Skip to main content Accessibility help
Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-20T12:18:46.816Z Has data issue: false hasContentIssue false

Chapter 29 - Evidence-Based Psychotherapeutic Approaches for Depressive Disorders

Published online by Cambridge University Press:  16 May 2024

Allan Young
Institute of Psychiatry, King's College London
Marsal Sanches
Baylor College of Medicine, Texas
Jair C. Soares
McGovern Medical School, The University of Texas
Mario Juruena
King's College London
Get access


This chapter describes evidence-based psychotherapeutic approaches for adults with depressive disorders. We focus on the most recognized, contemporary evidence-based psychotherapies for depression including: traditional and newer forms of cognitive behavioral therapy (defined broadly), interpersonal psychotherapy, brief dynamic psychotherapy and supportive psychotherapy. We summarize the findings on the extent to which these psychotherapies promote response, remission, relapse prevention, and recovery in adults and that permit these psychotherapies to be termed “evidence based.” Effect sizes are reported, allowing the reader to grasp quickly the efficacy of each psychotherapy used as a solitary treatment. We highlight current trends and future possibilities that may expand understanding of depressive disorders and increase access to effective psychotherapy for adults with depressive disorders.

Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


World Health Organization. Depression and other common mental disorders: global health estimates. 2017. Available at: (Accessed May 14, 2021)Google Scholar
Olfson, M., Marcus, S.C.. National trends in outpatient psychotherapy. Am J Psychiatry 2010; 167(12):1456–63.CrossRefGoogle ScholarPubMed
McHugh, R.K., Whitton, S.W., Peckham, A.D., Welge, J.A., Otto, M.W.. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry 2013; 74(6):595602.CrossRefGoogle ScholarPubMed
Gartlehner, G., Gaynes, B.N., Amick, H.R., 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(5):331–41.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association, 2013.Google Scholar
World Health Organization. ICD 11: classifying disease to map the way we live and die. 2018. Available at: (Accessed May 14, 2021).Google Scholar
Cuijpers, P., de Wit, L., Weitz, E., Andersson, G., Huibers, M.J.H.. The combination of psychotherapy and pharmacotherapy in the treatment of adult depression: a comprehensive meta-analysis. J Evid-Based Psychother 2015; 15(2):147–68.Google Scholar
Dunlop, B.W., LoParo, D., Kinkead, B., et al. Benefits of sequentially adding cognitive-behavioral therapy or antidepressant medication for adults with nonremitting depression. Am J Psychiatry 2019; 176(4):275–86.CrossRefGoogle ScholarPubMed
Cuijpers, P., Karyotaki, E., de Wit, L., Ebert, D.D.. The effects of fifteen evidence-supported therapies for adult depression: a meta-analytic review. J Soc Psychother Res 2020; 30(3):279–93.Google ScholarPubMed
Cuijpers, P., M. Reijnders, M.J. Huibers, H. The role of common factors in psychotherapy outcomes. Annu Rev Clin Psychol 2019; 15(1):207–31.CrossRefGoogle ScholarPubMed
Newby, J.M., McKinnon, A., Kuyken, W., Gilbody, S., Dalgleish, T.. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev 2015; 40:91110.CrossRefGoogle ScholarPubMed
Goodkind, M., Eickhoff, S.B., Oathes, D.J., et al. Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry 2015; 72(4):305–15.CrossRefGoogle ScholarPubMed
Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G.. Cognitive Therapy of Depression. New York: Guilford Press, 1979.Google Scholar
Jarrett, R.B., Kraft, D.. Prophylactic cognitive therapy for major depressive disorder. Sess Psychother Pract 1997; 3(3):6579.Google Scholar
Jacobson, N.S., Martell, C.R., Dimidjian, S.. Behavioral activation treatment for depression: returning to contextual roots. Clin Psychol Sci Pract 2001; 8(3):255.CrossRefGoogle Scholar
Martell, C.R., Dimidjian, S., Herman-Dunn, R.. Behavioral Activation for Depression: A Clinician’s Guide. New York: Guilford Press, 2010.Google Scholar
Segal, Z.V., Williams, J.M.G., Teasdale, J.D.. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. 2nd ed. New York : Guilford Press, 2013.Google Scholar
Baer, R., Walsh, E. Treating acute depression with mindfulness‐based cognitive therapy – treating depression. In Wells, A., Fisher, P., editors. Treating Depression: MCT, CBT and Third Wave Therapies. West Sussex: Wiley-Blackwell, 2016; 344–68. Available at: (Accessed May 12, 2021).Google Scholar
Hayes, S.C., Strosahl, K.D., Wilson, K.G.. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press, 1999.Google Scholar
Zettle, R.D.. ACT for Depression: A Clinician’s Guide to Using Acceptance & Commitment Therapy in Treating Depression. Oakland: New Harbinger, 2007.Google Scholar
McCullough, J.P.. Treatment for Chronic Depression: Cognitive behavioral Analysis System of Psychotherapy. New York: Guilford Press, 2000.Google Scholar
McCullough, J.P.. Treatment for chronic depression using cognitive behavioral analysis system of psychotherapy (CBASP). J Clin Psychol 2003; 59(8):833–46.CrossRefGoogle ScholarPubMed
Markowitz, J.C., Weissman, M.M.. Interpersonal psychotherapy: principles and applications. World Psychiatry 2004; 3(3):136–9.Google Scholar
Weissman, M.M., Markowitz, J.C., Klerman, G.L.. Comprehensive Guide to Interpersonal Psychotherapy. New York: Basic Books, 2000.Google Scholar
de Jonghe, F., de Maat, S., Van, R., et al. Short-term psychoanalytic supportive psychotherapy for depressed patients. Psychoanal Inq 2013; 33(6):614–25.CrossRefGoogle Scholar
Davanloo, H.. Intensive Short-Term Dynamic Psychotherapy. Philadelphia: Lippincott Williams & Wilkins, 2005.Google Scholar
Malan, D.. A Study of Brief Psychotherapy. New York: Routledge, 1963/2001.Google Scholar
Rogers, C.R.. On Becoming a Person: A Therapist’s View of Psychotherapy. Boston: Houghton Mifflin, 1961.Google Scholar
Novalis, P.M., Singer, V., Peele, R.. Clinical Manual of Supportive Psychotherapy. 2nd ed. Washington, DC: American Psychiatric Association; 2019.Google Scholar
Fawcett, J., Epstein, P., Fiester, S.J., Elkin, I., Autry, J.H.. Clinical management–imipramine/placebo administration manual. NIMH treatment of depression collaborative research program. Psychopharmacol Bull 1987; 23(2):309–24.Google ScholarPubMed
Biesheuvel-Leliefeld, K.E.M., Kok, G.D., Bockting, C.L.H., et al. Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression. J Affect Disord 2015; 174:400–10.CrossRefGoogle ScholarPubMed
van Bronswijk, S., Moopen, D., Beijers, L., Ruhe, H.G., Peeters, F.. Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression. Psychol Med 2019; 49(3):366–79.CrossRefGoogle ScholarPubMed
Klein, D.N., Santiago, N.J., Vivian, D., et al. Cognitive behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression. J Consult Clin Psychol 2004; 72(4):681–8.CrossRefGoogle ScholarPubMed
Cipriani, A., Furukawa, T.A., Salanti, G., et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018; 391(10128):1357–66.CrossRefGoogle ScholarPubMed
Kato, M., Hori, H., Inoue, T., et al. Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Mol Psychiatry 2021; 26(1):118–33.CrossRefGoogle ScholarPubMed
Cohen, J.. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.Google Scholar
Vittengl, J.R., Jarrett, R.B. Major depressive disorder. In Hoffman, S.G., Rief, W., editors. The Wiley Handbook of Cognitive Behavioral Therapy. New York: Wiley-Blackwell, 2014; 1131–60. Available at: (Accessed May 17, 2021).Google Scholar
Jacobson, N.S., Truax, P.. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59(1):12.CrossRefGoogle ScholarPubMed
Kraemer, H.C., Kupfer, D.J.. Size of treatment effects and their importance to clinical research and practice. Biol Psychiatry 2006; 59(11):990–6.CrossRefGoogle ScholarPubMed
American Psychological Association. APA clinical practice guideline for the treatment of depression across three age cohorts. Available at (Accessed May 12, 2021).Google Scholar
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J.. Erbaugh., An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561–71.CrossRefGoogle ScholarPubMed
Hamilton, M.. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23(1):5662.CrossRefGoogle ScholarPubMed
Jarrett, R.B., Vittengl, J.R. Efficacy of cognitive-behavioral therapy for depression. In Fisher, P.L., Wells, A, editors. Treating Depression: Principles and Practice of MCT, CBT, and Third Wave Therapies. New York: Wiley, 2016; 5280.Google Scholar
Bockting, C.L., Hollon, S.D., Jarrett, R.B., Kuyken, W., Dobson, D.. A lifetime approach to major depressive disorder: the contributions of psychological interventions in preventing relapse and recurrence. Clin Psychol Rev 2015; 41:1626.CrossRefGoogle ScholarPubMed
Jarrett, R.B., Vittengl, J.R., Clark, L.A. Preventing recurrent depression. In Whisman, M.A., editor. Adapting Cognitive Therapy for Depression: Managing Complexity and Comorbidity. New York: Guilford Press, 2008; 132–56.Google Scholar
Jarrett, R.B., Basco, M.R., Risser, R., et al. Is there a role for continuation phase cognitive therapy for depressed outpatients? J Consult Clin Psychol 1998; 66(6):1036–40.CrossRefGoogle Scholar
Jarrett, R.B., Kraft, D., Doyle, J., et al. Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial. Arch Gen Psychiatry 2001; 58(4):381.CrossRefGoogle ScholarPubMed
Jarrett, R.B., Minhajuddin, A., Gershenfeld, H., Friedman, E.S., Thase, M.E.. Preventing depressive relapse and recurrence in higher-risk cognitive therapy responders: a randomized trial of continuation phase cognitive therapy, fluoxetine, or matched pill placebo. JAMA Psychiatry 2013; 70(11):1152.CrossRefGoogle ScholarPubMed
Teasdale, J.D., Segal, Z.V., Williams, J.M.G., et al. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 2000; 68(4):615–23.CrossRefGoogle ScholarPubMed
van Aalderen, J.R., Donders, A.R.T., Giommi, F., et al. The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychol Med 2012; 42(5):9891001.CrossRefGoogle ScholarPubMed
de Jong, M., Peeters, F., Gard, T., et al. A randomized controlled pilot study on mindfulness-based cognitive therapy for unipolar depression in patients with chronic pain. J Clin Psychiatry 2018; 79(1):2634.CrossRefGoogle ScholarPubMed
Forman, E.M., Herbert, J.D., Moitra, E., Yeomans, P.D., Geller, P.A.. A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behav Modif 2007; 31(6):7299.CrossRefGoogle ScholarPubMed
Kroska, E.B., Roche, A.I., O’Hara, M.W. How much is enough in brief acceptance and commitment therapy? A randomized trial. J Context Behav Sci 2020; 15:235–44.CrossRefGoogle Scholar
Fledderus, M., Bohlmeijer, E.T., Pieterse, M.E., Schreurs, K.M.G.. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychol Med 2012; 42(3):485–95.CrossRefGoogle ScholarPubMed
Østergaard, T, Lundgren, T., Rosendahl, I., et al. Acceptance and commitment therapy preceded by attention bias modification on residual symptoms in depression: a 12-month follow-up. Front Psychol 2019; 10.CrossRefGoogle ScholarPubMed
Schramm, E., Kriston, L., Zobel, I., et al. Effect of disorder-specific vs nonspecific psychotherapy for chronic depression: a randomized clinical trial. JAMA Psychiatry 2017; 74(3):233–42.CrossRefGoogle ScholarPubMed
Klerman, G.L., Dimascio, A., Weissman, M., Prusoff, B., Paykel, E.S.. Treatment of depression by drugs and psychotherapy. Am J Psychiatry 1974; 131(2):186–91.CrossRefGoogle ScholarPubMed
Markowitz, J.C., Weissman, M.M.. Interpersonal psychotherapy: past, present and future. Clin Psychol Psychother 2012; 19(2):99105.CrossRefGoogle ScholarPubMed
Luyten, P., Blatt, S.J.. Psychodynamic treatment of depression. Psychiatr Clin North Am 2012; 35(1):111–29.CrossRefGoogle ScholarPubMed
Driessen, E., Dekker, J.J.M., Peen, J., et al. The efficacy of adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression: a systematic review and meta-analysis of individual participant data. Clin Psychol Rev 2020; 80:110.CrossRefGoogle ScholarPubMed
Markowitz, J.C.. What is supportive psychotherapy? Focus 2014; 12(3):285–9.Google Scholar
Kocsis, J.H., Gelenberg, A.J., Rothbaum, B.O., et al. Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP trial. Arch Gen Psychiatry 2009; 66(11):1178–88.CrossRefGoogle ScholarPubMed
Duncan, E., Best, C., Hagen, S.. Shared decision making interventions for people with mental health conditions. Cochrane Database Syst Rev 2010;2010(1):CD007297.Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats