Table 1.

The most important types of psychological interventions in primary care^a

Types of therapy	Description	Evidence
Cognitive behavior therapy (CBT)	− The best examined type of psychotherapy that is currently available, also in primary care. − Although it is the best studied type of therapy, there is no evidence that it is more effective than other therapies. − The therapist focuses on the impact a patient’s present dysfunctional thoughts have on current behavior and future functioning. − CBT is aimed at evaluating, challenging, and modifying a patient’s dysfunctional beliefs (cognitive restructuring). − Therapists exert an active influence over therapeutic interactions and topics of discussion, use a psycho-educational approach, and teach patients new ways of coping with stressful situations.	− Several meta-analyses of several dozens of trials have shown that CBT is effective in primary care [16–18]. − Meta-analyses of trials across setting have included more than 200 comparisons between CBT and control groups, overall indicating comparable effects as in primary care [19].
Behavioral activation therapy (BAT)	− BAT is often combined with CBT but can also be offered as a separate treatment [19]. − The patient registers pleasant routine and essential activities. − The patient is stimulated to increase positive interactions with his or her environment. − The delivery of BAT is less complicated than CBT. − Social skills training can also be a part of the intervention.	− No meta-analysis of trials of BAT in primary care has been conducted. − Meta-analyses of BAT across settings have included several dozens of trials, resulting in comparable effects as other therapies [19, 20]. − A large non-inferiority trial found that BAT delivered by nurses is non-inferior to CBT delivered by therapists [21••].
Interpersonal psychotherapy (IPT)	− A highly structured manual-based psychotherapy that addresses interpersonal issues in depression to the exclusion of all other foci of clinical attention [20, 21••, 22]. − In secondary care, usually the full version of 16 sessions is used, but there is also a brief version interpersonal counseling (IPC) that was developed for primary care [23]. − IPT has no specific theoretical origin although its theoretical basis can be seen as coming from the work of Sullivan, Meyer, and Bowlby. − The current form of the treatment was developed by the late Gerald Klerman and Myrna Weissman in the 1980s [22].	− No meta-analysis of trials of IPT in primary care has been conducted. − Meta-analyses of IPT across settings have included several dozens of trials, resulting in comparable effects as other therapies [19, 23].
Problem-solving therapy (PST)	− In PST, patients learn how to systematically solve their problems in a number of steps. − First, the problems are defined, then as many solutions as possible are generated, the best one is chosen, a plan is made to actually do it, the plan is executed and finally evaluated whether the problem is solved. If not, the patient should go back to the first step. − PST was originally developed as a 12-session intervention which was aimed at problem-solving and also on changing attitudes and beliefs that inhibit effective problem-solving [24, 25]. − However, in the 1990s, a brief 6-session version of PST was developed specifically for primary care [26, 27].	− A meta-analysis of 11 trials of PST in primary care found comparable effects as other therapies [25]. − A meta-analysis across settings has included a few dozen of trials [19].
Non-directive counseling	− Counseling is an unstructured therapy without specific psychological techniques other than those common to all approaches, such as helping people to ventilate their experiences and emotions and offering empathy [19, 28]. − It is not aimed at solutions or acquiring new skills. − The assumption is that relief from personal problems may be achieved through discussion with others. − Often described in the literature as either counseling or (non-directive) supportive therapy. − Counseling is examined in primary care in several studies.	− No meta-analysis of trials of counseling in primary care has been conducted. − Meta-analyses of counseling across settings have included several dozens of trials, resulting in effects that may be somewhat smaller than other therapies, but this is not clear [19, 28].
Other types of therapy	There are many other types of therapy that have been tested in other settings, but not extensively in primary care: − Psychodynamic therapies are based on the psycho-analytic framework and try to help patients through resolve depression through enhancing the patient’s understanding, awareness, and insight about repetitive conflicts [29]. − Life review therapy is mainly used in older adults and is aimed at resolving conflicts from the past and make up the balance of one’s life [30, 31]. − Third wave therapies are a heterogeneous group of treatments that introduce new techniques to CBT. They have in common that they abandon or only cautiously use content-oriented cognitive interventions and the use of skills deficit models to delineate the core maintaining mechanisms of the addressed disorders [32]. − Mindfulness-based CBT, in which CBT is combined with mindfulness and meditation, is an important example. Significant effects have been obtained with this therapy in patients with diagnostic levels of depression [33], being a treatment of choice for depression recurrence recommended by NICE guidelines [34].	− For the effects of 15 different therapies, see the recent meta-analysis of Cuijpers et al. 2019 [19].

^aThe definitions given in this table are based on a broader meta-analysis of 15 evidence-based therapies for adult depression [20]