Title: Cognitive Behavioural Therapy: An overview of systematic reviews and meta-analyses
Funder: Department of Health and Social Care

Abstract: Design A systematic review of systematic reviews including evidence mapping, qualitative synthesis, possible panoramic meta-analysis and justification for generalisation of effectiveness evidence with an embedded consultation group. Strategy Clinical, patient and research experts will form a consultation group who will guide the development of the search strategies and key terms. The information scientist will review existing literature and combine key terms with the consultation group recommendations to develop a draft search strategy using the InterTASC systematic review filters. Results of the draft searches will be tested to check they have picked up 20 key articles, identified by the consultation group, and revised accordingly. The searches will be run across multiple electronic databases with no language restrictions. Two reviewers will independently screen records, confirm eligibility and extract data. Methodological quality will be assessed using AMSTAR (Assessing the Methodological quality of Systematic Reviews) and the primary review quality assessments will be extracted. The unit of analysis is the summary statistics reported at the individual systematic review level. Evidence maps will demonstrate the weighting (strength, quality and size) of the evidence for cognitive behavioural therapy (CBT). Consistency and heterogeneity will be assessed and panoramic meta-analysis will be applied where possible. Pre-specified analyses will be conducted across indications, treatment subgroup and outcomes. A generalisation framework, developed with the consultation group using nominal group technique, will be used to justify possible generalisation of clinical effects from areas with a strong to those with a weak or no evidence base. Target population Children, adolescents, adults and older adults with mental or physical health problems including any co-morbidities in whom CBT has been evaluated in any setting. Heath technology Manualised CBT including its permutations of modular, high and low intensity CBT. In/exclusion criteria A systematic review will be selected if it 1)includes randomised control trials; 2)meets a minimum of 4 methodological criteria as defined by the Centre for Reviews and Dissemination in York; 3)Examined the effectiveness of CBT; 4)Assessed manualised CBT; 5)Compared CBT to a non-CBT comparator/no intervention/treatment as usual; 6)Reported a minimum of 1 of the following: health related quality of life (HR-QoL) or indication-specific outcome collected further than 6 months post-CBT. Outcomes Primary: HR-QoL and indication-specific outcomes. Secondary: Mechanisms, patient satisfaction, adverse events and economic outcomes. Secondary outcomes will be described qualitatively with no further analysis. Timetable Study duration is 24 months starting January 2018: 0-6 months: protocol registration and publication, template development, consultation group meeting, final search strategy. 7-12 months: data extraction, quality review and quality assurance. 13-18 months: qualitative/quantitative analysis, mapping and generalisation. 19-24 months: developing evidence summary, recommendations, final report and dissemination activities. Expertise Our research team has substantial experience conducting large scale evidence syntheses and includes experts in evidence synthesis (Hopewell, Lilford, Hemming, Fordham), research design (Lamb), generalisation (Howick), and psychology (Fordham).

Lay abstract: This project aims to provide a comprehensive map of existing research into cognitive behavioural therapy (CBT). The public, clinicians and researchers will be able to use this tool to look up a condition and see if there is enough evidence to decide whether CBT is beneficial or not. CBT is a very popular talking therapy in physical and mental health conditions. The usefulness of CBT has been examined in thousands of trials. When several trials are conducted in a similar population e.g. adults with depression, researchers pull the evidence together into a review. Due to the volume of research into CBT there are hundreds of these reviews. We propose to search for and bring together the key messages from all the reviews ever conducted into CBT for physical or mental health conditions. We will form a consultation group which includes patients and clinicians who use CBT in many different populations and researchers who have examined CBT’s effectiveness. This group will guide our entire project. First we search the electronic databases which hold the details of published reviews. One researcher will work through these results to select relevant reviews, describe their methodology, report their findings and rate the review quality against a recognised checklist. Another researcher will perform this same process independently to check nothing has been missed. From the included reviews, we will pull out the information which tells us whether CBT improved patients’ symptoms and whether this evidence is robust. We will produce a visual map which lists all of the physical and mental health conditions and whether there is evidence to support the use of CBT or not. We will also look to see if CBT consistently improves certain symptoms (e.g. pain) across different conditions and populations. With the consultation group we would explore whether we could generalise that CBT will always improve pain in any condition given a set of requirements are met i.e. CBT is delivered face to face or using a particular approach. Our research team includes a patient who has received CBT. They have agreed to work closely on the project at every stage. We will invite 3 more patient representatives to join the consultation group and offer their perspectives on the project. Before the patient representatives attend the group meetings they will meet with the lead researcher who will talk them through the project in more detail and discuss concerns. We usually present results at conferences, patient involvement events, in scientific and popular press publications but we are open to all suggestions from our consultation group.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH