Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis

Abstract

Jürgen Barth and colleagues use network meta-analysis - a novel methodological approach - to reexamine the comparative efficacy of seven psychotherapeutic interventions for adults with depression. Please see later in the article for the Editors' Summary

Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

“…17 Overall, psychological therapies appear to be effective in a broadly equivalent manner, although results vary with methods and measures. 18 Current evidence indicates that findings from adult patients cannot be assumed to reflect comparable efficacy or effectiveness for depressed adolescents. 19 Evidence to date from RCTs on adolescents suggest that CBT is not rapidly therapeutic in the acute phase of treatment.…”

Network Meta-Analysis for Complex Social Interventions: Problems and Potential

“…In a recently published network meta-analysis of psychotherapeutic interventions for depression, Barth et al (2013) addressed this problem by using a standardized classification system. Direct and indirect estimates were found to be consistent and no ambiguities were reported in the assignment of interventions to these pre-specified categories.…”

“…Classification systems such as the one used by Barth et al (2013) have less utility if intervention definitions are deliberately vague to enable local adaptation. For example, U.S. federal law mandates that older adolescents in foster care receive services to help them become self-sufficient when they age out of care; these services are usually in the form of Independent Living Programs (Foster Care Independence Act, 1999).…”

“…The number of applications to complex social interventions remains small (Bafeta, Trinquart, Seror, & Ravaud, 2013), but is likely to grow rapidly as statistical methods afford greater flexibility, software implementations become increasingly accessible, and more social researchers learn about the method and its advantages. Three of the five examples of which we are aware were published in the past 2 years (Barth et al, 2013;Chen et al, 2012;Cooper et al, 2012;Hasselblad, 1998;Welton, Caldwell, Adamopoulos, & Vedhara, 2009), and network metaanalysis was proposed in a recently published Campbell Collaboration protocol (Wilen, Littell, & Salanti, 2013).…”

In the pursuit of truth, we should not prioritize correlational over causal evidence

“…We stand in full agreement with the authors in affirming that the current balance of evidence indicates that it is unlikely that CBT is more effective than other psychotherapies and that this notion probably holds for psychopathology in general and for many specific disorders. In fact, it needs to be said that the meta-analyses critically discussed by Wampold et al (2017) add to an array of others that did not find added benefits of CBT over other psychotherapies (Barth et al, 2013;Cuijpers et al, 2013). Nevertheless, the converse contention that hence all therapies must work through universal mechanisms or common ingredients has yet to be supported with internally valid empirical evidence.…”