Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: Meta-analytic study of publication bias
ABSTRACT It is not clear whether the effects of cognitive-behavioural therapy and other psychotherapies have been overestimated because of publication bias.
To examine indicators of publication bias in randomised controlled trials of psychotherapy for adult depression.
We examined effect sizes of 117 trials with 175 comparisons between psychotherapy and control conditions. As indicators of publication bias we examined funnel plots, calculated adjusted effect sizes after publication had been taken into account using Duval & Tweedie's procedure, and tested the symmetry of the funnel plots using the Begg & Mazumdar rank correlation test and Egger's test.
The mean effect size was 0.67, which was reduced after adjustment for publication bias to 0.42 (51 imputed studies). Both Begg & Mazumbar's test and Egger's test were highly significant (P<0.001).
The effects of psychotherapy for adult depression seem to be overestimated considerably because of publication bias.
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- "Publication biases have not only been found in drug studies but also in psychotherapy trials (Cuijpers et al., 2010; Flint et al., 2014). Psychotherapy trials usually have markedly smaller sample sizes than drug trials and there is a risk that small studies with negative results are not published. "
ABSTRACT: To our knowledge, no previous meta-analysis has attempted to compare the efficacy of pharmacological, psychological and combined treatments for the three main anxiety disorders (panic disorder, generalized anxiety disorder and social phobia). Pre-post and treated versus control effect sizes (ES) were calculated for all evaluable randomized-controlled studies (n=234), involving 37 333 patients. Medications were associated with a significantly higher average pre-post ES [Cohen's d=2.02 (1.90-2.15); 28 051 patients] than psychotherapies [1.22 (1.14-1.30); 6992 patients; P<0.0001]. ES were 2.25 for serotonin-noradrenaline reuptake inhibitors (n=23 study arms), 2.15 for benzodiazepines (n=42), 2.09 for selective serotonin reuptake inhibitors (n=62) and 1.83 for tricyclic antidepressants (n=15). ES for psychotherapies were mindfulness therapies, 1.56 (n=4); relaxation, 1.36 (n=17); individual cognitive behavioural/exposure therapy (CBT), 1.30 (n=93); group CBT, 1.22 (n=18); psychodynamic therapy 1.17 (n=5); therapies without face-to-face contact (e.g. Internet therapies), 1.11 (n=34); eye movement desensitization reprocessing, 1.03 (n=3); and interpersonal therapy 0.78 (n=4). The ES was 2.12 (n=16) for CBT/drug combinations. Exercise had an ES of 1.23 (n=3). For control groups, ES were 1.29 for placebo pills (n=111), 0.83 for psychological placebos (n=16) and 0.20 for waitlists (n=50). In direct comparisons with control groups, all investigated drugs, except for citalopram, opipramol and moclobemide, were significantly more effective than placebo. Individual CBT was more effective than waiting list, psychological placebo and pill placebo. When looking at the average pre-post ES, medications were more effective than psychotherapies. Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects. However, the decision on whether to choose psychotherapy, medications or a combination of the two should be left to the patient as drugs may have side effects, interactions and contraindications.International clinical psychopharmacology 04/2015; 30(4). DOI:10.1097/YIC.0000000000000078 · 3.10 Impact Factor
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- "The Sanskrit derivation is " medha, " which means " wisdom " . Physical and psychological health changes such as increased cerebral blood flow, reductions in metabolic activity , heart and respiratory rates, blood pressure, oxygen consumption , and muscle tension, decrease in symptoms of depression and anxiety, have been empirically linked to the practice of meditation  . Although there are various styles of meditation, including Chakra yoga, Rinzai Zen, Mudra yoga, Sufism, Yoto Zen, and Buddhist insight meditation, two of the more commonly discussed forms of meditation are transcendental meditation (TM) and particularly mindfulness meditation (MM) have been found to be beneficial. "
ABSTRACT: Mindfulness-based cognitive therapy (MBCT) is frequently used for psychiatric disorders. Despite MBCT's considerable potential for improving psychological health for patients, there is little empirical evidence to support its practical application in Chinese. This review will define meditation and mindfulness, provide an overview of the development of MBCT, identify the evidence for the effectiveness of MBCT, and offer recommendations to medical personnels on how to provide support for patients receiving mindfulness intervention.06/2014; 1(2). DOI:10.1016/j.ijnss.2014.05.015
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- "Moreover, 40% of those patients whose depression does remit will relapse within 2 years  and 20% are at risk of developing chronic, unremitting depression [16,17]. Generally, meta-analyses indicate that all bona fide (non-placebo) psychological treatments for depression are equally efficacious , and the effect sizes of psychotherapy for adult depression vary from small to moderate . "
ABSTRACT: Depression is estimated to become the leading cause of disease burden globally by 2030. Despite existing efficacious treatments (both medical and psychotherapeutic), a large proportion of patients do not respond to therapy. Recent insights from evolutionary psychology suggest that, in addition to targeting the proximal causes of depression (for example, targeting dysfunctional beliefs by cognitive behavioral therapy), the distal or evolutionary causes (for example, inclusive fitness) should also be addressed. A randomized superiority trial is conducted to develop and test an evolutionary-driven cognitive therapy protocol for depression, and to compare its efficacy against standard cognitive therapy for depression.Methods/design: Romanian-speaking adults (18 years or older) with elevated Beck Depression Inventory (BDI) scores (>13), current diagnosis of major depressive disorder or major depressive episode (MDD or MDE), and MDD with comorbid dysthymia, as evaluated by the Structured Clinical Interview for DSM-IV (SCID), are included in the study. Participants are randomized to one of two conditions: 1) evolutionary-driven cognitive therapy (ED-CT) or 2) cognitive therapy (CT). Both groups undergo 12 psychotherapy sessions, and data are collected at baseline, mid-treatment, post-treatment, and the 3-month follow-up. Primary outcomes are depressive symptomatology and a categorical diagnosis of depression post-treatment. This randomized trial compares the newly proposed ED-CT with a classic CT protocol for depression. To our knowledge, this is the first attempt to integrate insights from evolutionary theories of depression into the treatment of this condition in a controlled manner. This study can thus add substantially to the body of knowledge on validated treatments for depression.Trial registration: Current Controlled Trials ISRCTN64664414The trial was registered in June 2013. The first participant was enrolled on October 3, 2012.Trials 03/2014; 15(1):83. DOI:10.1186/1745-6215-15-83 · 2.12 Impact Factor