usmani et al.464 2017	Anxiety	COPD	High	1 (238)	Adults	USA	Group CBT	NA	Education	NA	Long	✓	✗	✓	✓
Verberne et al.478 2018	Anxiety	Acquired brain injury	Low	1 (12)	Adults	NR	Individual CBT	NA	NA	WLC	Short	✗	✗	✓	✗
Waddell et al.482 2007	Anxiety	NA	Critically low	1 (594)	Children, adolescents	Australia	NA	‘Friends’ child group CBT (delivered by teachers)	NR	NR	Long	✗	✓	✓	✗
Wang et al.487 2017	Anxiety	NA	Low	20 (1811)	Children, adolescents	Australia, USA, Spain, Mexico, Ireland	Group CBT, individual CBT, mixed group CBT + individual CBT	NA	Education, non-specific counselling	Placebo, no intervention, TAU, group attention support	Short	✗	✗	✓	✗
Warwick et al.490 2017	Anxiety	Autistic spectrum disorders	Critically low	19 (1085)	Children, adolescents	NR	Group CBT, individual CBT	NA	NR	WLC	Short	✗	✗	✓	✗
Wersebe et al.497 2013	SAD	NA	Low	8 (403)	Adults	USA, China, Europe, Australia, NR	Group CBT, intensive group CBT	NA	NA	Placebo, WLC, TAU	Short	✗	✗	✓	✓
Wide Boman et al.499 2013	Phobia (dental)	NA	Low	1 (41)	Adults	USA	NR	NA	Behavioural therapy	WLC, positive dental experience	Long	≤	✗	✓	✗
Yang et al.509 2018	SAD	NA	Moderate	14 (1000)	Children, adolescents	NR	Group CBT, individual CBT	Internet-based CBT	Not used in analysis	WLC, placebo, no intervention	Short	′	′	✓	✗
Zhou et al.521 2018	GAD, SAD, panic, separation, selective mutism	NA	Low	78 (5035)	Children, adolescents	USA, Australia, Spain, UK, Iran, Norway, the Netherlands, China, Denmark, Canada, Switzerland, Germany, Sweden, Turkey	Group CBT ± parental involvement, individual CBT ± parental involvement, parent CBT, mixed individual CBT + group CBT	Internet-based CBT, bibliotherapy CBT	Bibliotherapy CBT, group behavioural therapy, individual behavioural therapy + parental involvement	No intervention, WLC, TAU, placebo	Short	✓	✗	✓	✗
Zhu et al.522 2014	GAD	NA	Moderate	4 (199)	Adults	NR	Group CBT, individual CBT	NA	Non-directive therapy, minimal contact control, supportive psychotherapy, discussion groups	NA	NR	✗	✗	✓	✗

TABLE 12 - Reviews in ICD-11 secondary: obsessive–compulsive or related disorders (6B20-25)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported; OCD, obsessive–compulsive disorder.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Dèttore et al.126 2015	OCD	NA	Moderate	5 (420)	Children, adolescents, adults	Sweden, UK, USA, Australia, UK and USA mixed	NA	Internet-based CBT, behavioural therapy steps, web-camera family-based CBT	Online non-directive therapy, progressive relaxation, bibliotherapy	WLC	Short	✗	✓	✓	✓
Funderburk et al.159 2018	Hypochondriasis	NA	Critically low	2 (104)	Adults	NR	Individual CBT, enhanced individual CBT, individual CBT + physiotherapy	NA	Physiotherapy/exercise	WLC	Short	✗	✗	✓	✓
Grist and Cavanagh181 2013	OCD	NA	Moderate	1 (204)	Adults	NR	NA	Computerised CBT	E-mail therapy	NA	Short	✗	′	✓	✓
Harrison et al.195 2016	Body dysmorphic disorder	NA	Moderate	5 (225)	Children, adolescents, adults	NR	Individual CBT	Internet-based CBT	Anxiety management, psychoeducation + telephone calls, supportive therapy	WLC	Short	✗	✓	✗	✗
Ipser et al.221 2009	Body dysmorphic disorder	NA	High	2 (73)	Adults	NR	Individual CBT	NA	NA	WLC, no intervention	Short	≤	✓	✓	✓
Julien et al.237 2016	OCD	NA	Critically low	2 (134)	NR	NR	Individual CBT	NA	Inference-based therapy, exposure and response prevention therapy	NA	Short	✓	′	✓	✓
O’Kearney et al.340 2006	OCD	NA	Moderate	6 (351)	Children, adolescents	Australia, USA, Brazil, the Netherlands, UK	Individual CBT, group CBT, family CBT	NA	Medication	Placebo, WLC, NR	Short	≤	✓	✓	✓
Petricone-Westwood et al.364 2018	Hypochondriasis	Diabetes, cardiac, cancer	Critically low	3 (NR)	Adults	NR	NR	Internet-based CBT	Motivational enhancement therapy	Online discussion, NR	Short	✗	✗	✓	✗
Schwartze et al.397 2016	OCD	NA	Moderate	3 (253)	Adults	NR	Group CBT	NA	Drug	NA	Short–long	✗	✓	✓	✓
Skapinakis et al.412 2016	OCD	Depression	Moderate	9 (231)	Adults	NR	Individual CBT	NA	Drug	WLC, placebo	Short	✗	✗	✓	✓
Stock and Andrews431 2004	OCD	NA	Critically low	1 (112)	Children, adolescents	NR	Individual CBT	NA	Drug	Placebo	Short	✗	✗	✓	✓
Thomson and Page450 2007	Hypochondriasis	NA	Moderate	3 (294)	Adults	UK, the Netherlands, USA	Individual CBT	NA	NA	WLC, TAU, placebo	Short–long	✗	✓	✓	✓
Watson and Rees492 2008	OCD	Paediatric OCD	Critically low	4 (189)	Children, adolescents	UK, Australia, USA	Individual CBT, group CBT, mixed individual CBT + group CBT	NA	NA	WLC, placebo	Short	✗	✗	✓	✓
Weston et al.498 2016	OCD	Autism spectrum disorder	Low	1 (46)	Adolescents, adults	UK	Individual CBT	NA	Anxiety management	NA	Short	✗	′	✓	✓
Williams et al.500 2006	Body dysmorphic disorder	NA	Critically low	1 (19)	Adults	NR	Individual CBT	NA	NA	WLC	Short	✗	✓	✗	′
Wootton504 2016	OCD	NA	Critically low	6 (462)	Children, adolescents, adults	Sweden, UK, USA, Norway, Australia, multiple countries	NA	Remote CBT (internet-based CBT, computerised CBT, video conferencing CBT, bibliotherapy CBT, telephone CBT)	Face-to-face CBT, relaxation	WLC, attention control	Short–long	✗	✗	✓	✓

TABLE 13 - Reviews in ICD-11 secondary: disorders specifically associated with stress (6B40-45)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); CBT-SAP, Cognitive–Behavioural Therapy for Sexually Abused Pre-school children; EMDR, eye movement desensitisation and reprocessing; NA, not applicable; NR, not reported; PTSD, post-traumatic stress disorder.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Arends et al.50 2012	Adjustment disorder	NA	Moderate	2 (204)	Adults	Netherlands	Group CBT, individual CBT	NA	NA	TAU, no intervention	Long	≤	✓	✗	✗
Bisson69 2010	PTSD	Physical injury	Critically low	3 (358)	Adults	NR	Individual CBT	NA	Person-centred therapy	TAU, no intervention	Short–long	✗	✓	✓	✓
Blainey70 2012	PTSD	Birth trauma	Critically low	1 (56)	Adults	NR	Individual CBT	NA	NA	TAU	NR	✗	✗	✓	✓
Brooks et al.77 2018	PTSD	NA	Critically low	1 (21)	Adults	USA	Individual CBT (modified for disaster workers)	NA	NA	TAU	Short	✗	✓	✓	✓
Cary and McMillen91 2012	PTSD	NA	Critically low	3 (333)	Children, adolescents	NR	Trauma-focused individual CBT	NA	NA	WLC, standard community care, non-directive supportive care	Long	✗	✓	✓	✓
Chen et al.96 2018	PTSD	Sexual abuse	Low	1 (14)	Children	Syria	Individual CBT	NA	EMDR	NA	Short	✗	≤	≤	✓
Ehring et al.135 2014	PTSD	NA	Low	1 (74)	Adults	NR	Trauma-focused individual CBT	NA	Present-centred therapy	WLC	Short	✗	✓	✓	✓
Field and Cottrell147 2011	PTSD	Sexual abuse	Critically low	1 (14)	Children	Iran	Individual CBT	NA	EMDR	NA	Short	✗	✗	✓	✓
Forman-Hoffman et al.154 2018	PTSD	Combat assault	Low	9 (809)	Adults	NR	Individual CBT ‘Seeking safety’	NA	Exposure therapy, imaginal exposure, relaxation	WLC,TAU	Short	′	✓	✓	✗
Forneris et al.155 2013	PTSD	Motor vehicle, industrial, non-sexual assault	Low	3 (105)	Adults	Australia	Brief individual CBT	NA	Supportive counselling	NA	Short	✗	✓	✓	✓
Furuta et al.160 2018	PTSD	Traumatic birth	Low	2 (161)	Adults	Sweden, USA	Trauma-focused individual CBT	Internet-based CBT + TAU	NA	WLC + TAU, attention control + TAU	Short	✗	✗	✓	✓
Gillies et al.169 2016	PTSD	Exposed to traumatic events	Moderate	5 (319)	Children, adolescents	USA, Netherlands, Iran	Trauma-focused individual CBT	NA	Play therapy, EMDR	TAU	Short	≤	✓	✓	✓
Guest et al.183 2016	PTSD	Post vehicle accident	Low	2 (95)	Adults	China, Germany	Individual CBT	NA	Self-help book CBT	WLC	Short	✗	✓	✓	✓
Ho and Lee212 2012	PTSD	NA	Critically low	8 (227)	Adults	NR	Trauma-focused individual CBT	NA	EMDR	NA	Short	✗	✓	✓	✓
Khan et al.247 2018	PTSD	Traumatic events	Critically low	1 (23)	Adults	NR	NR	NA	EMDR	NA	Short	✗	✓	′	′
Kim et al.249 2013	PTSD	NA	Moderate	1 (55)	NR	USA	Individual CBT	NA	NA	WLC	NR	✗	✓	✓	✓
Kowalik et al.257 2011	PTSD	Sexual abuse	Critically low	4 (427)	Children	NR	Individual CBT or parent–child CBT, sexual specific/trauma-focused/adapted for sexually abused pre-school children (CBT-SAP)	NA	Non-directive support therapy, child-centred play therapy	NA	Short	✗	✗	✓	✓
Leigh-Hunt and Perry272 2015	PTSD	Offenders	Low	1 (44)	Adults	USA	Group CBT	NA	NA	TAU	Short	≤	≤	✓	✓
Lewis et al.275 2018	PTSD	NA	High	6 (437)	Adults	USA, Sweden, Iraq, UK	NA	Internet-based CBT	Other internet-based psychological therapy	WLC, TAU	Short	✓	✓	✓	✓
Mabey and van Servellen290 2014	PTSD	Severe mental illness (depression, bipolar, schizophrenia)	Critically low	1 (108)	Adults	USA	Individual CBT	NA	NA	TAU	Short	≤	✓	✓	✓
Macedo et al.292 2018	PTSD	NA	Moderate	1 (156)	Adults	NR	Individual CBT	NA	Brief treatment programme (breathing + psychoeducation)	NA	Long	✗	✗	✓	✗
Moreno-Alcázar et al.320 2017	PTSD	NA	Moderate	3 (119)	Children, adolescents	NR	Individual CBT	NA	EMDR	NA	Short	✗	✓	✓	✓
Nocon et al.333 2017	PTSD	War displacement	Critically low	1 (399)	Children	Sri Lanka	Individual CBT	NA	NA	WLC	Short	✗	✓	✓	✓
O’Donnell et al.338 2018	Adjustment disorder	NA	Critically low	1 (54)	Adults	NR	NA	Self-help bibliotherapy	NA	WLC	Short	✗	✓	✓	✗
Palic and Elklit355 2011	PTSD	Refugees	Critically low	5 (106)	Adults	Vietnam, Cambodia, mixed southern Asian nationality	Culturally sensitive individual CBT for South East Asians, individual CBT	NA	Psychoactive medication, exposure therapy	WLC	Short	✓	✓	✓	✓
de Medeiros Passarela et al.303 2010	PTSD	Sexual abuse	Low	2 (136)	Children, adolescents	USA, Australia	Family/parent CBT	NA	NA	TAU	Short	✗	✗	✓	✓
Patel et al.357 2014	PTSD	Torture survivors	High	1 (16)	Adults	Sweden	Individual CBT	NA	Behavioural exposure	NA	Short	✓	✓	✓	✓
Roberts et al.385 2009	PTSD	NA	Moderate	3 (248)	Adults	NR	Trauma-focused individual CBT	NA	Supportive counselling	WLC	Long	✗	✗	✓	✓
Roberts et al.384 2016	PTSD	Substance misuse	Moderate	1 (353)	Adults	USA	Group CBT or individual CBT: ‘seeking safety’, integrated CBT	NA	Group women’s health education	NA	Short–long	✗	✗	✓	✓
Rodenburg et al.387 2009	PTSD	NA	Critically low	2 (52)	Children, adolescents	NR	NR	NR	EMDR	NA	Short	✗	✗	✓	✓
Russell and Davis391 2007	PTSD	Sexual assault	Critically low	1 (10)	Adults	NR	NR	NA	NA	WLC	Short	✗	✓	✗	✓
Schwartze et al.399 2017 (PTSD)	PTSD	NA	Moderate	1 (24)	Adults	NR	Culturally adapted group CBT	NA	Applied muscle relaxation + TAU	NA	Short	✗	′	✓	✓
Sebastian and Nelms402 2017	PTSD	Sexual violence	Critically low	1 (50)	NR	Democratic republic of Congo	NR	NA	EFT	NA	Short	✗	≤	✓	✓
Silverman et al.408 2008	PTSD	Sexual abuse, traumatic event	Critically low	3 (164)	Children, adolescents	Iran, NR	Trauma-focused group CBT, trauma-focused individual CBT	NA	EMDR	WLC	Short	✗	✓	✓	✓
Sin et al.409 2017	PTSD	Psychosis	Moderate	3 (145)	Adults	USA, UK	Trauma-focused individual CBT	NA	Brief psychoeducation	TAU	Short–long	✓	✓	✓	✓
Soo and Tate422 2007	Acute stress disorder	Traumatic brain injury	Moderate	1 (24)	Adults	UK	Individual CBT	NA	Supportive counselling	NA	Short	✗	✗	✓	✗
Sullivan and Simonson436 2016	PTSD	Refugees	Critically low	1 (31)	Children, adolescents	USA (refugees/immigrants from Burundi, Congo, Kenya, Liberia, Rwanda, Somalia, Tanzania, Myanmar, Nepal, Russia, Bosnia, Afghanistan, Iraq, Turkey and Uzbekistan)	Trauma-focused individual CBT	NA	Child-centred play therapy	NA	Short	✗	✗	✓	✗
Swan et al.439 2017	PTSD	Psychosis	Critically low	1 (108)	Adults	USA	Individual CBT	NA	NA	TAU	Short	✗	✓	✓	≤
Torchalla and Strehlau452 2018	PTSD	Workplace trauma	Critically low	1 (31)	Adults	USA	Trauma-focused individual CBT	NA	NA	No intervention	Short	✗	✗	✓	✗

TABLE 14 - Reviews in ICD-11 secondary: feeding or eating disorders (6B80-85)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); CD-ROM, compact disc read-only memory; BED, binge-eating disorder; EDNOS, eating disorder not otherwise specified; FPDP, Focal Psychodynamic Psychotherapy; NA, not applicable; NR, not reported; SSCM, Specialist Supportive Clinical Management.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Brownley et al.78 2016	BED	NA	Low	7 (699)	Adults	USA	Therapist-led individual CBT, partially therapist-led individual CBT	Guided or pure self help	Interpersonal therapy	WLC	Short	✗	✓	✗	✓
de Jong et al.120 2018	Bulimia nervosa, BED, EDNOS	NA	Low	1 (130)	Adults	UK	NR	NA	Interpersonal therapy	NA	Long	✗	✗	✗	✓
Flament et al.148 2012	BED and anorexia nervosa	NA	Critically low	1 (108)	Adults	Italy	Individual CBT	NA	Drug	NA	Long	✗	✗	✗	✓
Flodgren et al.150 2015	BED	NA	High	1 (128)	Adults	USA	NA	Video-teleconference CBT	Face-to-face CBT	NA	Short	✓	✓	✗	✓
Ghaderi and Andersson166 1999	Mixed	NA	Critically low	5 (334)	NR	NR	NR	NA	Drug, supportive–expressive therapy, interpersonal therapy	WLC	Short	✗	✗	✗	✓
Ghaderi et al.167 2018	Bulimia nervosa	NA	Moderate	9 (949)	Adults	USA, Switzerland, the Netherlands	Individual CBT, group CBT, mixed individual CBT + group CBT	Self-help, guided self-help	Interpersonal therapy, behavioural weight loss	WLC, placebo	Short–long	≤	✓	✗	✓
Grenon et al.179 2017	BED	NA	Moderate	4 (328)	Adults	USA, Canada	Group CBT	NA	Behavioural therapy, interpersonal therapy, group psychodynamic interpersonal therapy	NA	Short	✗	′	✗	✓
Grenon et al.178 2018	Bulimia nervosa, BED	NA	Critically low	1 (42)	Adults	USA	Group CBT	NA	Behavioural therapy	NA	Short	✗	′	✗	✓
Hay and Claudino200 2010	Mixed	NA	Critically low	3 (220)	Adults	NR	Individual CBT for bulimia nervosa	NA	Guided self-help CBT	WLC	Short	≤	✓	✗	✓
Hay et al.201 2012	Bulimia nervosa	NA	Low	1 (33)	Adults	NR	Individual CBT	NA	Individual nutritional counselling	NA	Long	✗	✗	✗	✓
Hay et al.199 2001	Anorexia nervosa	NA	Moderate	4 (141)	Adults	USA, Canada	Individual CBT	NA	Drug	NA	Short	✗	✓	✗	✓
Hay et al.198 2009	Bulimia nervosa	NA	Moderate	17 (1367)	Adults	USA, Canada, UK, Australia	Group CBT or individual CBT for bulimia, mixed group CBT + individual CBT	NA	Self-monitoring, CBT/exposure and response prevention, interpersonal therapy, behavioural therapy, short-term focal psychotherapy, psychoeducation, supportive–expressive therapy, hypo behavioural therapy, prescriptive therapy non-directive counselling and ‘focused evocative unfolding’	WLC, no intervention	Short	✗	✓	✗	✓
Hay et al.197 2015	Anorexia nervosa	NA	Moderate	2 (56)	Adults	New Zealand, Germany	Individual CBT	NA	Interpersonal therapy, SSCM, FPDT	Optimised TAU	Long	✗	✓	✗	✓
Hilbert et al.208 2019	BED	NA	Low	5 (494)	Adults	NR	Group CBT, individual CBT	NA	Weight loss treatment, drug	NA	Short	✗	′	✗	✓
Keel and Haedt243 2008	Bulimia nervosa, EDNOS	NA	Critically low	1 (85)	Adolescents	NR	NA	CBT guided self-care	Family therapy	NA	Long	✗	✗	✗	✓
Loucas et al.287 2014	Anorexia nervosa, bulimia nervosa, BED, EDNOS	NA	Low	4 (474)	Adults	NR	NA	Internet-based CBT, CD-ROM CBT	High-intensity face-to-face CBT	WLC, TAU	Short–long	✗	✗	✗	✓
Miniati et al.311 2018	Anorexia nervosa	NA	Low	1 (56)	Adults	NR	Individual CBT	NA	Interpersonal therapy	Non-specific supportive clinical management	Short	✗	✗	✗	✓
Norris et al.337 2019	Mixed	NA	Critically low	5 (249)	Adults	Australia, UK, USA, Germany	Enhanced individual CBT	NA	NR	NR	Short	✗	✗	✗	✓
Palavras et al.353 2017	BED	NA	Low	3 (261)	Adults	USA, Switzerland	Group CBT, individual CBT	Guided self-help	Behavioural weight loss therapy, interpersonal therapy	NA	Long	✗	✗	✗	✓
Peat et al.359 2017	BED	NA	Critically low	2 (170)	Adults	NR	Group CBT	NA	Behavioural weight loss therapy	NA	Long	✗	✓	✗	✓
Pittock et al.367 2018	Bulimia nervosa	NA	Low	1 (196)	Adults	USA	NA	Internet-based CBT	Face-to-face CBT	NA	Long	✗	✗	✗	✓
Polnay et al.369 2014	Bulimia nervosa	NA	Moderate	3 (133)	Adults	USA, Norway	Group CBT (delivered by doctoral qualified psychologists)	NA	NA	WLC	Short	✗	✓	✗	✓
Reas and Grilo378 2008	BED	NA	Critically low	1 (108)	Adults	USA	Individual CBT	NA	Fluoxetine	Placebo	Short	✗	✗	✗	✓
Svaldi et al.438 2018	Bulimia nervosa	NA	Moderate	4 (295)	Adolescents, adults	NR	Individual CBT	NA	(Active arms not included in analysis)	WLC	Short	✗	✓	✗	✓
Watson et al.491 2016	Mixed	NA	Low	1 (76)	Adults	USA	NA	Internet-based CBT	Psychoeducation	NA	Short	✗	✗	✗	✓

TABLE 15 - Reviews in ICD-11 secondary: disorders of bodily distress or bodily experience (6C20-21)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Nezu et al.328 2001	Bodily distress or experience disorder	NA	Critically low	1 (50)	Adults	NR	Group CBT	NA	NA	WLC	Short	✗	✓	✗	✓
van Dessel et al.469 2014	Bodily distress or experience disorder	NA	High	4 (504)	Adults	USA, Spain, Germany, the Netherlands	Group CBT, individual CBT	NA	Progressive muscle relaxation	TAU	Short–long	✓	✓	✓	✓

TABLE 16 - Reviews in ICD-11 secondary: disorders due to substance use or addictive behaviours (6C40-51)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Dugosh et al.130 2016	Opioid addiction	NA	Critically low	1 (60)	NR	NR	Individual CBT + methadone maintenance treatment	NA	Methadone maintenance treatment	NA	Long	✓	✗	✗	✗
Eccleston et al.133 2017	Opioid misuse	Chronic back/neck pain	Moderate	1 (42)	Adults	NR	Group CBT, individual CBT for the prevention of opioid misuse	NA	NA	TAU	Short	✗	✓	✓	✓
Harada et al.193 2018	Due to use of stimulants	Amphetamine-type stimulants	High	1 (160)	Adults	Australia	NA	Internet-based CBT	NA	WLC	Short	✓	✗	✗	✗
Minozzi et al.312 2016	Due to use of hallucinogens	Psychostimulant	High	0 (0)	Adults	NA	NA	NA	NA	NA	NA	✗	≤	✗	≤
Stevens et al.429 2018	Internet gaming disorder	NA	Critically low	3 (148)	Adolescents, NR	China, Republic of Korea, NR	Group CBT, group CBT + medication	NA	Medication only, physical exercise	No intervention	Short	✗	✓	✓	✗
van der Maas et al.468 2019	Gambling disorder	NA	Critically low	1 (66)	Adults	Sweden	NA	Internet-based CBT and e-mail and discussion groups	NA	WLC	Long	✗	✓	✓	✗

TABLE 17 - Reviews in ICD-11 secondary: personality disorders and related traits (6D10-11)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Davidson and Tran115 2014	Personality disorder	NA	Critically low	1 (106)	Adults	NR	Individual CBT for personality disorder	NA	NA	TAU	Long	✗	✓	✗	✗
Gibbon et al.168 2010	Personality disorder	Cocaine dependence	Moderate	1 (43)	Adults	UK	Individual CBT	NA	NA	TAU	Short	≤	✓	✓	✗
Matusiewicz et al.298 2010	Personality disorder	NA	Critically low	4 (348)	Adults	NR	Individual CBT	NA	Brief dynamic therapy, brief relational therapy	WLC, TAU	Short	✗	✓	✓	✓
Stoffers et al.432 2012	Personality disorder	NA	Moderate	1 (106)	Adults	UK	Individual CBT	NA	NA	TAU	Short	✗	✓	✓	✓

TABLE 18 - Reviews in ICD-11 secondary: neurocognitive disorders (6D70-72)

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; NA, not applicable.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Sleight415 2016	Mild neurocognitive disorder	Cancer (breast)	Critically low	1 (41)	Adults	USA	Individual CBT intervention ‘Memory and Attention Adaption Training’	NA	NA	WLC	Short	✓	✗	✗	✗

TABLE 19 - Reviews in ICD-11 secondary: mental disorders associated with pregnancy, childbirth or the puerperium

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); IVF, in vitro fertilisation; NA, not applicable; NR, not reported; PTSD, post-traumatic stress disorder.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Bledsoe and Grote71 2006	Depressive disorder	Pregnancy and postpartum depression	Critically low	3 (172)	Adults	UK, France	Home-based individual CBT	NA	NA	TAU, placebo, NR	Short	✗	✓	✗	✗
Craig and Howard109 2009	Postnatal depression	NA	Critically low	5 (502)	Adults	NR	Individual CBT, individual CBT + antidepressants, group CBT	Individual CBT (delivered by early-childhood nurses), group CBT (delivered by health visitors)	Non-directive counselling, psychodynamic therapy, antidepressants	TAU	Short–long	≤	✓	✗	✗
De Crescenzo119 2014	Postnatal depression	NA	Moderate	1 (35)	Adults	NR	Individual CBT + paroxetine	NA	Paroxetine only	NA	Short	✗	✓	✗	✗
Dennis125 2004	Postnatal depression	NA	Critically low	1 (176)	Adults	Finland	Individual CBT with between-session telephone support	NA	NA	TAU	Short	✗	✓	✗	✗
Huang216 2018	Postnatal depression	NA	Low	6 (510)	Adults	Canada, Australia, France, Iran	Individual CBT, group CBT	Internet-based CBT	NA	TAU	Short	′	✓	✓	✗
Lau267 2017	Postnatal depression	Pregnancy loss, PTSD, depression	Moderate	6 (530)	Adults	Canada, USA, Australia, Germany, Sweden	NA	Internet-based CBT with therapist support	NA	TAU, WLC	Short	✗	✓	✓	✗
Lavender268 2016	Antenatal depression	NA	Critically low	1 (55)	Adults	USA	Modified individual CBT	NA	NR	NR	Short	✗	✓	≤	✗
Leis273 2009	Postnatal depression	NA	Critically low	1 (37)	Adults	Australia	NA	CBT (delivered by early-childhood nurses)	Support sessions	NA	Short	✗	✓	✗	✗
LoGiudice284 2018	Undergoing IVF	NA	Critically low	1 (31)	Adults	Iran	Group CBT	NA	NR	NR	Short	≤	✓	✓	✗
Maguire294 2018	Postnatal depression	NA	Critically low	2 (172)	Adults	Germany, Australia	Group CBT, individual CBT	NA	NA	TAU	Short	✗	✗	✓	✗
McDonagh301 2014	Postnatal depression	NA	Low	1 (35)	Adults	Canada	NR	NA	Paroxetine only	NA	Short	✗	✓	✗	✗
Mendelson307 2017	Perinatal anxiety, depression	NA	Low	1 (39)	Adults	USA	Individual CBT	NA	NA	TAU	Short	✗	✓	≤	✗
Nillni331 2018	Perinatal anxiety, depression	NA	Critically low	1 (105)	Adults	NR	Individual CBT	NA	NA	TAU + parent mentor programme	Short	✗	✓	✓	✗
Perveen363 2013	Postnatal depression	NA	Critically low	5 (607)	Adults	UK, USA, Australia	Individual CBT (delivered by therapists)	CBT (delivered by health visitor or research staff)	NA	TAU	Short	✗	✓	✓	✗
Sangsawang393 2018	Postnatal depression	NA	Critically low	1 (47)	Adolescents	USA	NA	CBT adapted for Apache adolescents, ‘Living in Harmony’ programme	Educational support	NA	Short	✗	✓	≤	≤
Scope400 2013	Postnatal depression	NA	Low	1 (192)	Adults	Australia	Group CBT	NA	Group + individual counselling	TAU	Short	✗	✓	✗	✗
Stevenson430 2010	Postnatal depression	NA	Moderate	1 (192)	Adults	Australia	Group CBT	NA	Group counselling	NA	Short	✗	✓	✗	✗
van Ravesteyn471 2017	Antenatal depression	NA	Low	1 (1300)	Adults	NR	Group CBT, individual CBT	NA	Supportive counselling, psychoeducation, health-care visits	TAU, booklet	Short	✗	✓	✗	✗
Webb494 2004	Perinatal psychosis	Perinatal period	Moderate	0 (0)	Adults	NR	NA	NA	NA	NA	NA	✗	✗	≤	✗

TABLE 20 - Reviews with populations from mixed mental health conditions

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); AIDS, acquired immunodeficiency syndrome; GAD, generalised anxiety disorder; HIV, human immunodeficiency virus; NA, not applicable; NR, not reported; OCD, obessesive–compulsive disorder; PTSD, post-traumatic stress disorder; SAD, social anxiety disorder.
ICD-11 primary/secondary	Condition description	Study	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
ICD-11 primary/secondary	Condition description	Study	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition-specific
Anxiety disorder Mood disorder Stress disorder	Anxiety Depression PTSD	Adelufosi35 2017	Female genital mutilation	Critically low	0 (0)	Children, adults	NR	NA	NA	NA	NA	NA	✗	≤	≤	≤
Anxiety disorder Mood disorder	Anxiety Depression	Andersen44 2016	NA	Moderate	5 (435)	Adults	Australia, USA	Transdiagnostic individual or group CBT	Transdiagnostic internet-based CBT + e-mail/telephone	NA	WLC	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Andrews46 2018	NA	Moderate	53 (8279)	Adults	NR	NA	Internet-based CBT	High-intensity face-to-face CBT, bibliotherapy CBT	WLC ± discussion group, WLC ± attention placebo, TAU, information, self-monitoring	Short–long	✗	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Armento52 2012	Parkinson’s disease	Critically low	2 (174)	Older adults	NR	Individual CBT, 1 session of individual CBT + telephone sessions	NA	Supportive therapy	Clinical monitoring	Short	✓	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Arnberg53 2014	NA	Low	21 (1855)	Children, adolescents, adults	Australia, Sweden, Switzerland	NA	Internet-based CBT	High-intensity individual CBT, online supportive therapy	WLC, online forum	NR	✗	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Bower74 2003	NA	Low	1 (NR)	Adults	NR	NR	NA	Non-directive counselling	NA	Long	✗	✓	≤	✗
Anxiety disorder Mood disorder	GAD Panic Phobia Depression	Cape86 2010	NA	Critically low	11 (709)	Adults	Australia, UK	Individual CBT	NA	NA	TAU	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Chibanda99 2015	HIV	Low	1 (13)	Adults	China	Group CBT	NA	NA	WLC	Short	✗	✓	≤	✗
Anxiety disorder Mood disorder	Anxiety Depression	Clarke101 2015	NA	Low	1 (1477)	Adolescents	Australia	NA	Internet-based CBT	NA	WLC	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Coventry108 2008	COPD	Low	1 (48)	Adults	USA	Individual CBT	NA	Education	NA	NR	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Davies117 2014	NA	Moderate	4 (198)	Adults	Australia, Canada, Spain	NA	Internet-based CBT	Other psychotherapy	WLC, no intervention	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Ebert131 2015	NA	Low	11 (778)	Children, adolescents	Australia, the Netherlands, New Zealand, Sweden	NA	Internet-based CBT	NA	WLC, placebo	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Farrand143 2015	Myocardial infarction, multiple sclerosis	Moderate	2 (235)	Adults	NR	NA	Internet-based CBT	NA	TAU, attention control	Long	✗	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Fulton158 2018	Breast cancer	Critically low	1 (13)	Adults	NR	Group CBT	NA	Supportive therapy	NA	Short	✓	′	′	✗
Anxiety disorder Mood disorder	Anxiety Depression	Garcia-Escalera162 2016	NA	Low	14 (1337)	Children, adults	Australia, UK, USA	Transdiagnostic individual or group CBT	Transdiagnostic internet-based CBT	NA	WLC, discussion group	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder Stress disorder	Anxiety Depression PTSD	Giummarra171 2018	Traumatic injury	Low	3 (366)	Adults	Australia, the Netherlands	Individual CBT, modular CBT	Internet-based CBT	Supportive counselling	TAU	Short	✗	✓	✓	✗
Anxiety disorder Stress disorder	Panic PTSD	Gonçalves173 2015	NA	Low	3 (67)	Adults	NR	Individual CBT	NA	NA	WLC	Short	✗	✗	✓	✓
Anxiety disorder Stress disorder OCD	GAD Panic Agoraphobia PTSD OCD	Gould175 2012	NA	Moderate	3 (172)	Older adults	NR	Individual CBT	NA	Drug, supportive therapy	TAU	Long	✗	✓	✓	✗
Anxiety disorder Stress disorder	Agoraphobia PTSD	Gregory177 2018	NA	Critically low	2 (53)	Adults	USA	Individual CBT, group CBT	NA	NR	NR	Short	✗	✗	✓	✗
Anxiety disorder Mood disorder OCD	SAD Depression OCD	Grist182 2018	NA	Low	3 (408)	Children, adolescents	The Netherlands, Sweden	NA	Internet-based CBT	High-intensity, face-to-face CBT	WLC	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Hobbs214 2011	Alcohol dependence	Critically low	2 (131)	Adults	NR	NR	NA	NR	NR	Short	✗	✓	✓	✓
Anxiety disorder Mood disorder	SAD Depression	Huang215 2018a	NA	Critically low	2 (79)	Adults	Australia, USA	Group CBT	Internet-based CBT	NA	Placebo, no intervention	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Jennings229 2015	Learning disability	Critically low	1 (32)	Adults	UK	Individual CBT	NA	NA	TAU	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Kaltenthaler239 2006	NA	Low	1 (274)	Adults	UK, USA	NA	Internet-based CBT	NA	TAU, information	Short	≤	✓	✓	≤
Anxiety disorder Mood disorder Stress disorder	Anxiety Depression PTSD	Kayrouz242 2018	NA	Moderate	1 (159)	Adults	Iraq	NA	Internet-based CBT	NA	WLC	Short	✗	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Mac-donald291 2016	Childhood abuse	Moderate	6 (658)	Children, adolescents	Australia, Norway, USA	Individual CBT, trauma-focused individual CBT, sexual-abuse individual CBT, child individual CBT	NA	Supportive therapy, child-centred therapy	WLC, TAU	Short	≤	✓	✓	✓
Anxiety disorder OCD	GAD SAD Panic OCD/hypochondriasis	Mayo-Wilson299 2013	NA	High	22 (2001)	Adults	Australia, Canada, the Netherlands, Spain, Sweden, UK, USA	NA	Internet-based CBT, telephone CBT, bibliotherapy CBT, mixed CBT (bibliotherapy + internet-based CBT)	High-intensity CBT	WLC, TAU	Short	✓	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Mehndiratta305 2013	Epilepsy	Critically low	1 (37)	Older adults	Australia	Group CBT	NA	NA	TAU	Short	✗	✓	≤	✓
Anxiety disorder Stress disorder	Phobia PTSD	Montero-Marin315 2018	NA	Moderate	4 (495)	Adults	Spain, USA, Norway	Group CBT, individual CBT	NA	Progressive relaxation, applied relaxation	NA	Short–long	′	✓	✓	✓
Anxiety disorder Mood disorder Stress disorder	Anxiety Depression Stress	Naidu324 2016	NA	Low	5 (390)	Adults	Sweden, Australia	NA	Internet-based CBT	High-intensity face-to-face individual or group CBT	NA	Short	✗	≤	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Newby327 2016	NA	Low	14 (1606)	Adults, older adults	Sweden, Canada, Australia, UK, Switzerland, Germany, Austria	NA	Transdiagnostic internet-based CBT	Relaxation	WLC, TAU, discussion, forum	Short	✓	✓	✓	✗
Anxiety disorder Mood disorder Disorders due to substance use or addictive behaviour	Anxiety Depression Addictive behaviour	Ng329 2018	NA	Critically low	1 (NR)	Adults, older adults	China	Group CBT	NA	NA	WLC, no intervention	Short	✓	≤	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Noble332 2018	Epilepsy	Critically low	1 (59)	Adults	Australia	Individual CBT	NA	NA	WLC	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Noone335 2018	Dementia	Low	2 (82)	Older adults	UK, USA	Individual CBT	NR	NA	TAU	Short	✗	✓	✓	✗
Anxiety Mood disorder	Anxiety Depression	Normann336 2018	NA	Critically low	2 (122)	Adults	NR	Individual CBT	NA	Metacognitive therapy	NA	Short–long	✗	✓	✓	✗
Anxiety disorder Stress disorder OCD	GAD SAD Panic PTSD OCD	Olthuis343 2016	NA	Moderate	28 (4998)	Adults	Australia, Austria, Germany, the Netherlands, Sweden, Switzerland	NA	Internet-based CBT	High-intensity face-to-face CBT	WLC, attention control, information, discussion	Short–long	✓	✗	✓	✓
Mood disorder Anxiety disorder	Depressive disorders Anxiety	Opoka344 2018	Psychosis	Critically low	1 (150)	Adults	NR	Individual CBT	NA	NA	TAU	Short	✗	✗	✗	✓
Mood disorder Stress disorder	Depression Stress	O’Sullivan351 2016	War-affected children and young people	Critically low	2 (102)	Children, adolescents	Democratic Republic of the Congo	Group trauma-focused CBT	NA	NA	WLC		✗	′	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Păsărelu356 2017	NA	Low	4 (283)	Adults	Sweden, Australia	NA	Transdiagnostic internet-based CBT	NA	WLC	Long	✓	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Pennant360 2015	NA	Low	15 (2615)	Children, adolescents, young adults	NR	NA	Computerised CBT	High-intensity face-to-face CBT, attention bias modification, computer control	WLC, TAU, no intervention	Short	✗	✓	✓	✓
Anxiety disorder Mood disorder Stress disorder Bodily distress disorder	Anxiety Depression PTSD Somatoform	Purgato373 2018	NA	Moderate	1 (313)	Children, adolescents, adults	Thailand, China, Iraq, Democratic Republic of the Congo	Trauma-focused individual CBT	Web-based CBT, group CBT (delivered by school staff and paraprofessionals)	NA	TAU, no intervention, general support, WLC	Short	✓	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Rasing377 2017	NA	Critically low	16 (4422)	Adolescents	Australia, USA, the Netherlands, Canada	Group CBT	NA	Activity	Information	Long	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Reavell379 2018	Cardiovascular disease	Low	1 (38)	Adults	Australia	Individual CBT	NA	NA	TAU	Long	′	✓	✓	≤
Anxiety disorder Stress disorder	Panic PTSD	Rodrigues388 2011	NA	Critically low	5 (132)	Adults	NR	Individual CBT	NA	Drug	WLC	Short	✗	✗	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Smith418 2014	COPD	Low	4 (378)	Adults	Norway, Australia, USA	Group CBT, individual CBT	NA	COPD education	TAU	Short	′	✓	✓	✗
Mood disorder Feeding or eating disorder	Depression Eating	Snoek419 2002	Diabetes	Critically low	8 (85)	Adults	NR	Group CBT, individual CBT	NA	Non-prescriptive therapy	No intervention	Short	✗	✓	✓	✓
Anxiety disorder Mood disorder OCD	Anxiety Depression OCD	Spain423 2015	Autism spectrum disorder	Critically low	1 (37)	Adults	UK	Individual CBT for OCD	NA	Anxiety management	NA	Short	✗	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Spek424 2007	NA	Low	10 (1465)	Adults	NR	NA	Internet-based CBT	NA	WLC, TAU, placebo, self-monitoring, information, online discussion group	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Spies425 2013	HIV/AIDS	Critically low	3 (250)	Adults	Hong Kong, USA	Group CBT, individual CBT	NA	Supportive psychotherapy, peer counselling, intervention control	No intervention	NR	✓	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Tay442 2018	Dementia	Critically low	1 (50)	Older adults	NR	Individual CBT (for mild to moderate dementia patients)	NA	NA	TAU	Short	✗	✓	′	✗
Anxiety disorder Mood disorder	Anxiety Depression	Thabrew445 2018	Long-term physical health problems	High	8 (770)	Children, adolescents	USA, UK, India, Australia, Serbia, Montenegro	Group CBT, individual CBT, home-based individual CBT, clinic-based group CBT, transdiagnostic CBT	NA	Education, supportive psychotherapy, supportive non-directive therapy, non-directive behavioural counselling	WLC, TAU, information	Short–long	✓	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Thabrew446 2018b	Long-term physical health problems	High	4 (469)	Children, adolescents	USA, Germany	NA	Internet-based CBT or Web-MAP	Specialised headache treatment, education, applied relaxation	WLC	Short–long	✓	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depresssion	Troeung457 2013	Parkinson’s disease	Critically low	1 (80)	Older adults	USA	Individual CBT	NA	NA	Clinical monitoring	Short	✗	✓	✓	✗
Anxiety disorder Mental or behavioural disorders associated with pregnancy, childbirth or puerperium	Panic Postnatal depression	Twomey461 2015	NA	Low	25 (3716)	Adults	NR	Individual CBT, group CBT	Computerised CBT, guided CBT, telephone CBT	NA	WLC, no intervention, TAU	Short	✗	✓	✓	✓
Anxiety disorder Mood disorder	Anxiety Depression	Twomey459 2017 (MoodGYM)	NA	Critically low	11 (4570)	Adults	Australia, Ireland, UK, Norway	NA	Internet-based CBT ‘MoodGYM’	Telephone support or website	TAU, no intervention	Short	✗	✓	≤	✗
Anxiety disorder Mood disorder	Anxiety Depression	Valimaki466 2017	NA	Low	1 (187)	Adolescents	New Zealand	NA	Computerised CBT ‘SPARX’	NA	TAU	Short	✗	′	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Verdeli479 2006	NA	Critically low	3 (118)	Adolescents	NR	Group CBT, individual CBT, school-based CBT	NA	Interpersonal therapy	No intervention, WLC, attention support	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder	Anxiety Depression	Wang484 2013	NA	Moderate	2 (115)	Adults	Hong Kong	Group CBT, individual CBT	NA	Dejian mind–body intervention	WLC	Short	✗	✓	≤	✗
Anxiety disorder Stress disorder OCD	GAD SAD Panic PTSD OCD	Watts493 2015	NA	Critically low	48 (6926)	Adults	NR	Individual CBT (delivered by therapists, psychologists)	CBT (delivered by nurses, social workers, behavioural health specialists)	NA	TAU	Short	✗	✓	✓	✗
Anxiety disorder Mood disorder Stress disorder	Anxiety Depression Stress	Yatham511 2018	NA	Critically low	2 (615)	Children, adolescents	Palestine	Individual CBT ‘teaching recovery techniques’, individual CBT adapted ‘teaching recovery techniques’	NA	NA	WLC	Short	✗	′	✓	✗

TABLE 21 - Reviews in ICD-11 primary: 07 Sleep–wake disorders

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); eCBT, digitally-delivered CBT; NA, not applicable; NR, not reported; PTSD, post-traumatic stress disorder.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Bohra 201372	Insomnia	Pain	Critically low	1 (51)	Older adults	NR	Group CBT for insomnia	NA	Stress management and wellness	NA	Short	✗	✗	✗	✓
Brasure 201675	Insomnia	NA	Low	11 (1182)	Adults	USA, UK, Europe	Group CBT for insomnia, individual CBT for insomnia	Self-help CBT for insomnia, internet-based CBT for insomnia	Sleep hygiene, self-help	Internet sham, placebo (drug), WLC, TAU	Short	✗	✗	✗	✓
Budhrani 201580	Insomnia	Breast cancer	Critically low	1 (72)	Adults	NR	Individual CBT	NA	NR	NR	Short	✗	✗	✗	✓
Cheng 201297	Insomnia	NA	Low	4 (300)	Adults	USA, Canada, Sweden	NA	Computerised CBT for insomnia	NA	WLC, self-monitoring	Short	✗	✗	✗	✓
Cheung 201898	Insomnia	NA	Critically low	1 (139)	Adults	UK	NA	Group CBT (delivered by health visitors)	NA	Sleep monitoring	Long	✗	✗	✗	✓
Gebara 2018163	Insomnia	Depression	Critically low	3 (124)	Adults	USA, Sweden	Group CBT, individual CBT	NA	Drug, relaxation	WLC	Short	✗	✓	✗	✓
Johnson 2016233	Insomnia	Cancer	Critically low	5 (621)	Adults	NR	Individual CBT for insomnia, group CBT for insomnia	Video-based CBT for insomnia	Behavioural placebo, mindfulness-based cancer recovery	WLC, TAU	Short	✗	✗	✗	✓
Koffel 2015255	Insomnia	NA	Low	6 (408)	Adults	NR	Group CBT	NA	Sleep/pain education	WLC, TAU, diary-keeping	Short	✗	✓	✗	✓
Mitchell 2012314	Insomnia	NA	Critically low	3 (201)	Adults, older adults	Norway, Canada, China	Group CBT, individual CBT	NA	Drug	NA	Short–long	✓	✓	✓	✓
Montgomery 2003316	Insomnia	NA	Moderate	2 (102)	Older adults	USA	Group CBT, individual CBT	NA	NA	WLC, placebo	Short	≤	✗	✗	✓
Morin 1999321	Insomnia	NA	Critically low	1 (24)	Adults	NR	Multicomponent group CBT	NA	NA	WLC	Long	✗	✗	✗	✓
Navarro-Bravo 2015326	Insomnia	NA	Critically low	5 (456)	Adults	NR	Individual CBT	NA	Stress management and wellness, sleep hygiene education	WLC, TAU	Short	✗	✗	✗	✓
Okajima 2011339	Insomnia	NA	Critically low	4 (226)	Adults	NR	Group CBT, individual CBT	NA	Drug	WLC, placebo, TAU	Long	✗	′	✗	✓
Phelps 2017366	Insomnia	NA	Critically low	1 (81)	Adults	USA	NR	NA	Sleep hygiene	NA	Short	✗	✗	✗	✓
Seyffert 2016403	Insomnia	NA	Low	11 (1886)	Adults	Canada, Hong Kong, UK, Sweden, the Netherlands, Germany, USA	NA	Internet-based CBT	Group CBT, telehealth CBT, internet-based CBT without support, internet control, imagery relief therapy	WLC	Short–long	✗	✓	✗	✓
Smallfield 2018416	Insomnia	NA	Critically low	1 (60)	Older adults	NR	NA	Telephone CBT (delivered using workbook)	NA	Information	Short	✗	✗	✗	✓
Taylor 2014443	Insomnia	Depression, PTSD, alcohol abuse	Critically low	4 (132)	Adults	NR	Individual CBT	Self-help CBT with telephone support	NA	Placebo, WLC, NR	Short	✗	✓	✓	✓
Trauer 2015455	Insomnia	NA	Moderate	5 (240)	Adults	Canada, USA, China, Australia	Group CBT for insomnia, individual CBT for insomnia	NA	Sleep hygiene education	WLC, placebo, tablets	Short–long	✗	✗	✗	✓
Twomey 2013460	Insomnia	NA	Critically low	33 (5768)	Adults	Australia, UK, Spain, USA, Switzerland, Canada, Germany	NA	Computerised CBT	High-intensity face-to-face CBT, psychoeducation, computer-guided self-relaxation	WLC, TAU, NR	Short	✗	✓	✓	✓
Werner-Seidler 2018496	Insomnia	NA	Low	2 (173)	Adolescents, young adults	The Netherlands, UK	NA	eCBT for insomnia	NA	WLC	Short	≤	✓	✓	✓
Wu 2015505	Insomnia	Medical/psychiatric conditions	Low	10 (609)	Adults	NR	Individual CBT for insomnia, individual CBT for insomnia + drug	NA	Sleep hygiene, escitalopram plus quasi desensitisation, mindfulness-based stress reduction, obstructive sleep apnoea surgery, wellness education, audiotape relaxation training	WLC, TAU	Short	✗	′	′	✓
Zachariae 2016516	Insomnia	NA	Low	11 (1460)	Adults	NR	NA	Internet-based CBT for insomnia	NR	WLC	Short	✗	✗	✗	✓

TABLE 22 - Reviews in ICD-11 primary: 08 Diseases of the nervous system

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Bagnell 200756	Post-viral fatigue syndrome	NA	Low	4 (459)	Children, adults	NR	Individual CBT	NA	Relaxation, guided support group	TAU, WLC, no intervention	Long	✓	✓	✓	✓
Carlson 201788	Psychogenic non-epileptic seizures	NA	Low	1 (34)	Adults	USA	Individual CBT	NA	NA	TAU	Short	✗	✗	✗	✓
Castell 201193	Post-viral fatigue syndrome	NA	Critically low	16 (1457)	Adults	NR	Individual CBT, group CBT	NA	Education/support, relaxation, supportive listening, adaptive pacing, counselling	WLC, placebo, injection, TAU, medical care	Short	✓	′	′	′
Cleare 2015103	Post-viral fatigue syndrome	NA	Critically low	9 (1552)	Children, adolescents, adults	NR	Group CBT, individual CBT	Internet-based CBT	Guided support, relaxation, education and support, psychoeducation, specialist medical care	No intervention, TAU	Long	✓	✓	✓	✓
Cross 2015110	Epilepsy or seizures	NA	Critically low	2 (60)	Adolescents, adults	NR	Group CBT, individual CBT	NA	Supportive counselling	No intervention, TAU	Short	✓	✓	✗	✓
Gillings 2007170	Post-viral fatigue syndrome	NA	Low	4 (NR)	Adults	NR	NR	NA	Relaxation and guided support	No intervention	Short–long	✓	✓	✓	✓
Koychev 2017258	Parkinson’s disease	NA	Critically low	1 (45)	Adults	NR	Individual CBT	NA	NA	WLC	Short	′	✓	✓	✓
Larun 2017266	Post-viral fatigue syndrome	NA	Low	2 (331)	Adults	UK, USA	Individual CBT	NA	Anaerobic activity therapy, cognitive therapy, relaxation, specialist medical care, adaptive pacing therapy, graded exercise therapy	NA	Long	′	✓	✓	✓
Maguire 2011293	Epilepsy or seizures	NA	Critically low	2 (60)	Adolescents, adults	NR	NR	NA	Supportive counselling	TAU, no intervention	Short	✓	✓	✗	✓
Martlew 2014297	Epilepsy or seizures	NA	Moderate	1 (66)	Adults	UK	Individual CBT	NA	NA	TAU	Short	≤	✓	✓	✓
Price 2008371	Post-viral fatigue syndrome	NA	Moderate	8 (1050)	Adults	UK, USA, the Netherlands, Australia	Group CBT, individual CBT	NA	Education, relaxation, psychodynamic, exercise, cognitive therapy, counselling, guided support group	WLC, TAU, no intervention	Short	✓	✓	✓	✓
Reid 2011103	Post-viral fatigue syndrome	NA	Critically low	1 (69)	Children, adolescents	NR	Individual CBT	NA	NA	No intervention	Short	≤	≤	≤	✓
Russell 2017390	Post-viral fatigue syndrome	NA	Critically low	1 (640)	Adults	NR	Individual CBT	NA	NA	TAU	Long	✗	✗	✗	✓
Walklet 2016483	Motor neuron diseases or related disorders	NA	Low	2 (60)	Adults	NR	Individual CBT	Na	NA	TAU	Short	✓	✗	✗	✗

TABLE 23 - Reviews in ICD-11 primary: 10 Diseases of the ear or mastoid process

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Fackrell 2017140	Hyperacusis	NA	Critically low	1 (60)	Adults	NR	Individual CBT	NA	NA	WLC	Long	✓	✓	✓	✓
Hoare 2011213	Tinnitus	NA	Low	8 (410)	Adults, older adults	UK	Therapist-delivered individual CBT	Internet-based CBT	Internet-based education, education, minimal contact education relaxation, tinnitus retraining therapy	WLC	Short	✗	✓	✓	✓
Toivonen 2017451	Tinnitus	NA	Moderate	1 (64)	Adults	Sweden	NA	Internet-based CBT	Asynchronous web-based acceptance and commitment therapy	Online discussion forum	Short–long	✓	✓	✓	✓

TABLE 24 - Reviews in ICD-11 primary: 12 Diseases of the respiratory system

✓, Outcome searched for in the review, and RCT data identified and extracted; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of patients)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Kew 2016246	Asthma	NA	High	6 (134)	Adults	UK, India, Belgium, Canada, Italy	Individual CBT	NA	NA	WLC, no intervention TAU, self-management	Short	✓	✓	✓	✓
Yorke 2015514	Asthma	NA	Low	1 (40)	Adults	NR	Individual CBT	NA	Self-management intervention	NA	Short	✓	≤	′	✓

TABLE 25 - Reviews in ICD-11 primary: 13 Diseases of the digestive system

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Amorim 201842	Dentofacial parafunctional disorders	NA	Low	1 (57)	Adults	Germany	NA	CBT (delivered by health-care professional)	Occlusal splint	NA	Short	✗	✓	≤	✓
Clarkson 2010102	Oral mucositis	Cancer	Low	2 (68)	Adults	USA	Individual CBT	NA	Hypnosis, relaxation and imagery	Therapist contact, TAU	Short	≤	✗	✗	✓
Cong 2018107	Irritable bowel syndrome	NA	Critically low	2 (149)	Adults	UK, Sweden	NA	Internet-based CBT, self-management CBT	NA	WLC, TAU	Short	✓	✓	≤	✓
Ford 2019152	Irritable bowel syndrome	NA	Critically low	5 (307)	Adults	USA, New Zealand, Sweden	NA	Internet-based CBT, self-administered/minimal contact CBT	NA	NR	Short	✗	✗	✗	✓
Hanlon 2018192	Irritable bowel disorder/syndrome	NA	Moderate	7 (770)	Adolescents, adults	Sweden, UK, USA, Australia	NA	Internet-based CBT	Stress management, drug	TAU, placebo	Short–long	✓	✓	✓	✓
Li 2014279	Irritable bowel syndrome	NA	Low	4 (NR)	Adults	Australia, USA, the Netherlands, UK	Individual CBT (delivered by psychologists)	Internet-based CBT (delivered by nurses)	Relaxation, drug	TAU, WLC	Short	✓	′	′	✓
Li 2018276	Irritable bowel syndrome	NA	Low	1 (199)	Adults	New Zealand	NA	Internet-based CBT	NA	TAU	Short	✓	✗	≤	✓
Thakur 2018447	Irritable bowel disorder	NA	Critically low	1 (32)	Adults	Iran	Group CBT	NA	NA	WLC	Short	✗	✓	≤	≤
Zijdenbos 2009523	Irritable bowel syndrome	NA	Critically low	4 (497)	Adults	NR	Group CBT, individual CBT	NA	NA	TAU, placebo, education	Short–long	✓	✗	✗	✓

TABLE 26 - Reviews in ICD-11 primary: 14 Diseases of the skin

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Chan 201294	Diseases of the skin	NA	Critically low	1 (16)	Adults	UK	Group CBT (delivered by psychologist)	NA	NA	TAU	Short	✓	✗	✗	✗
Chida 2007100	Atopic eczema	NA	Critically low	1 (55)	Adults	Germany	Individual CBT	NA	Dermatological education	NA	Long	≤	✓	✓	✓
Lert 2010274	Vitiligo	NA	Low	1 (16)	Adults	UK	Group CBT	NA	NA	TAU	Short	✓	✗	✗	✗

TABLE 27 - Reviews with populations in ICD-11 primary: 16 Diseases of the genitourinary system

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Tao 2017441	Menopausal hot flushes	Breast Cancer	Critically low	2 (518)	Adults	UK, the Netherlands	Individual CBT	NA	Physical exercise	TAU, WLC	Short	✗	✗	✗	✓
Tremblay 2008456	Menopausal hot flushes	NA	Low	1 (29)	Adults	NR	Group CBT	NA	NA	WLC	Short	✓	✗	✗	✓
van Driel 2018470	Menopause	Breast cancer	Low	1 (173)	Adults	NR	Group CBT	NA	NA	WLC	Short	✗	✗	✗	✓
Vélez Toral 2014474	Menopause	NA	Critically low	1 (140)	Adults	NR	Individual CBT	NA	Self-help CBT	WLC	Short	✓	✓	≤	✓

TABLE 28 - Reviews in ICD-11 primary: 17 Conditions related to sexual health

✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Khera 2011248	Male erectile dysfunction	NA	Critically low	0 (0)	Adults	NA	NA	NA	NA	NA	NA	≤	✗	✗	≤

Reviews falling under ICD-11 primary code 21 (Table 29) have been subdivided into those with mental conditions and those with physical conditions. The reviews are listed under each of their respective categories.

TABLE 29 - Reviews with populations in ICD-11 primary: 21 Symptoms, signs or clinical findings, not elsewhere classified

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); CD-ROM, compact disc read-only memory; FMS, Fibromyalgia Syndrome; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Mental conditions
Ali 201539	Aggression	Intellectual disabilities	High	1 (179)	Adults	UK	NA	Manualised group CBT anger management therapy (delivered by lay therapist)	NA	WLC, TAU	Short	✓	✓	✓	✓
Smedslund 2007417	Aggression	NA	Moderate	0 (0)	Adults	NA	NA	NA	NA	NA	NA	✗	≤	≤	≤
Chen 201895	Fear of cancer	Cancer	Critically low	1 (88)	NR	NR	Blended individual CBT + additional electronic consultations	NA	NR	NR	Short	✓	✓	✓	✗
Liu 2018282	Fear of falling	NA	Moderate	5 (1103)	Older adults	NR	NA	Group or individual CBT (delivered by nurses)	Tai Chi	TAU	Short	✗	✗	✗	✓
Iyengar 2018223	Suicidal behaviour	NA	Critically low	1 (40)	Adolescents	NR	Integrated individual CBT and group CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Lai 2014263	Suicidal behaviour	NA	Critically low	2 (351)	Adults	NR	NA	Internet-based CBT	Information website	TAU	Short	✗	✓	✗	✗
Leavey 2017271	Suicidal behaviour	NA	Low	3 (551)	Adults	USA, the Netherlands, Australia	NA	Internet-based CBT	Information website	TAU	Short	✗	✓	✗	✗
Scott 2016401	Stress	Caregiver (dementia)	Moderate	4 (505)	Adults	NR	NA	Technology-based CBT	NA	WLC	Short	✓	✓	✓	✗
Physical conditions
Abbott 201732	Chronic pain	NA	High	5 (369)	Children, adolescents	Germany, USA, Australia, the Netherlands	Individual CBT	CD-ROM CBT	Education, medical dietary advice	WLC	Short–long	✓	✓	✓	✗
Anie 201547	Chronic pain	Sickle cell disease	Moderate	1 (53)	Adolescents	USA	Family home-based group CBT	NA	Disease education	NA	Long	≤	≤	✗	✓
Bender 201160	Chronic pain	NA	Moderate	4 (299)	Children, adolescents, adults	USA, Germany, Canada	NA	Family internet-based CBT + online support, internet-based CBT + e-mail/telephone support	Internet psychoeducation with support	WLC	Short	≤	✓	✓	✓
Bernardy 201363	Chronic pain	NA	High	13 (840)	Children, adolescents, adults	Europe, USA	Group CBT, individual CBT, mixed group CBT + individual CBT	NA	Exercise, FMS education and information	WLC, TAU, attention control	Short	✓	✓	✗	✓
Bernardy 201964	Chronic pain	NA	Low	3 (212)	Adults	Spain, USA, Canada	NA	Guided or unguided internet-based CBT	High-intensity CBT	WLC, TAU	Short	✓	✓	✗	✓
Birnie 201868	Chronic pain	NA	Moderate	1 (20)	Children, adolescents	Greece	NA	CBT (delivered by non-psychologists)	Hypnosis	TAU	Short	✗	✗	✗	✓
Burgstaller 201481	Chronic pain	NA	Moderate	4 (191)	Adults	USA, Norway, UK, the Netherlands	Individual CBT	NA	NA	TAU	Short–long	✗	✓	✓	′
Caemmerer 201283	Excessive weight gain	Schizophrenia and schizoaffective, bipolar, schizotypal, depression and personality disorders	Critically low	1 (61)	Adults	NR	Individual CBT	NA	NR	NR	Short	✗	✗	✗	✓
Cantor 201485	Fatigue	Fatigue	Critically low	1 (12)	Adults	NR	Individual CBT for social anxiety	NA	NA	WLC	NR	✗	✗	✓	✓
Eccleston 2015134	Chronic pain	NA	Moderate	1 (54)	Adults	The Netherlands	Individual CBT	NA	NA	WLC	Short	✓	✗	✓	✓
Farley 2012141	Excessive weight gain	Smoking	Moderate	1 (44)	Adults	USA	Weight gain individual CBT	NA	NA	TAU, standard cessation counselling + placebo	Long	✗	✗	✗	✓
Fleming 2016149	Chronic pain	NA	High	1 (54)	Adults	China	NA	Self-help listening to 10 minutes of CBT	Brain wave music therapy	No intervention	Short	≤	✗	✗	✓
Frank 2014157	Chronic pain	NA	Critically low	1 (701)	Adults	UK	NA	Group CBT + advice (delivered by physiotherapist)	Advice	NA	Long	✓	✗	✗	✓
George 2008164	Chronic pain	NA	Moderate	1 (223)	Adults	NR	Individual CBT + physiotherapy	NA	Physiotherapy	WLC	NC	✗	✗	✗	✓
Greenwood 2016176	Chronic pain	NA	Moderate	1 (130)	Adults	NR	Individual CBT + supervised exercise (TAU)	NA	NA	Supervised exercise (TAU)	Long	✓	✗	✗	✓
Gupta 2018185	Chronic pain	NA	Critically low	1 (61)	Adults	NR	Group CBT using virtual reality	NA	NA	TAU (medication)	Short	✓	✓	✗	✗
Hajihasani 2018187	Chronic pain	NA	Low	8 (404)	Adults	NR	Individual CBT + physical therapy	NA	Physical therapy	NA	NR	✓	✓	✗	✓
Hall 2018188	Chronic pain	NA	Moderate	4 (1128)	Adults	UK	NA	Individual CBT, group CBT, mixed individual + group CBT (all physiotherapist led)	Spinal stability, physiotherapy, advice, advice + exercises	NA	Long	✓	✗	✗	✓
Harris 2015194	Chronic pain	NA	Low	5 (305)	Adults, older adults	Germany, Australia, USA, Canada	Individual CBT + relaxation, group CBT + relaxation	NA	Relaxation, biofeedback, self-management CBT	WLC	Short–long	✗	✗	✗	✓
Hjorth 2014210	Excessive weight gain	Schizophrenia	Critically low	1 (15)	Adults	NR	Group CBT	NA	NA	TAU	Short	✗	✗	✗	✓
Ho 2019211	Chronic pain	NA	Moderate	4 (457)	Adults	USA, UK, Canada	Individual CBT or group CBT for pain and/or insomnia	NA	Education, behavioural desensitisation (placebo)	Symptom monitoring, WLC	Short	≤	✓	✓	✓
Iwasaki 2018222	Chronic pain	NA	Critically low	2 (256)	Adults	USA	Intensive individual CBT, brief individual CBT	N	NA	TAU	Long	✗	✗	✗	✓
Jacob 2018225	Excessive weight gain	NA	Low	1 (18)	Adults	Portugal	Individual CBT	NA	NA	WLC	Short	✗	′	✓	′
Kisely 2015251	Chronic pain	NA	Moderate	8 (422)	NR	NR	Group CBT, individual CBT	Brief CBT (delivered by nurses)	Paroxetine only	TAU, WLC, placebo, assessment	Short	′	′	✓	✓
Larkin 2014265	Fatigue	Prostate cancer	Critically low	2 (85)	Adults	The Netherlands, Scotland	Individual CBT (delivered by therapists)	CBT (delivered by nurses)	Brief nursing intervention	TAU	Short	✗	✗	✗	✓
Liu 2012281	Chronic pain	NA	Low	2 (275)	Adults	NR	NR	NA	NA	TAU, attention control	Long	✗	✓	✗	✓
Lonergan 2016285	Chronic pain	NA	Critically low	6 (501)	Children, adolescents	Australia, the Netherlands, Germany, USA	Family CBT	NA	Education, education + drug	TAU, WLC	Short–long	✗	✗	✗	✓
Macea 2010129	Chronic pain	NA	Critically low	1 (51)	Adults	Sweden	NA	Internet-based CBT	NA	WLC	Short	✗	✗	✗	✓
McMahon 2013302	Chronic pain	NA	Moderate	1 (29)	Adults	NR	Individual CBT	NA	Education	NA	Short	✓	✓	✓	✓
Mehta 2018306	Chronic pain	NA	Low	22 (3014)	Adults	USA, Sweden, Australia, Spain, Germany, Canada, the Netherlands	NA	Internet-based CBT	High-intensity face-to-face CBT, positive psychology therapy, internet-based acceptance and commitment therapy	WLC, TAU, attention control, discussion groups, information	Short	✗	✓	✓	✓
Monticone 2015317	Chronic pain	NA	Moderate	4 (226)	Adults	NR	Individual CBT (delivered by psychologist)	CBT ([delivered by health-care professional)	Physiotherapy or medication	WLC	Short	✓	≤	≤	✓
Niknejad 2018330	Chronic pain	NA	Critically low	2 (370)	Older adults	NR	Group CBT or individual CBT for pain	NA	Education	Symptom monitoring	Short	✗	′	′	✓
O’Keeffe 2016341	Chronic pain	NA	Low	1 (80)	Adults	NR	NR	NA	Neck exercises	NA	Long	✗	✗	✗	✓
Palermo 2010354	Chronic pain	NA	Low	2 (68)	Children, adolescents	NR	NA	Internet-based CBT and CD-ROM CBT	NA	WLC	Short	≤	✗	✗	✓
Raggi 2018374	Chronic pain	NA	Critically low	4 (391)	Children, adolescents, adults	NR	NR	NA	Education, education + drug	NA	Short	≤	✓	✗	✓
Ramond-Roquin 2014375	Chronic pain	NA	Moderate	3 (348)	Adults	USA, Sweden	NR	NA	Education	TAU, NR	Long	✓	✗	✗	✓
Randhawa 2016376	Chronic pain	NA	Low	1 (117)	Adults	USA	Individual CBT	NA	NA	TAU	Long	≤	✓	≤	✓
Richmond 2015382	Chronic pain	NA	Moderate	14 (2706)	Adults	NR	Individual or group CBT (delivered by psychologists)	Individual CBT or goup CBT (delivered by physiotherapist or other health-care professionals)	NA	TAU, WLC	Long	✓	✗	✗	✓
Sakamoto 2016392	Chronic pain	NA	Moderate	2 (127)	Adults	USA, UK	NR	NA	NA	No intervention	Short	✓	✗	✓	′
Schofield 2006396	Chronic pain	NA	Critically low	1 (28)	Older adults	Canada	Individual CBT	NR	Attention support	NA	Short	✗	✗	✗	✓
Shamliyan 2013404	Chronic pain	NA	Low	1 (158)	Adults	Germany	Individual CBT minimal contact programme	NA	NA	Brochures	NR	≤	✓	✓	✓
Shearer 2016406	Chronic pain	NA	Low	1 (80)	Adults	Italy	NA	CBT (delivered by physiotherapist)	Multimodal physiotherapy	NA	Long	✓	✗	✗	✓
Skelly 2018413	Chronic pain	NA	Low	9 (1708)	Adults	Spain, USA, UK, Finland, NR	Group CBT, individual CBT, mixed group + individual CBT	Group CBT, individual CBT, mixed group + individual CBT (delivered by health-care professionals)	Drug, exercise	TAU, attention control, active management	Short–long	✓	✓	✓	✓
Sprenger 2011426	Chronic pain	NA	Critically low	5 (225)	Children, adolescents	NR	Individual CBT, family CBT	Internet-based CBT	NR	NR	Short	✗	✗	✗	✓
Tang 2018440	Chronic pain	NA	Low	3 (404)	Children, adolescents	USA	NA	Internet-based CBT, family internet-based CBT	Internet-based education, specialised headache treatment programme	WLC	Short	✗	✓	✓	✓
Veehof 2016473	Chronic pain	NA	Low	2 (190)	Adults	NR	Group CBT	NA	Acceptance and commitment therapy, mindfulness-based stress reduction	NA	Short	≤	✓	≤	✓
Velleman 2010475	Chronic pain	NA	Critically low	4 (179)	Children, adolescents	NR	NA	Computerised CBT	Computerised education programme	WLC	Short	✗	✗	✗	✓
Verhagen 2009480	Chronic pain	NA	Moderate	2 (68)	Adults	NR	Individual CBT	NA	Drug, relaxation	NA	Short	✗	✓	✓	✓
Wendebourg 2017495	Fatigue	Multiple sclerosis	Low	3 (152)	Adults	UK, New Zealand, USA	Face-to-face individual CBT, face-to-face individual CBT + telephone contact	Internet-based CBT + telephone contact	Group intervention (not CBT), relaxation	No intervention	Short	′	′	✗	✓
Xu 2017508	Fatigue	Traumatic brain injury	Low	1 (12)	Adults	Australia	Individual CBT	NA	NA	WLC	Short	✗	✗	✗	✓

TABLE 30 - Reviews in ICD-11 primary: 22 Injury, poisoning or certain other consequences of external causes

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Al Sayegh 201038	Injuries to the head	Head injury	Low	1 (16)	Adults	NR	Individual CBT adapted to account for difficulties with attention, concentration, fatigue and memory, single session individual CBT + manual	NA	NA	WLC, TAU	Short	≤	✓	✓	✓
Gómara-Toldrà 2014172	Spinal cord injury	NA	Low	1 (61)	Adults	The Netherlands	Multidisciplinary individual CBT for coping with neuropathic pain	NA	NA	WLC	Short	✓	✗	✗	✓
Sullivan 2018437	Intracranial injury	NA	Low	1 (58)	Adults	USA	Single session individual CBT with therapist	NA	NA	TAU	Short	✗	✗	✗	✓
Thomas 2017449	Intracranial injury	Depression	Moderate	1 (77)	Adults	USA	Individual CBT	NA	Supportive psychotherapy	NA	Short	✓	′	′	✗

Reviews falling under primary ICD-11 code 24 (Table 31) have been subdivided into those with mental conditions and those with physical conditions. The reviews are listed under each of their respective categories.

TABLE 31 - Reviews with populations in ICD-11 primary: 24 Factors influencing health status or contact with health services

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ≤, outcome searched for in the review, but no CBT data found; NA, not applicable; NR, not reported.
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Mental conditions
McDaid 2008300	Bereavement	NA	Moderate	1 (134)	Adolescents, adults	The Netherlands	Family CBT	NA	NA	TAU	Long	✗	✓	✗	✗
Physical conditions
Moraes 2018319	Care involving peritoneal dialysis	NA	Critically low	1 (24)	NR	NR	Individual CBT	NA	NR	NR	Short	✗	≤	≤	✓

TABLE 32 - Reviews with populations from mixed physical and mental conditions

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; ′, outcome searched for in the review and RCT data identified, but unable to extract because of insufficient information (e.g. which individual studies contributed to this outcome, relevant data pooled with non-CBT or non-RCT studies); NA, not applicable; NR, not reported; OCD, obsessive–compulsive disorder; SAD, social anxiety disorder.
ICD-11 primary/secondary	Condition description	Study	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
ICD-11 primary/secondary	Condition description	Study	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Anxiety disorder Mood disorder OCD Symptoms involving the ear Sexual health	SAD Panic Phobia Depression Body dissatisfaction Tinnitus Male sexual dysfunction	Andersson 201445	NA	Low	11 (934)	Adults	Australia, the Netherlands, Spain, Sweden, Switzerland, USA	NA	Internet-based CBT	High-intensity CBT	NA	Short	✗	✓	✓	✓
Mood disorder General symptoms	Depression Pain	Barrett 201658	Substance abuse	Critically low	1 (66)	Adults	USA	Integrated individual CBT for substance abuse disorder, depression and pain	NA	Twelve-step facilitation	NA	Long	✗	✓	✗	✗
Anxiety disorder Mood disorder OCD Sleep–wake disorder Symptoms involving the ear Sexual health General symptoms	SAD Panic Phobia Depression Body dissatisfaction Insomnia Tinnitus Male sexual dysfunction Pain/fibromyalgia	Carlbring 201887	NA	Low	16 (914)	Adults	Australia, the Netherlands, Spain, Sweden, Germany, USA	NA	Internet-based CBT	High-intensity CBT	NA	Short	✗	′	✓	✓
Anxiety disorder Mood disorder Feeding or eating disorder Sleep–wake disorder	Anxiety Depression Eating Sleep	Farrand 2013142	NA	Low	35 (2977)	Adults	NR	NA	Guided self-help CBT, minimal contact CBT, self-administered CBT	NA	WLC TAU Attention control	Short	✗	✓	✓	✓
Schizophrenia and other primary psychotic disorder Mood disorder Cognition Injuries to the head Neurodevelopmental disorder	Psychosis Bipolar Cognitive deficiency Brain injury Autism	Kolubinski 2018256	Psychosis, bipolar, cognitive deficit, brain injury, learning disability, autism	Critically low	2 (562)	Adults	UK	Group CBT	NA	NA	WLC	Short	✗	✓	✗	✗
Anxiety disorder Mood disorder General symptoms	Anxiety Depression Pain	Osborn 2006348	Cancer survivors	Critically low	1 (34)	Adults	NR	Individual CBT	NA	NR	NR	Short	✗	✓	✓	✓
Anxiety disorder General symptoms	Anxiety Pain	Ruiz 2012389	NA	Critically low	3 (258)	Adults	NR	Group CBT, individual CBT	NA	Acceptance and commitment therapy	NA	Short–long	✓	✓	✓	✓
Mood disorder Sleep disorder Schizophrenia and other primary psychotic disorder	Depression Sleep Psychosis	Yoshinaga 2015515	NA	Critically low	2 (68)	NR	NR	Group CBT, individual CBT	NA	Group occupational therapy	TAU	Short	✓	✓	✓	✓

TABLE 33 - Summary table of reviews with populations from mixed physical conditions

✓, Outcome searched for in the review, and RCT data identified and extracted; ✗, outcome was not searched for in the review; NA, not applicable; NR, not reported;
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	CBT intervention group		Comparator group		Outcome
Study	Condition description	Comorbid/specific symptoms	AMSTAR-2 quality rating	Number of RCTs (number of participants)	Age	Country of RCTs	High intensity (description)	Low intensity (description)	Active (description)	Non-active (description)	Follow-up time	HRQoL	Depression	Anxiety	Condition specific
Bernard 201862	COPD, heart failure, cancer, chronic pain	NA	Critically low	8 (NR)	Adults	Brazil, the Netherlands, Pakistan, USA, international	CBT + exercise therapy (some group)	NA	Exercise therapy	NA	Short	✗	✓	✓	✓
van Beugen 2014467	Tinnitus, diabetes, chronic pain, cancer, headache, epilepsy, fatigue, functional gastrointestinal	NA	Low	19 (3974)	Adults	NR	NA	Internet-based CBT	NA	TAU, WLC	Short	✓	✓	✓	✓

Appendix 8 Gap maps of included systematic reviews grouped according to the condition each targeted, as per the ICD-11

TABLE 34 - Gap map of mental conditions (in ICD-11: 06 Mental, behavioural or neurodevelopmental disorders)

AN, anorexia nervosa; BED, binge eating disorder; BN, bulimia nervosa; EDNOS, eating disorder not otherwise specified; GAD, generalised anxiety disorder; GP, general practitioner; IVF, in vitro fertilisation; MUS, medically unexplained symptoms; OCD, obsessive–compulsive disorder; SAD, social anxiety disorder.

Purple denotes an evidence gap (i.e. no reviews were identified). Green indicates that the review did not report on this attribute.
Secondary ICD-11 (number of reviews, RCTs, participants)	Who: severity					What: intensity			When: delivered				Where: participants recruited							Follow-up
Secondary ICD-11 (number of reviews, RCTs, participants)	Subclinical	Clinical	Chronic	Severe	Not reported	High	Low	Not reported	Preventative	Standard	Relapse prevention	Not reported	Community	GP primary	Outpatients	Inpatients	School/university	Institution	Not reported	Short	Long	Not reported
6B00-06: Anxiety or fear-related disorders [agoraphobia with panic disorder, GAD, panic, phobia, SAD, selective mutism, mixed anxiety disorders (GAD, panic, phobia, SAD, separation, selective mutism)], n = 50 reviews (346 RCTs; 24,078 participants)	0	30	1	1	20	42	10	1	2	48	0	0	5	2	8	4	6	0	35	41	10	1
6C40-51: Disorders due to substance use or addictive behaviours (gambling, gaming, hallucinogens, stimulants, substance use), n = 6 reviews (7 RCTs; 476 participants)	0	1	0	0	5	3	2	1	0	6	0	0	2	0	2	0	0	0	2	3	2	1
6C20-21: Disorders of bodily distress or bodily experience (somatoform/MUS], n = 2 reviews (5 RCTs; 554 participants)	0	1	0	0	1	2	0	0	0	2	0	0	1	1	1	0	0	0	1	2	1	0
6B40-45: Disorders specifically associated with stress (acute stress disorders, adjustment disorders, post-traumatic stress disorder), n = 39 reviews (89 RCTs; 6110 participants)	4	17	0	1	18	37	3	0	3	36	0	0	11	2	6	1	6	1	22	35	7	0
6B80-85: Feeding or eating disorders [AN, BED, BN, mixed (AN, BN, BED, EDNOS)], n = 25 reviews (87 RCTs; 7132 participants)	2	13	1	1	10	20	8	0	1	23	1	0	8	3	8	1	1	0	13	17	10	0
6B80-85: Mental disorders associated with pregnancy, childbirth or the puerperium (during IVF, antenatal depression, perinatal anxiety and depression, postnatal depression), n = 19 reviews (39 RCTs; 4737 participants)	0	7	0	0	12	15	6	1	3	16	0	0	4	0	0	2	0	0	13	18	1	1
6A60-80: Mood disorders (bipolar or related disorder, depressive disorders, premenstrual dysphoric disorder, subthreshold depression, treatment-resistant depression), n = 92 reviews (272 RCTs; 42,676 participants)	9	43	4	3	39	76	29	2	8	84	4	0	14	11	19	6	7	2	48	72	26	1
6D70-72: Neurocognitive disorders, n = 1 review (1 RCT; 41 participants)	0	1	0	0	0	1	0	0	0	1	0	0	0	0	0	0	0	0	1	1	0	0
6A00-06: Neurodevelopmental disorders (attention deficit hyperactive disorder), n = 5 reviews (13 RCTs; 746 participants)	0	3	0	0	2	5	1	0	0	5	0	0	0	0	1	0	0	0	4	5	0	0
6B20-25: Obsessive–compulsive or related disorders (body dysmorphic disorder, hypochondriasis, OCD), n = 16 reviews (54 RCTs; 3117 participants)	0	9	0	1	7	13	5	0	0	16	0	0	1	4	2	0	1	0	12	16	3	0
6D10-11: Personality disorders and related traits, n = 4 reviews (7 RCTs; 603 participants)	0	2	0	0	2	4	0	0	0	4	0	0	0	0	3	0	0	0	1	3	1	0
6A20-25: Schizophrenia or other primary psychotic disorders (attenuated psychosis syndrome, delusional disorder, early-onset psychosis, psychosis), n = 31 reviews (135 RCTs; 14,924 participants)	0	14	0	1	16	31	0	0	6	24	1	0	3	1	10	8	0	0	17	20	14	0
Mixed mental (anxiety, addictive, bodily distress, depression, eating disorder, obsessive, stress), n = 60 reviews (447 RCTs; 57,213 participants)	1	31	1	1	28	40	26	1	2	58	0	0	16	8	18	3	11	0	26	53	13	1

TABLE 35 - Gap map of mental conditions (in other ICD-11 categories)

GP, general practitioner.
Primary and secondary ICD-11 (number of reviews, RCTs, participants)	Who: severity					What: intensity			When: delivered				Where: participants recruited							Follow-up
	Subclinical	Clinical	Chronic	Severe	Not reported	High	Low	Not reported	Preventative	Standard	Relapse prevention	Not reported	Community	GP primary	Outpatients	Inpatients	School/university	Institution	Not reported	Short	Long	Not reported
21. Symptoms, signs or clinical findings, not elsewhere classified: mental, behavioural symptoms (aggression, caregivers stress, fear of cancer, fear of falling, suicidal behaviour), n = 8 reviews (17 RCTs; 2817 participants)	0	2	0	1	6	2	5	1	1	7	0	0	1	0	1	0	0	0	6	6	1	1
24. Factors influencing health: associated with absence, loss or death of others (bereavement through suicide), n = 1 review (1 RCT; 134 participants)	0	0	0	0	1	1	0	0	0	1	0	0	0	1	0	0	0	0	0	0	1	0

TABLE 36 - Gap map of physical conditions

AIDS, acquired immunodeficiency syndrome; GP, general practitioner; HIV, human immunodeficiency virus; OA, osteoarthritis; RA, rheumatoid arthritis; RAP, recurrent abdominal pain.
Primary ICD-11 (number of reviews, RCTs, participants)	Who: severity					What: intensity			When: delivered				Where: participants recruited							Follow-up
Primary ICD-11 (number of reviews, RCTs, participants)	Subclinical	Clinical	Chronic	Severe	Not reported	High	Low	Not reported	Preventative	Standard	Relapse prevention	Not reported	Community	GP primary	Outpatients	Inpatients	School/university	Institution	Not reported	Short	Long	Not reported
01 Certain infectious or parasitic diseases (HIV/AIDS), n = 1 review (1 RCT; 46 participants)	0	0	0	0	1	1	0	0	0	1	0	0	0	0	0	0	0	0	1	1	0	0
02 Neoplasms (chemotherapy, malignant breast), n = 8 reviews (21 RCTs; 3204 participants)	0	6	0	0	2	8	0	0	0	8	0	0	0	0	1	0	0	0	7	6	4	0
05 Endocrine, nutritional or metabolic diseases (diabetes mellitus, diabetic neuropathy), n = 3 reviews (8 RCTs; 1061 participants)	0	1	0	0	2	3	1	0	0	3	0	0	0	0	2	0	0	0	1	2	2	0
07 Sleep–wake disorders (insomnia disorders), n = 22 reviews (125 RCTs; 14,315 participants)	0	8	2	0	12	15	10	0	0	22	0	0	6	1	2	0	1	0	15	19	6	0
08 Diseases of the nervous system (epilepsy or seizure, neuromuscular disorders, non-epileptic seizures, Parkinson’s disease, post-viral fatigue syndrome), n = 14 reviews (54 RCTs; 5883 participants)	0	5	0	0	9	14	1	0	0	14	0	0	1	1	4	2	0	0	8	10	5	0
10 Diseases of the ear or mastoid process (hyperacusis, tinnitus), n = 3 reviews (9 RCTs; 534 participants)	0	0	0	0	3	2	2	0	0	3	0	0	0	0	0	0	0	0	3	3	1	0
12 Diseases of the respiratory system (asthma), n = 2 reviews (7 RCTs; 174 participants]	0	2	0	0	0	2	0	0	0	2	0	0	0	0	0	0	0	0	2	2	0	0
13 Diseases of the digestive system (dentofacial parafunctional disorders, irritable bowel disorder/syndrome, oral mucositis), n = 9 reviews (27 RCTs; 2079 participants)	0	2	0	0	7	4	6	0	0	9	0	0	1	2	4	0	0	0	5	9	2	0
14 Diseases of the skin (atopic eczema, vitiligo), n = 3 reviews (3 RCTs; 87 participants)	0	1	0	0	2	3	0	0	0	3	0	0	2	0	0	0	0	0	1	2	1	0
16 Diseases of the genitourinary system (menopausal hot flushes, menopause), n = 4 reviews (5 RCTs; 860 participants)	0	0	0	0	4	4	0	0	0	1	0	0	0	0	0	0	0	0	4	4	0	0
17 Conditions related to sexual health (male erectile dysfunction), n = 1 review (0 RCTs; 0 participants)	0	0	0	0	1	0	0	1	0	1	0	0	0	0	0	0	0	0	1	0	0	1
21 General symptoms, signs or clinical findings: fatigue, n = 4 reviews (7 RCTs; 261 participants)	0	0	0	0	4	4	2	0	0	4	0	0	0	0	1	1	0	0	3	4	0	0
21 General symptoms, signs or clinical findings: pain (back pain, chronic non-cancer pain, chronic pain, headaches and migraines, fibromyalgia, leukaemia, lumbar fusion surgery, neck pain, non-specific chest pain, spinal pain and injury, OA, orthodontic treatment, RA, RAP, sickle cell disease pain, tempro mandibular disorder), n = 42 reviews (156 reviews; 17,105 participants)	0	11	9	0	22	30	18	0	2	39	1	0	10	4	15	3	3	1	22	31	16	0
21 General symptoms, signs or clinical findings: weight gain, n = 4 reviews (4 RCTs; 138 participants)	0	2	0	0	2	4	0	0	0	4	0	0	1	0	0	0	0	0	3	3	1	0
22 Injury, poisoning or certain other consequences of external causes (intracranial injury, spinal cord injury), n = 4 reviews (4 RCTs; 212 participants)	0	2	0	1	1	4	0	0	1	3	0	0	1	0	2	3	0	0	1	4	0	0
24 Factors influencing health status (peritoneal dialysis), n = 1 review (1 RCT; 24 participants)	0	0	0	0	1	1	0	0	0	1	0	0	0	0	0	0	0	0	1	1	0	0
Mixed physical conditions (COPD, cancer, chronic pain, diabetes, epilepsy, headache, heart failure, fatigue, functional gastrointestinal, tinnitus), n = 2 reviews (27 RCTs; 3974 participants)	0	0	1	0	1	1	1	0	0	2	0	0	1	0	0	0	0	0	1	2	0	0

TABLE 37 - Gap map of mixed mental and physical conditions

GP, general practitioner.
Primary physical/secondary mental ICD-11 category (number of reviews, RCTs, participants)	Who: severity					What: intensity			When: delivered				Where: participants recruited							Follow-up
	Subclinical	Clinical	Chronic	Severe	Not reported	High	Low	Not reported	Preventative	Standard	Relapse prevention	Not reported	Community	GP primary	Outpatients	Inpatients	School/university	Institution	Not reported	Short	Long	Not reported
Physical: brain injury, conditions related to sexual health, chronic pain, diseases of the ear or mastoid process, sleep–wake disorders; mental: anxiety, autism, bipolar, bodily distress, depression, eating disorders, learning disability, psychosis, stress disorders, n = 8 (71 RCTs; 5813 participants)	0	2	0	0	6	5	3	0	0	8	0	0	3	0	4	1	0	0	3	7	2	0

Appendix 9 Health-related quality of life

Sensitivity analysis: review quality

The sensitivity analysis was conducted with an additional 10 reviews that had been rated as being of low or critically low quality on the AMSTAR-2. Therefore, the sensitivity analysis was conducted with 34 reviews (76 RCTs, 7466 participants). 32,39,63,82,165,188,193,219,220,231,235,236,270,275,276,279,286,299,317,329,343,347,356,371,409,413,445,446,464,467,469,513,518,521 Inclusion of lower-quality reviews increased the estimate of effect (SMD 0.28, 95% CI 0.17 to 0.38) and produced higher levels of heterogeneity (I² = 71%) (Figure 15).

Sensitivity analysis: prioritisation of mental subscales

We re-ran the PMA, replacing the physical component scores with the mental component scores from the SF-12/SF-36 in the two reviews that presented both the physical and mental component scores. 220,464 The replacement did not change the overall effect or heterogeneity rating for the HRQoL outcome (SMD 0.24, 95% CI 0.14 to 0.33; I² = 38%) (Figure 16).

Synthesis of reviews reporting change scores

Data were presented as change scores for the HRQoL outcome in four reviews (four RCTs, 185 participants). 158,246,406,523 Each review represented a different condition: digestive system diseases (irritable bowel syndrome), mixed mental problems (anxiety and depression), pain (neck and whiplash) and respiratory system diseases (asthma). Pooled results showed a moderate effect in favour of CBT (SMD 0.58, 95% CI 0.15 to 1.00; I² = 66%) (Figure 17).

Synthesis of reviews reporting dichotomous outcomes

Only one review (two RCTs, 145 participants) reported HRQoL outcome results as RRs. 170 This review in nervous system disorder (post-viral fatigue syndrome) identified a large effect for CBT (SMD 1.57, 95% CI 0.78 to 2.37) (Figure 18).

Appendix 10 Depression

Primary analysis

Within-condition heterogeneity varied between 0% (6D10-11: Personality disorders) and 86.3% (6A60-80: Mood disorders) and across-condition heterogeneity was 81%. The across-condition heterogeneity was too high for us to pool across the ICD-11 category subgroups (Figure 19).

Publication bias

No publication bias was detected using funnel plots (Figure 20) and Egger’s test showed no small-study effects (p = 0.87).

Appendix 11 Anxiety

Publication bias

There was no evidence of publication bias, nor of small-study effects (Egger’s test p = 0.70) (Figure 21).

Subgroup analysis

Cognitive–behavioural therapy intensity

The pooling of 28 meta-analyses collected from reviews of high-intensity CBT (face to face with a highly trained CBT therapist) found a modest effect in favour of CBT (SMD 0.28, 95% CI 0.15 to 0.42; I² = 54.3%) (Figure 22).

We identified five reviews87,306,343,360,521 (11 RCTs, 503 participants) that directly compared high- with low-intensity CBT interventions on anxiety outcomes in 6B00-06: Anxiety, 6A60-80: Mood and pain [tinnitus 21 Symptoms and signs not otherwise specified (MG30 pain)] conditions. In this subset of direct comparisons, there was no difference between high- and low-intensity CBT (SMD 0.03, 95% CI –0.14 to 0.21; I² = 20%) (Figure 23).

Type of comparators

The pooling of 14 meta-analyses collected from reviews of CBT compared with an active comparator (i.e. another type of therapy) found a non-significant effect of CBT (SMD 0.19, 95% CI –0.00 to 0.37; I² = 48.6%). The pooling of 20 meta-analyses collected from reviews of CBT compared with a non-active comparator (e.g. WLC) found a modest effect in favour of CBT (SMD 0.37, 95% CI 0.19 to 0.55; I² = 64.3%) (Figure 24).

Duration of follow-up

The pooling of 10 meta-analyses collected from reviews that collected long-term follow-up data (> 12 months post intervention) found a modest effect of CBT (SMD 0.38, 95% CI 0.15 to 0.60; I² = 65.9%). The pooling of 26 meta-analyses collected from reviews that collected only short-term follow-up data (< 12 months) found a similar effect in favour of CBT (SMD 0.27, 95% CI 0.12 to 0.43; I² = 59.4%) (Figure 25).

Age

The pooling of seven meta-analyses collected from child and adolescent populations (aged < 18 years) found an effect in favour of CBT (SMD 0.37, 95% CI 0.12 to 0.62; I² = 67%). The pooling of 26 meta-analyses collected from adult populations (aged 18–65 years) found a significant effect in favour of CBT (SMD 0.32, 95% CI 0.15 to 0.48; I² = 64%). The pooling of two meta-analyses collected from older adult populations (aged > 65 years) found a non-significant effect of CBT on anxiety outcomes (SMD 0.06, 95% CI –0.30 to 0.43; I² = 0%) (Figure 26).

Sensitivity analysis

As the heterogeneity across the conditions’ subgroups was too large, we did not pool effects across conditions (Figure 27).

Synthesis of reviews reporting change scores

Four lower-quality reviews (four RCTs, 255 participants) reported anxiety outcome data as change scores. 56,105,336,457 These included reviews of 6B00-06: Anxiety, 6A60-80: Mood and 08 Diseases of the nervous system. The heterogeneity was too high (I² = 88%) to pool across reviews (Figure 28).

Synthesis of reviews reporting dichotomous outcomes

The lower-quality review of Noble et al. 332 (one RCT, 27 participants), classified under mixed mental conditions (anxiety and depression), reported anxiety data as risk differences and showed an effect in favour of CBT (SMD 0.36, 95% CI 0.01 to 0.71). The lower-quality review of Stoll et al. 433 (one RCT, 112 participants), targeting anxiety disorders, presented anxiety outcome data as ORs and reported an effect in favour of CBT (SMD 1.01, 95% CI 0.96 to 1.06) (Figure 29).

Appendix 12 Pain

Publication bias

No publication bias was detected using funnel plots (Figure 30), and Egger’s test showed no small-study effects (p = 0.19).

Subgroup analysis

Cognitive–behavioural therapy intensity

The SMD generated across the high-intensity reviews was in favour of CBT (SMD 0.19, 95% CI 0.01 to 0.37; I² = 18%) (Figure 31).

Type of comparators

We found an effect in favour of CBT across reviews in the non-active comparator group (SMD 0.59, 95% CI 0.07 to 1.11; I² = 69%), but the effect was much smaller across reviews in the active comparator subgroup (SMD 0.14, 95% CI –0.11 to 0.38; I² = 73%) (Figure 32).

Duration of follow-up

Both subgroups produced effects in favour of CBT. The effect was larger in the short-term follow-up group (SMD 0.32, 95% CI 0.04 to 0.59; I² = 71%) than in the long-term follow-up group (SMD 0.19, 95% CI 0.08 to 0.31; I² = 0%) (Figure 33).

Age

The standardised mean effect across the reviews conducted in adults was in favour of CBT (SMD 0.21, 95% CI 0.12 to 0.31; I² = 0%) (Figure 34).

Sensitivity analysis

The across-condition pooled effect was in favour of CBT (SMD 0.21, 95% CI 0.11 to 0.31; I² = 51%) for reducing pain intensity (Figure 35).

Synthesis of reviews reporting dichotomous outcomes

The review of Bernardy et al. 64 (one RCT, 118 participants) reported pain outcome data as risk difference and showed a non-significant effect for CBT (SMD 0.08, 95% CI –0.03 to 0.19) (Figure 36a). One review, Palermo et al. 354 (two RCTs, 68 participants), presented pain outcome data as ORs. This review demonstrated a non-significant effect for CBT (SMD 7.99, 95% CI –2.72 to 18.70) (Figure 36b).

List of abbreviations

ADHD: attention deficit hyperactivity disorder
AMSTAR: A MeaSurement Tool to Assess systematic Reviews
BAI: Beck Anxiety Inventory
CBT: cognitive–behavioural therapy
CI: confidence interval
CINAHL: Cumulative Index to Nursing and Allied Health Literature
COPD: chronic obstructive pulmonary disease
CRD: Centre for Reviews and Dissemination
DARE: Database of Abstracts of Reviews of Effects
ECG: expert consultation group
HRQoL: health-related quality of life
HTA: Health Technology Assessment
ICD-11: International Classification of Diseases, Eleventh Revision
NDORMS: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
NIHR: National Institute for Health Research
OR: odds ratio
PMA: panoramic meta-analysis
PPI: patient and public involvement
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
RCT: randomised controlled trial
RR: risk ratio
SF-12: Short Form questionnaire-12 items
SF-36: Short Form questionnaire-36 items
SIGN: Scottish Intercollegiate Guidelines Network
SMD: standardised mean difference
TAU: treatment as usual
VAS: visual analogue scale
WHO: World Health Organization
WLC: wait-list control

This report is a summary of research examining if a psychological therapy called cognitive–behavioural therapy can improve the quality of life of people living with physical and/or mental conditions. Cognitive–behavioural therapy uses a set of techniques that help individuals to identify and change problematic thoughts or behaviour patterns that might contribute to and maintain their physical or mental symptoms. It can be delivered face to face or through mediums such as the internet. We aimed to understand if cognitive–behavioural therapy helps patients with specific conditions only, or if it can help patients with any condition.

We searched relevant databases to find articles that combine the results from multiple trials testing cognitive–behavioural therapy. These are known as systematic reviews. We graded these reviews as providing good- or poor-quality evidence. We identified the conditions for which we had good-quality evidence on whether or not cognitive–behavioural therapy was helpful.

From each review, we took numerical data that told us if cognitive–behavioural therapy improved quality of life for that specific condition. Next, we combined all the numerical data together, across all the conditions, to see if there was a consistent benefit of cognitive–behavioural therapy.

The statistical analyses found that cognitive–behavioural therapy consistently improved quality of life across all the conditions where it has been tested. We have evidence that it can help children, adolescents and adults, of either sex, who are living in Europe, North America and Australasia. We are unsure if it will help older adults or people living in Africa, Asia or South America, nor do we know if cognitive–behavioural therapy is equally effective across different ethnic groups.

It is recommended that future research should prioritise understanding how cognitive–behavioural therapy works, why some people do not want to use cognitive–behavioural therapy and why some patients do not benefit from it.

Background

Cognitive–behavioural therapy is an amalgam of interventions that emerged from cognitive and behavioural psychological models. It aims to improve quality of life by changing maladaptive cognitions that maintain problematic symptoms. An overview of cognitive–behavioural therapy systematic reviews was conducted in 2012 and included 269 reviews, concluding that cognitive–behavioural therapy was effective across many conditions. However, only 11 of the included reviews synthesised randomised controlled trials. Since then, there have been many more randomised controlled trials and subsequent reviews. In parallel, there has been more guidance on improving trial and review quality. Hence, the time was right to undertake an updated overview, focused on high-quality randomised controlled trial evidence, to introduce new methods to understand how consistent the effects are across different conditions and to understand where future research resources would be best invested.

Objectives

This overview aimed to comprehensively map the existing evidence base to identify where we have high-quality evidence of the effectiveness of cognitive–behavioural therapy and where we have evidence gaps. Then we examined the consistency of the effectiveness of cognitive–behavioural therapy across different conditions and, when appropriate, generated an across-condition general effect estimate. Finally, we considered the extent to which the existing evidence base could be used to guide treatment, commissioning and research investment decisions.

To answer these research aims, we undertook two steps: (1) a mapping exercise – we identified all available systematic reviews of cognitive–behavioural therapy, assessed their quality and stratified them by quality, condition, context and population; and (2) a panoramic meta-analysis – we selected higher-quality reviews with sufficient quantitative data and conducted panoramic meta-analyses for the primary outcome of health-related quality of life and for the secondary outcomes of depression, anxiety and pain.

Finally, we considered the implications of the mapping and panoramic meta-analytic data. We used a model of generalisation to examine how the data of the overview answer the questions needed to inform treatment, commissioning and research investment decisions.

Methods

We worked with a cognitive–behavioural therapy expert consultation group consisting of clinical academics (n = 6), research academics (n = 8) and patient representatives (n = 4) throughout the overview process to guide the protocol development, synthesis strategy, data analysis, and interpretation.

Data sources and search strategy

The Database of Abstracts of Reviews of Effects (up to March 2015), Cochrane Database of Systematic Reviews, MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), Child Development and Adolescent Studies (via EBSCOhost) and OpenGrey databases were searched up until January 2019. Publication year was restricted to after 1992 to eliminate superseded reviews.

Inclusion criteria

A systematic review of cognitive–behavioural therapy in any condition [recognised in the International Classification of Diseases, Eleventh Revision (ICD-11)] across any age group or setting was considered for inclusion if:

the review fulfilled at least four of the five Centre for Reviews and Dissemination criteria to qualify as a systematic review
the intervention was reported as cognitive–behavioural therapy or included at least one cognitive and one behavioural element
the cognitive–behavioural therapy trials were qualitatively or quantitatively summarised
one of the following outcomes was considered in the review – health-related quality of life, depression, anxiety or pain
it was available in English.

Stage one: mapping

Data extraction

The Covidence (Melbourne, VIC, Australia) platform was used for sifting and article management, and Microsoft Excel^® (Microsoft Corporation, Redmond, WA, USA) was used for data extraction and management. Article screening, data extraction and quality assessment were conducted independently in duplicate by two researchers. A third researcher resolved conflicts. The online A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2 was used to assess the quality of the included reviews (i.e. high, moderate, low or critically low).

Reviews were categorised by the condition that they aimed to improve with cognitive–behavioural therapy. Physical conditions were classified by primary codes of the ICD-11, whereas mental conditions were represented by secondary codes under the primary code of ‘Mental, behavioural and neurodevelopmental disorders.’ We extracted descriptive information, such as participant characteristics (age, sex, ethnicity, country of residence), intervention (intensity, timing, context), control groups (active or non-active), outcomes, follow-up duration and patient perspectives (satisfaction, dropout rates, acceptability).

Evidence synthesis

The mapping exercise included producing (1) a bubble chart through TIBCO Spotfire^® (TIBCO, Software Inc., Palo Alto, CA, USA) software to present the volume of evidence, in terms of number of reviews, randomised controlled trials and participants across all conditions; (2) summary tables to present the descriptions of the included reviews as per the ICD-11 classification; and (3) gaps maps, sectioned by condition, population, context and quality to highlight gaps in the evidence base.

Stage 2: panoramic meta-analysis

Data extraction

From the reviews identified in stage one, we selected reviews that contained quantitative data suitable for extraction. From these, we selected those reviews that were rated as ‘moderate’ or ‘high’ on the AMSTAR-2 checklist (henceforth referred to as ‘higher-quality’ reviews). Then we compared these reviews to identify if any review shared the same randomised controlled trial as another review. When we identified reviews that included the same randomised controlled trial, we chose (1) the review with the longest follow-up, (2) the review with the highest AMSTAR-2 rating, (3) the most recent review or (4) the review with the largest number of trials.

The primary analysis was conducted using the higher-quality reviews with suitable quantitative data. The analyses were conducted on the primary outcome of health-related quality of life and the secondary outcomes of depression, anxiety and pain.

Data synthesis

A panoramic meta-analysis using a two-step frequentist approach (random-effects model) was conducted with continuous end-point data for each outcome in Stata^® versions 13 and 16 (StataCorp LP, College Station, TX, USA). The analysis produced a within- and across-condition I² heterogeneity statistic. If the heterogeneity (I²) was < 75%, we proceeded to pool the estimates across (1) the within-condition reviews and (2) across the condition estimates. We produced standardised mean differences with 95% confidence intervals for all analyses. We also calculated prediction intervals for the primary analyses. For meta-analyses with > 10 reviews, we produced funnel plots and conducted Egger’s test to detect publication bias and small-study effects. Next, we conducted subgroup analyses based on the ages of participants (children and adolescents, adults, older adults), cognitive–behaviour therapy intervention intensity (high, low), comparator groups (active, non-active) and duration of follow-up [short (< 12 months), long (≥ 12 months)]. We performed a sensitivity analysis that combined all of the lower-quality reviews (rated ‘low’ or ‘critically low’ on the AMSTAR-2 checklist) with the higher-quality review data.

To aid interpretation of these results, we transformed the standardised mean difference into an approximate mean difference on the most common outcome measure (e.g. Beck Depression Inventory for depression). To do this, we multiplied the overall pooled estimate for each outcome by the standard deviation of the outcome measure to produce an estimate of the mean difference for each measure. We identified the standard deviation from a trial, judged as having a low risk of bias, in a higher quality review.

Generalisation of the evidence

The expert consultation group helped form a list of pertinent questions regarding the generalisability of this evidence. The questions were as follows:

Is there evidence of a general effect of cognitive–behaviour therapy across conditions?
Is this effect robust across the conditions represented in each ICD-11 code?
Is the effect robust across conditions that are represented by lower-quality reviews only?
Is the effect robust across the populations and contexts we have tested?
Can we infer that the effect might be observed across conditions that are not included in the current overview?

We drew on an established model of generalisation to guide the interpretation of the overview data.

Results

Mapping

We mapped 494 reviews (2052 trials, 221,128 participants). The most common reason for a review to be excluded was because it did not include a synthesis of the included cognitive–behaviour therapy trials or it did not fulfil the Centre for Reviews and Dissemination criteria to qualify as a systematic review. Ten per cent (237/2454) of the full-text reviews were excluded because full texts were not available in English.

Most of the included reviews (284/494, 57%) were published in the preceding 5 years (2015 onwards). Of the 494 reviews, only 142 reviews (29%) were rated as ‘high’ or ‘moderate’ on the AMSTAR-2.

The 494 reviews included 13 out of 20 ICD-11 mental condition categories and 14 out of 20 ICD-11 physical condition categories. ‘Mood disorders’ were the most researched condition (92 reviews, 272 trials, 42,676 participants). Most reviews considered the effects of high-intensity cognitive–behaviour therapy (397/494, 80%) delivered as a standard treatment (463/494, 93%) in the short term (402/494, 81%) in the adult population (378/494, 77%). Research with older adults was limited (30/494, 6%). The effects of cognitive–behaviour therapy as a preventative intervention (29/494, 6%) or as part of relapse prevention (7/494, 1%) were under-researched. Reporting on condition severity (247/494, 50%) and the setting whence participants were recruited was also poor (283/494, 57%). Nearly half of the included reviews did not report details on sex (218/494, 44%) or the country where the trials were conducted (218/494, 44%), and the majority did not report the ethnicity of the participants (458/494, 93%). Only a very small proportion of reviews had included trials from the Asian, South American and African continents (45/494, 9%).

Panoramic meta-analysis

Of the 494 reviews, 71 (207 trials, 20,862 participants) were high-quality reviews with data suitable for inclusion in the panoramic meta-analyses.

Health-related quality of life

Estimates from 24 reviews (49 trials, 4304 participants) representing 10 different conditions demonstrated low heterogeneity (I² = 32%). The analysis produced a modest effect in favour of cognitive–behavioural therapy (standardised mean difference 0.23, 95% confidence interval 0.14 to 0.33, prediction interval –0.03 to 0.50). This translates to an estimated mean change of 3 points on the Short Form questionnaire-36 items tool. No publication bias or small-study effects were identified (p = 0.18).

The sensitivity analysis found that the inclusion of an additional 10 lower-quality reviews increased the heterogeneity (I² = 71%), but did not alter the effect estimates (standardised mean difference 0.28, 95% confidence interval 0.17 to 0.38). The effect was larger for cognitive–behavioural therapy compared with non-active comparator groups than for cognitive–behavioural therapy compared with active comparator groups. The interaction effect between these two types of reviews (active and non-active comparator groups) was statistically significant. None of the other subgroup analyses reported significant interaction effects between the groups.

All of the analyses from the primary, condition-specific, subgroups and sensitivity analyses produced effect estimates consistent with the general effect.

Depression

There was too much heterogeneity within and between conditions in the depression analyses; therefore, we did not pool any reviews together. No publication or small-study bias was detected (p = 0.87).

Anxiety

The heterogeneity across the 12 conditions represented by the anxiety analysis was acceptable (I² = 62%). We pooled across 34 high-quality reviews (59 trials, 4673 participants) and identified a small effect in favour of cognitive–behavioural therapy (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval –0.28 to 0.88). This translates to an estimated mean change of 4 points on the Beck Anxiety Inventory. No publication or small-sample bias was detected (p = 0.70). All of the analyses from the primary, conditions, subgroups and sensitivity analyses produced effect estimates consistent with the general effect.

Pain

The heterogeneity of effect estimates generated for the outcome of pain, across abdominal, leukaemia-related, non-specific chest, osteoarthritis, spinal, back and neck pain was high, but acceptable (I² = 64%). The overall pooled effect, from 10 high-quality reviews (22 trials, 2581 participants), was modest and in favour of cognitive–behavioural therapy (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.28 to 0.74). The effect translated to a change of 6 mm on the 100-mm visual analogue scale. No publication or small-sample bias was detected (p = 0.19). All of the analyses from the primary, conditions, subgroups and sensitivity analyses produced effect estimates consistent with the general effect.

Generalisation

From our mapping and panoramic meta-analyses, we found that cognitive–behavioural therapy produced a general effect of improving health-related quality of life across different conditions.

The effects we found remained consistent across all conditions tested and when considering the broader number of health conditions represented by comorbidities of these patients. We suggested that this effect was robust across the conditions represented in the ICD-11 primary (physical conditions) and secondary (mental conditions) codes.

The consistency of the general effect leads us to suggest that it is robust across the populations (age, sex) and contexts (health-care setting, intervention delivery/timing, condition severity) that have been represented by this overview. We are less sure of the consistency of the effect across ethnic groups, as this was poorly reported. Nor are we sure of the effect in countries in Africa, Asia and South America, as these were under-researched.

The debate of whether or not the general effect can be generalised across conditions that are not represented in this overview remains contentious. There is no evidence to suggest that cognitive–behavioural therapy would not be effective or would be harmful. The expert consultation group did not reach agreement that cognitive–behavioural therapy effects change through shared mechanisms for every condition: some members of the group felt that additional detailed information on mechanistic data would be needed to make broader generalisations, but several members of the investigator team felt that it was sufficient that the statistical and remaining principles of generalisation had been met. Therefore, it remains uncertain if the effect would be replicated in conditions not represented in this overview.

Conclusion

The best-quality evidence available has estimated that cognitive–behavioural therapy produces a general improvement in health-related quality of life and reduces specific contributing symptoms (pain and anxiety). The effect is observed when cognitive–behavioural therapy is delivered via high- or low-intensity formats and is evident when data are collected > 12 months after a patient has received cognitive–behavioural therapy. The effect becomes much smaller when cognitive–behavioural therapy is compared with active comparators such as pharmacotherapy, relaxation or exercise therapy. However, we did not identify any condition for which there was evidence in favour of the comparator group (i.e. a statistically significant effect in favour of the comparator). Cognitive–behavioural therapy has been tested in participants with 22 different conditions. Given that there is no condition for which it has been demonstrated that there is no benefit of cognitive–behavioural therapy, cognitive–behavioural therapy is likely to work across most, if not all, conditions. However, some of our expert consultation group were not in agreement that we can make this generalisation across conditions not represented in the overview without more evidence on the mechanisms of how cognitive–behavioural therapy effects change.

We suggest that this effect is applicable to children, adolescents and adults, who are male or female, living in Europe, North America and Australasia. We recommend that future research examines (1) if ethnicity can moderate the effectiveness of cognitive–behavioural therapy, (2) if older adults experience the same effect as adults and children/adolescents, (3) the preventative use of cognitive–behavioural therapy and (4) targeting reviews published in languages other than English to try and identify evidence from countries in Africa, Asia and South America.

The main limitation of the panoramic meta-analyses is that we extracted and analysed data at the review level. Many reviews synthesised cognitive–behavioural therapy randomised controlled trial evidence in combination with other therapies or types of study design. We were often unable to extract the purely cognitive–behavioural therapy randomised controlled trial data in isolation; therefore, we could not use the data from that review. If we had been able to return to the randomised controlled trial data sources, then we could have included the individual randomised controlled trials in the panoramic meta-analyses, but this was beyond the scope of this study.

Study registration

This study is registered as PROSPERO CRD42017078690.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

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Cognitive behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

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Responses

Background

Objectives

Data sources

Review methods

Results

Limitations

Conclusion

Future work

Study registration

Funding

Notes

Article history

Permissions

Copyright statement

Chapter 1 Background

Chapter 2 Aim and objectives

Aim

Objectives

Step 1: data mapping

Step 2: panoramic meta-analysis

Chapter 3 Review methods

Mapping

Inclusion and exclusion criteria for the mapping

Types of reviews

Type of health condition

Types of participants

Types of health-care setting

Types of delivery timing

Types of interventions

Types of comparators

Types of outcomes

Length of follow-up

Search methods for identification of systematic reviews

Information sources

Search strategy

Restrictions

Data management

Study selection

Data extraction

Quality assessment of reviews

Visualisations mapping

Bubble chart

Summary tables

Gap maps

Panoramic meta-analysis

Inclusion and exclusion criteria

Data extraction

Data management

Data analyses

Heterogeneity tests

Assumptions for pooling across conditions

Panoramic meta-analysis method

Primary analysis

Secondary analysis

Transforming the standardised mean difference into a mean difference

Publication bias

Subgroup analysis

Sensitivity analysis

Consistency of effect

Expert consultation group including patient and public involvement

Expert consultation group meeting 1: January 2018

Expert consultation group meeting 2: February 2019

Expert consultation group meeting 3: September 2019

Protocol revisions

Chapter 4 Results: mapping

Process of study selection

Excluded studies

Description of the included systematic reviews

Summary tables

Bubble charts

Gap maps

Context characteristics of the included reviews

Context characteristics well reported

Context characteristics poorly reported

Context characteristics rarely examined