Effectiveness of Cognitive Behavioral Therapy(CBT) on Relapse in Adults with Depression: A Systematic Review and Meta-Analysis

Abstract

Depression is a prevalent condition manifested by prolonged sadness, functional impairment and an increased risk of relapse. Relapse prevention remains a primary concern for clinicians. Cognitive Behavioural Therapy (CBT) is widely recognized as an evidence-based treatment; thereby research is needed to comprehend its overall impact on depressive symptoms. The aim of this review was to analyze the effectiveness of Cognitive Behavioral Therapy (CBT) compared to Treatment as Usual (TAU) in preventing depressive relapse amongst the adult population. A systematic search was conducted on electronic databases like PubMed and Cochrane library, along with register Clinicaltrials.gov and other sources, for studies published between 2010 and 2025. Nine randomized controlled trials were selected with sufficient data to perform meta-analysis. Covidence was used for data extraction, while Cochrane Risk of Bias Tool (RoB 2) for evaluating study quality. The results showed no significant difference, and the effect size was negligible (Hedges' g = 0.068). Subgroup and meta-regression analyses evaluated that the outcome of CBT was not influenced by the number of CBT sessions or the duration of the follow-up. However, the severity of depression did have some degree of influence. From the evidence currently available, there is no indication that CBT is superior to TAU in preventing depressive relapse in adults. Future studies with longer follow-up periods and defined CBT frameworks are needed to better grasp the long-term effectiveness of CBT.