A systematic review of cognitive behavioral therapy for depression in Veterans

Research conducted in the civilian population demonstrates that cognitive-behavioral therapies are effective for depression, but some evidence suggests that Veterans' treatment response may differ from civilians. This review examined cognitive-behavioral treatment (CBT) for depression in Veteran samples. A literature search for treatment outcome studies with Veteran samples was conducted using PsycInfo, PubMed, and SCOPUS databases. Nine studies met inclusion criteria and were assessed for methodological rigor (randomized controlled trials = 5; open trials = 4). Controlled effect sizes were compared for randomized controlled trials, and pre-post effect sizes were used to compare treatment groups across all studies. The open trials reviewed demonstrated large pre-post effect sizes, though these studies were of lower methodological quality. CBT performed better than control treatment in only two of five randomized controlled trials reviewed, a finding that contrasts with research in non-Veteran samples. Possible reasons for these findings are discussed, including psychosocial factors that may influence the course of depression treatment in Veterans. Additional high quality research is needed to conclusively determine if depression treatment outcomes differ for Veterans and, if so, what modifications to current CBT protocols might enhance response to treatment.