Importance of CBT components in the treatment of depression: a comparative Delphi study of therapists and experts by experience

Abstract Delphi studies allow for the generation of a consensus among experts. This has historically been professional experts in their field. This study aimed to obtain a consensus regarding the most important components of cognitive behavioural therapy (CBT) for depression not only for professional experts (therapists) but also for adult experts by experience. Perceptions of importance between therapists and experts by experience differed in multiple areas including content components such as behavioural activation and experiments, psychoeducation, and homework, which the latter did not agree were important. Experts by experience found several components relating to delivery process important which therapists did not, such as delivery method and session length. The strongest agreement from both groups involved the importance of positive therapist factors such as being non-judgemental, knowledgeable, understanding, and trustworthy. Both groups were in agreement on the importance of cognitive restructuring. Neither experts by experience nor therapists met consensus agreement on the inclusion of mindfulness as part of a wider CBT intervention for depression, being rated among the lowest components for both groups. Findings highlight several aspects of CBT content and delivery which may benefit from review in order to increase acceptability for recipients. Key learning aims (1) To identify what recipients and deliverers feel are the most important parts of a CBT intervention for depression. (2) To compare these responses, and consider reasons why these similarities and differences may exist. (3) To discuss ways in which these differences could impact acceptability and perceived efficacy of cognitive behavioural therapy. (4) To reflect on ways gained knowledge could be used to consider ways to improve the delivery of cognitive behavioural therapy.