Network Meta-Analysis of the Efficacy of Individual Cognitive-Behavioral Therapy, Family Therapy, and Combined Interventions on Depression and Anxiety: Direct and Indirect Comparisons of Treatment Effects

Background: Depression and anxiety disorders are among the most prevalent and disabling mental health conditions globally. Individual cognitive-behavioral therapy (CBT), family therapy, and combined interventions are widely utilized; however, their comparative efficacy remains insufficiently characterized. This study employed network meta-analysis to compare these three treatment modalities. Methods: A systematic search of PubMed, PsycINFO, Scopus, Web of Science, and Cochrane Library identified randomized controlled trials (RCTs) evaluating individual CBT, family therapy, or combined CBT-family interventions for depression and anxiety. Effect sizes were calculated as Hedges' g with ۹۵% confidence intervals (CIs). A random-effects network meta-analysis was conducted to synthesize direct and indirect evidence, and treatment rankings were derived from surface under the cumulative ranking curve (SUCRA) values. Results: Twelve RCTs comprising ۱,۸۴۷ participants were included. All three active interventions significantly outperformed control conditions for both depression and anxiety. Combined interventions yielded the largest effect sizes (depression: g = ۰.۸۹, ۹۵% CI: ۰.۷۲–۱.۰۶; anxiety: g = ۰.۸۱, ۹۵% CI: ۰.۶۴–۰.۹۸), followed by individual CBT (depression: g = ۰.۷۱, ۹۵% CI: ۰.۵۵–۰.۸۷; anxiety: g = ۰.۶۷, ۹۵% CI: ۰.۵۰–۰.۸۴) and family therapy (depression: g = ۰.۵۲, ۹۵% CI: ۰.۳۴–۰.۷۰; anxiety: g = ۰.۴۸, ۹۵% CI: ۰.۳۰–۰.۶۶). Combined interventions were significantly superior to family therapy for both outcomes. SUCRA rankings confirmed combined interventions as the most effective treatment. Conclusions: Combined CBT-family interventions demonstrate the greatest efficacy for depression and anxiety, followed by individual CBT and family therapy. These findings support a stepped-care model in which combined approaches are prioritized for complex cases.

کلیدواژه ها:

network meta-analysis ، cognitive-behavioral therapy ، family therapy ، depression ، anxiety ، combined intervention