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Long-Term Effect of Cognitive Behavioral Therapy in Managing Subclinical Depression: A Systematic Review and
Raffy C F Chan1, Ming Chen1, Jacqueline L M Chan1
1Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
Depression and Anxiety
|August 27, 2025
Summary
Cognitive Behavioral Therapy (CBT) effectively reduces subclinical depression and anxiety symptoms. While showing promise in preventing major depression, further research is needed due to data limitations and geographic bias.
Area of Science:
- Psychiatry and Behavioral Sciences
- Clinical Psychology
- Evidence-Based Medicine
Background:
- Depression is viewed as a continuum, underscoring the need for early intervention in subclinical cases.
- Previous research on cognitive behavioral therapy (CBT) for subclinical depression often lacked comparative analysis and focused on specific populations.
- A systematic review and meta-analysis was conducted to address these gaps, evaluating CBT's effectiveness and preventive potential.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of CBT in managing subclinical depressive symptoms.
- To assess CBT's potential in preventing the transition from subclinical to major depression.
- To identify factors influencing CBT effectiveness, such as the number of sessions.
Main Methods:
- A comprehensive literature search was performed across seven databases (inception to March 2025).
- Included 23 randomized controlled trials (RCTs) with 5877 participants.
- Employed meta-regression, sensitivity analysis, and funnel plots to analyze data and assess study quality and bias.
Main Results:
- CBT significantly reduced subclinical depressive symptoms (postassessment and follow-up) and anxiety symptoms (postassessment and follow-up).
- No significant impact of CBT was observed on participants' quality of life.
- Meta-regression indicated that the number of CBT sessions influenced treatment effectiveness for depressive symptoms. A statistically significant preventive effect against transitioning to major depression was found (RR=0.62), though limited by self-reported data.
Conclusions:
- CBT is effective in managing depressive and anxiety symptoms in individuals with subclinical depression.
- Evidence suggests CBT may help prevent the transition to major depression, but requires further validation.
- Limitations include a predominance of European studies, restricting generalizability, and limited comparisons between CBT variations. Further research in diverse regions and comparative studies are recommended.
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