Talking therapy

Also called: CBT, psychotherapy, counselling.

Last reviewed 2026-09-22. How this works.

Distress and mood Grade B

Good human evidence, with a limit worth knowing.

Talking therapy helps with distress after a cancer diagnosis, and a year later the benefit can no longer be seen.

Randomised evidence, large after treatment, and no effect left at twelve months.

The claim

The claim is that talking therapy helps with the distress and low mood that follow a cancer diagnosis.

What it does

This entry is graded on how long the effect lasts, and on how much the trials disagree with each other, rather than on whether the effect is there at all.

The evidence

A meta-analysis of fifteen randomised trials compared the change in people given cognitive behavioural therapy against the change in people given usual care. Straight after treatment the difference in depression scores was large, a standardised mean difference of 0.88 with an interval of 0.46 to 1.29, and it was still large at six months, 0.92, interval 0.27 to 1.58.1

At twelve months the difference was 0.21, with an interval running from below zero to above it, which is a way of saying that nothing could be told apart from nothing. Anxiety followed the same shape: large after treatment and at six months, and 0.10 at twelve.1

The trials also disagree with one another. Heterogeneity for depression was significant, with I-squared above fifty percent, which means the pooled figure is an average across trials that did not find the same thing. Those two limits are what hold this entry where it is on the ladder rather than higher.1

What the book draws from this is not that the therapy does not work. It is that this is an argument for getting back to it when it is needed, rather than a course done once and finished with.1

The studies this rests on

  • Pooled randomised trials of cognitive behavioural therapy for anxiety and depression in cancer survivors1

    A meta-analysis, summarising randomised trials, measured what patients reported.

    depression and anxiety scores improved against usual care straight after treatment and at six months; at twelve months no difference could be detected.

    standardised mean difference 0.88, interval 0.46 to 1.29. depression, straight after treatment, against usual care; 0.92, interval 0.27 to 1.58, at six months; 0.21, interval -0.28 to 0.70, at twelve months

What is absent

At twelve months the pooled comparison against usual care showed no difference that could be told apart from none, for either depression or anxiety.

Scope: benefit still present a year after treatment ends.

Established by published review, the meta-analysis of fifteen randomised trials recorded in chapter 22 note 9, checked 2026-09-22. Result: depression 0.21, interval -0.28 to 0.70, P=0.40; anxiety 0.10, interval -0.16 to 0.35, P=0.45.1

What to ask

If I need this again in a year, how would I get back to it?

The dish-to-person gap

Talking therapy is not a compound that reaches a concentration in the blood, so the dish-to-person comparison does not apply.

When to call your team — no warning signs are recorded

If you have started something new, or are thinking about it, the people treating you can only weigh it if they know about it. That is true when nothing has been written down here, and it is most true then.

The register records no warning signs for this entry.

Interactions

A talking or behavioural treatment is not checked against treatment classes in this register.

The whole interaction list, and how to turn it into a pharmacy review request.

Find a trial instead

This is a treatment to ask for rather than a trial to join.

References

  1. Zhang L, Liu X, Tong F, Zou R, Peng W, Yang H, Liu F, Yang D, Huang X, Yi L, Wen M, Jiang L. Cognitive behavioral therapy for anxiety and depression in cancer survivors: a meta-analysis. Scientific Reports 2022;12:21466.

    doi:10.1038/s41598-022-25068-7 · PMC9744858

    How this was reached: transcribed from chapter note, via docs/CHAPTER-NOTES.json, chapter 22 note 9.