Also, there was significant statistical evidence selleck chem for study bias using both Beggs test and Eggers test. Using the trim and fill analysis, the SMD was ?0. 32. Discussion We analysed 16 comparisons Inhibitors,Modulators,Libraries from 14 publications, targeting the largest size and highest quality meta analysis. Consequently, this review found that CCBT has appar ently a moderate post treatment effect size for adult depressive symptoms compared with control conditions, indicating almost the same result as those of past meta analyses. Nevertheless, we further found a possibility that this result may have to be re considered downward in terms of practical im plementation and research Inhibitors,Modulators,Libraries methodology. Thus, we would like to examine these two aspects.

Considering Inhibitors,Modulators,Libraries the lack of the endurance of effectiveness, functional improvement and the high dropout rate, our result inevitably casts doubt on the Inhibitors,Modulators,Libraries actual practicability of the current CCBT for depression. To begin with, the attenuation of long term effective ness Inhibitors,Modulators,Libraries with CCBT seems to be a serious issue from a clin ical point of view. In fact, although one of the past reviewers implied this tendency, long follow up has not been clearly reviewed in meta analyses until today. In this context, ours is the first review to meta analyse long follow up outcomes. This was paradoxical from the perspective that it has been reported that the effect of standard face to face CBT on depression does not usu ally attenuate sharply after intervention even without maintenance sessions.

For example, the latter view has been advocated by the Annual Review of Psychology, which mentions that the effectiveness of CBT appears to be at least more enduring than that of antidepressants for depressive patients. However, it is still unclear why such variance could arise according to differences in modality, while van Londen et al. raised this question in the context of bibliotherapy. In addition to long follow up outcomes, it also has not been meta analysed until our study about whether CCBT can contribute to functional improvement, even though this outcome is critically important in view of evaluating cost utility, which is referred to as a distinct ive advantage of CCBT. In our analysis, CCBT intervention did not provide a significant effect in terms of function. There are a few possible reasons for this. Firstly, current CCBT may not be fundamentally good enough to improve function. The attainment of social functions such as returning to work has been commonly recognised as being more difficult than simply reducing depressive symptoms. Secondly, we may have to consider the scale sensitivity of function. Revicki et al. also referred to the property of generic measures that improvements in those scores are less sensitive in less depressive patients.