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Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults

  1. Jonathan I Bisson1,*,
  2. Neil P Roberts1,2,
  3. Martin Andrew1,
  4. Rosalind Cooper2,
  5. Catrin Lewis1

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 13 DEC 2013

Assessed as up-to-date: 12 APR 2013

DOI: 10.1002/14651858.CD003388.pub4

How to Cite

Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD003388. DOI: 10.1002/14651858.CD003388.pub4.

Author Information

  1. 1

    Cardiff University School of Medicine, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK

  2. 2

    Cardiff and Vale University Health Board, Psychology and Counselling Direcorate, Cardiff, UK

*Jonathan I Bisson, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK. bissonji@cardiff.ac.uk. jon.bisson@btinternet.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 13 DEC 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 4]
Figure 4. Funnel plot of comparison: 1 Individual trauma-focused CBT/Exposure therapy vs waitlist/usual care, outcome: 3.1 Severity of PTSD symptoms - clinician-rated.
[Figure 5]
Figure 5. Funnel plot of comparison: 3 Trauma-focused CBT/Exposure Therapy vs other therapies, outcome: 3.1 Severity of PTSD symptoms - clinician-rated.
[Figure 6]
Figure 6. Funnel plot of comparison: 1 Individual trauma-focused CBT/Exposure therapy vs waitlist/usual care, outcome: 1.7 PTSD diagnosis after treatment.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 1 Severity of PTSD symptoms - clinician.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 2 Severity of PTSD symptoms at 1 - 4 month follow-up.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 3 Severity of PTSD symptoms at 5 - 8 month follow-up..
[Analysis 1.4]
Analysis 1.4. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 4 Severity of PTSD symptoms 9 - 12 month follow-up.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 5 Leaving the study early for any reason.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 6 Severity of PTSD symptoms - self report: 1 - 4 month follow-up.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 7 Severity of PTSD symptoms - self report: 5 - 8 months).
[Analysis 1.8]
Analysis 1.8. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 8 Severity of PTSD symptoms - self report: 9 - 12 month follow up.
[Analysis 1.9]
Analysis 1.9. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 9 Depression.
[Analysis 1.10]
Analysis 1.10. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 10 Depression 1 - 4 month follow-up.
[Analysis 1.11]
Analysis 1.11. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 11 Depression 5 - 8 month follow-up.
[Analysis 1.12]
Analysis 1.12. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 12 Depression 9 - 12 month follow-up.
[Analysis 1.13]
Analysis 1.13. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 13 Anxiety.
[Analysis 1.14]
Analysis 1.14. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 14 Anxiety 1 - 4 month follow-up.
[Analysis 1.15]
Analysis 1.15. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 15 Anxiety 9 - 12 month follow-up.
[Analysis 1.16]
Analysis 1.16. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 16 Exploration of publication bias.
[Analysis 1.17]
Analysis 1.17. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 17 Sensitivity analysis - clinician-rated PTSD symptoms - studies at low risk of bias only.
[Analysis 1.18]
Analysis 1.18. Comparison 1 Trauma-focused CBT/Exposure therapy vs waitlist/usual care, Outcome 18 PTSD diagnosis after treatment.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 1 Severity of PTSD Symptoms - clinician.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 2 Severity of PTSD symptoms - clinician - follow-up (1 - 4 months).
[Analysis 2.3]
Analysis 2.3. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 3 Severity of PTSD symptoms - clinician - follow-up (5 - 8 months).
[Analysis 2.4]
Analysis 2.4. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 4 Severity of PTSD symptoms - clinician - follow-up (9 - 12 months).
[Analysis 2.5]
Analysis 2.5. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 5 Leaving the study early for any reason.
[Analysis 2.6]
Analysis 2.6. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 6 Severity of PTSD symptoms - self report.
[Analysis 2.7]
Analysis 2.7. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 7 Severity of PTSD symptoms - self report - follow-up (1-4 months).
[Analysis 2.8]
Analysis 2.8. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 8 Depression.
[Analysis 2.9]
Analysis 2.9. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 9 Depression - follow-up (1 - 4 months).
[Analysis 2.10]
Analysis 2.10. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 10 Depression - follow-up (5 - 8 months).
[Analysis 2.11]
Analysis 2.11. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 11 Depression - follow-up (9 - 12 months).
[Analysis 2.12]
Analysis 2.12. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 12 Anxiety.
[Analysis 2.13]
Analysis 2.13. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 13 Anxiety - follow-up (1 - 4 months).
[Analysis 2.14]
Analysis 2.14. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 14 Anxiety - follow-up (5 - 8 months).
[Analysis 2.15]
Analysis 2.15. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 15 Anxiety - follow-up (9 - 12 months).
[Analysis 2.16]
Analysis 2.16. Comparison 2 Trauma-focused CBT/Exposure therapy vs non-TFCBT, Outcome 16 PTSD diagnosis after treatment.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 1 Severity of PTSD symptoms - clinician.
[Analysis 3.2]
Analysis 3.2. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 2 Severity of PTSD symptoms - clinician - 1 - 4 month follow-up.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 3 Severity of PTSD symptoms - clinician - 5 - 8 month follow-up.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 4 Severity of PTSD symptoms - clinician - 9 - 12 month follow-up.
[Analysis 3.5]
Analysis 3.5. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 5 Leaving the study early for any reason.
[Analysis 3.6]
Analysis 3.6. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 6 Severity of PTSD symptoms - self report.
[Analysis 3.7]
Analysis 3.7. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 7 Severity of PTSD symptoms - self report - follow-up (1 - 4 months).
[Analysis 3.8]
Analysis 3.8. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 8 Severity of PTSD symptoms - self-report - follow-up (5 - 8 months).
[Analysis 3.9]
Analysis 3.9. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 9 Severity of PTSD symptoms - self-report - follow-up (9 - 12 months).
[Analysis 3.10]
Analysis 3.10. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 10 Depression - self report.
[Analysis 3.11]
Analysis 3.11. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 11 Depression - self-report - follow-up (1-4 months).
[Analysis 3.12]
Analysis 3.12. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 12 Depression - follow-up (5-8 months).
[Analysis 3.13]
Analysis 3.13. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 13 Depression 9-12 month follow up.
[Analysis 3.14]
Analysis 3.14. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 14 Anxiety - self report.
[Analysis 3.15]
Analysis 3.15. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 15 Anxiety - self-report - follow-up (1 - 4 months).
[Analysis 3.16]
Analysis 3.16. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 16 Anxiety - follow-up (5 - 8 months).
[Analysis 3.17]
Analysis 3.17. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 17 PTSD diagnosis after treatment.
[Analysis 3.18]
Analysis 3.18. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 18 Severity of PTSD symptoms - clinician - 13-24 month follow-up.
[Analysis 3.19]
Analysis 3.19. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 19 Sensitivity analysis - PTSD symptoms - studies at low risk of bias only.
[Analysis 3.20]
Analysis 3.20. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 20 Sensitivity analysis - drop-out - studies at low risk of bias only.
[Analysis 3.21]
Analysis 3.21. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 21 Subgroup analysis: severity of PTSD symptoms - women-only studies.
[Analysis 3.22]
Analysis 3.22. Comparison 3 Trauma-focused CBT/Exposure Therapy vs other therapies, Outcome 22 Subgroup analysis: severity of PTSD symptoms - clinician - excluding Vietnam veterans.
[Analysis 4.1]
Analysis 4.1. Comparison 4 EMDR vs waitlist/usual care, Outcome 1 Severity of PTSD symptoms - Clinician.
[Analysis 4.2]
Analysis 4.2. Comparison 4 EMDR vs waitlist/usual care, Outcome 2 Leaving study early due to any reason.
[Analysis 4.3]
Analysis 4.3. Comparison 4 EMDR vs waitlist/usual care, Outcome 3 Severity of PTSD symptoms - self report.
[Analysis 4.4]
Analysis 4.4. Comparison 4 EMDR vs waitlist/usual care, Outcome 4 Depression.
[Analysis 4.5]
Analysis 4.5. Comparison 4 EMDR vs waitlist/usual care, Outcome 5 Anxiety.
[Analysis 4.6]
Analysis 4.6. Comparison 4 EMDR vs waitlist/usual care, Outcome 6 PTSD diagnosis after treatment.
[Analysis 5.1]
Analysis 5.1. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 1 Severity of PTSD symptoms - clinician.
[Analysis 5.2]
Analysis 5.2. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 2 Severity of PTSD symptoms - clinician - follow-up (1 - 4 months).
[Analysis 5.3]
Analysis 5.3. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 3 Leaving study early for any reason.
[Analysis 5.4]
Analysis 5.4. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 4 Severity of PTSD symptoms - self report.
[Analysis 5.5]
Analysis 5.5. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 5 Severity of PTSD symptoms - self-report - follow-up (1 - 4 months).
[Analysis 5.6]
Analysis 5.6. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 6 Depression.
[Analysis 5.7]
Analysis 5.7. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 7 Depression - follow-up (1 - 4 months).
[Analysis 5.8]
Analysis 5.8. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 8 Anxiety.
[Analysis 5.9]
Analysis 5.9. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 9 Anxiety - follow-up (1 - 4 months).
[Analysis 5.10]
Analysis 5.10. Comparison 5 EMDR vs Trauma-focused CBT, Outcome 10 PTSD diagnosis after treatment.
[Analysis 6.1]
Analysis 6.1. Comparison 6 EMDR vs non-TFCBT, Outcome 1 Severity of PTSD symptoms - clinician.
[Analysis 6.2]
Analysis 6.2. Comparison 6 EMDR vs non-TFCBT, Outcome 2 Severity of PTSD symptoms - clinician - follow-up (1-4 months).
[Analysis 6.3]
Analysis 6.3. Comparison 6 EMDR vs non-TFCBT, Outcome 3 Leaving the study early for any reason.
[Analysis 6.4]
Analysis 6.4. Comparison 6 EMDR vs non-TFCBT, Outcome 4 Severity of PTSD symptoms - self report.
[Analysis 6.5]
Analysis 6.5. Comparison 6 EMDR vs non-TFCBT, Outcome 5 Severity of PTSD symptoms - self-report - follow-up (1 - 4 months).
[Analysis 6.6]
Analysis 6.6. Comparison 6 EMDR vs non-TFCBT, Outcome 6 Depression.
[Analysis 6.7]
Analysis 6.7. Comparison 6 EMDR vs non-TFCBT, Outcome 7 Depression - follow-up (1 - 4 months).
[Analysis 6.8]
Analysis 6.8. Comparison 6 EMDR vs non-TFCBT, Outcome 8 Anxiety.
[Analysis 6.9]
Analysis 6.9. Comparison 6 EMDR vs non-TFCBT, Outcome 9 Anxiety - follow-up (1 - 4 months).
[Analysis 6.10]
Analysis 6.10. Comparison 6 EMDR vs non-TFCBT, Outcome 10 PTSD diagnosis after treatment.
[Analysis 7.1]
Analysis 7.1. Comparison 7 EMDR vs other therapies, Outcome 1 Leaving study early for any reason.
[Analysis 7.2]
Analysis 7.2. Comparison 7 EMDR vs other therapies, Outcome 2 Severity of PTSD symptoms - self report.
[Analysis 7.3]
Analysis 7.3. Comparison 7 EMDR vs other therapies, Outcome 3 Depression.
[Analysis 7.4]
Analysis 7.4. Comparison 7 EMDR vs other therapies, Outcome 4 Anxiety.
[Analysis 7.5]
Analysis 7.5. Comparison 7 EMDR vs other therapies, Outcome 5 PTSD diagnosis after treatment.
[Analysis 8.1]
Analysis 8.1. Comparison 8 Non-TFCBT vs waitlist/usual care, Outcome 1 Severity of PTSD symptoms - Clinician.
[Analysis 8.2]
Analysis 8.2. Comparison 8 Non-TFCBT vs waitlist/usual care, Outcome 2 Leaving the study early for any reason.
[Analysis 8.3]
Analysis 8.3. Comparison 8 Non-TFCBT vs waitlist/usual care, Outcome 3 Severity of PTSD symptoms - Self-report.
[Analysis 8.4]
Analysis 8.4. Comparison 8 Non-TFCBT vs waitlist/usual care, Outcome 4 Depression.
[Analysis 8.5]
Analysis 8.5. Comparison 8 Non-TFCBT vs waitlist/usual care, Outcome 5 Anxiety.
[Analysis 8.6]
Analysis 8.6. Comparison 8 Non-TFCBT vs waitlist/usual care, Outcome 6 PTSD diagnosis after treatment.
[Analysis 9.1]
Analysis 9.1. Comparison 9 Non-TFCBT vs other therapies, Outcome 1 Severity of PTSD symptoms - Clincian.
[Analysis 9.2]
Analysis 9.2. Comparison 9 Non-TFCBT vs other therapies, Outcome 2 Severity of PTSD symptoms - clinician - follow-up (3 months).
[Analysis 9.3]
Analysis 9.3. Comparison 9 Non-TFCBT vs other therapies, Outcome 3 Leaving the study early for any reason.
[Analysis 9.4]
Analysis 9.4. Comparison 9 Non-TFCBT vs other therapies, Outcome 4 Depression - self report.
[Analysis 9.5]
Analysis 9.5. Comparison 9 Non-TFCBT vs other therapies, Outcome 5 Depression - self report - follow-up (3 months).
[Analysis 9.6]
Analysis 9.6. Comparison 9 Non-TFCBT vs other therapies, Outcome 6 Anxiety - self report.
[Analysis 9.7]
Analysis 9.7. Comparison 9 Non-TFCBT vs other therapies, Outcome 7 Anxiety - self report - follow-up (3 months).
[Analysis 9.8]
Analysis 9.8. Comparison 9 Non-TFCBT vs other therapies, Outcome 8 PTSD diagnosis after treatment.
[Analysis 10.1]
Analysis 10.1. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 1 Clinician-rated.
[Analysis 10.2]
Analysis 10.2. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 2 Severity of PTSD 5 - 8 month follow-up.
[Analysis 10.3]
Analysis 10.3. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 3 Leaving the study early for any reason.
[Analysis 10.4]
Analysis 10.4. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 4 Severity of PTSD symptoms - self report.
[Analysis 10.5]
Analysis 10.5. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 5 Severity of PTSD - self report - 1 - 4 months.
[Analysis 10.6]
Analysis 10.6. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 6 Depression.
[Analysis 10.7]
Analysis 10.7. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 7 Depression 1 - 4 month follow-up.
[Analysis 10.8]
Analysis 10.8. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 8 Anxiety.
[Analysis 10.9]
Analysis 10.9. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 9 Anxiety 1 - 4 month follow-up.
[Analysis 10.10]
Analysis 10.10. Comparison 10 Group TFCBT vs waitlist/usual care/minimal contact, Outcome 10 PTSD diagnosis after treatment.
[Analysis 11.1]
Analysis 11.1. Comparison 11 Group CBT (trauma-focused) vs Group CBT (non-trauma-focused), Outcome 1 Severity of PTSD symptoms.
[Analysis 11.2]
Analysis 11.2. Comparison 11 Group CBT (trauma-focused) vs Group CBT (non-trauma-focused), Outcome 2 Leaving the study early for any reason.
[Analysis 11.3]
Analysis 11.3. Comparison 11 Group CBT (trauma-focused) vs Group CBT (non-trauma-focused), Outcome 3 PTSD diagnosis after treatment.
[Analysis 12.1]
Analysis 12.1. Comparison 12 Other therapies vs waitlist/usual care, Outcome 1 Severity of PTSD symptoms - clinician.
[Analysis 12.2]
Analysis 12.2. Comparison 12 Other therapies vs waitlist/usual care, Outcome 2 Leaving the study early due to any reason.
[Analysis 12.3]
Analysis 12.3. Comparison 12 Other therapies vs waitlist/usual care, Outcome 3 Severity of PTSD symptoms - self report.
[Analysis 12.4]
Analysis 12.4. Comparison 12 Other therapies vs waitlist/usual care, Outcome 4 Depression.
[Analysis 12.5]
Analysis 12.5. Comparison 12 Other therapies vs waitlist/usual care, Outcome 5 Anxiety - Self report.
[Analysis 12.6]
Analysis 12.6. Comparison 12 Other therapies vs waitlist/usual care, Outcome 6 PTSD diagnosis after treatment.
[Analysis 13.1]
Analysis 13.1. Comparison 13 Group non-TFCBT vs waitlist/usual care, Outcome 1 Leaving the study early for any reason.
[Analysis 13.2]
Analysis 13.2. Comparison 13 Group non-TFCBT vs waitlist/usual care, Outcome 2 Severity of PTSD symptoms - self report.
[Analysis 13.3]
Analysis 13.3. Comparison 13 Group non-TFCBT vs waitlist/usual care, Outcome 3 Severity of PTSD symptoms - self report 1 - 4 months.
[Analysis 13.4]
Analysis 13.4. Comparison 13 Group non-TFCBT vs waitlist/usual care, Outcome 4 Depression.
[Analysis 13.5]
Analysis 13.5. Comparison 13 Group non-TFCBT vs waitlist/usual care, Outcome 5 Depression - 1 - 4 months.