Empirically supported treatments (or therapies; ESTs) are the gold standard in therapeutic interventions for psychopathology. Based on a set of methodological and statistical criteria, the APA has assigned particular treatment-diagnosis combinations EST status and has further rated their empirical support as Strong, Modest, and/or Controversial. Emerging concerns about the replicability of research findings in clinical psychology highlight the need to critically examine the evidential value of EST research. We therefore conducted a meta-scientific review of the EST literature, using clinical trials reported in an existing online APA database of ESTs, and a set of novel evidential value metrics (i.e., rates of misreported statistics, statistical power, R-Index, and Bayes Factors). Our analyses indicated that power and replicability estimates were concerningly low across almost all ESTs, and individually, some ESTs scored poorly across multiple metrics, with Strong ESTs failing to continuously outperform their Modest counterparts. Lastly, we found evidence of improvements over time in statistical power within the EST literature, but not for the strength of evidence of EST efficacy. We describe the implications of our findings for practicing psychotherapists and offer recommendations for improving the evidential value of EST research moving forward. General Scientific Summary: This review suggests that although the underlying evidence for a small number of empirically supported therapies is consistently strong across a range of metrics, the evidence is mixed or consistently weak for many, including some classified by Division 12 of the APA as "Strong."

Depressive symptoms are common in older adults, but antidepressant medications may be contraindicated or poorly tolerated in this population. Intervention studies demonstrate that exercise may be an effective alternative. This meta-analysis included 41 randomized controlled trials of aerobic and nonaerobic exercise interventions investigating the effect of exercise on depressive symptoms in adults aged 60 or older. A random effects model demonstrated that exercise was associated with significantly lower depression severity (SMD = 0.57, 95% CI 0.36-0.78). This effect was not significantly different for different ages of participants, types of control groups, or types of exercise interventions. Studies requiring a diagnosis of depression had significantly greater mean effect sizes than studies that did not require a depression diagnosis (Qbet = 6.843, df = 1, p = .009). These findings suggest that exercise is an effective treatment option for older individuals with depressive symptoms.

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Empirically supported treatments (or therapies; ESTs) are the gold standard in therapeutic interventions for psychopathology. Based on a set of methodological and statistical criteria, the APA has assigned particular treatment-diagnosis combinations EST status and has further rated their empirical support as Strong, Modest, and/or Controversial. Emerging concerns about the replicability of research findings in clinical psychology highlight the need to critically examine the evidential value of EST research. We therefore conducted a meta-scientific review of the EST literature, using clinical trials reported in an existing online APA database of ESTs, and a set of novel evidential value metrics (i.e., rates of misreported statistics, statistical power, R-Index, and Bayes Factors). Our analyses indicated that power and replicability estimates were concerningly low across almost all ESTs, and individually, some ESTs scored poorly across multiple metrics, with Strong ESTs failing to continuously outperform their Modest counterparts. Lastly, we found evidence of improvements over time in statistical power within the EST literature, but not for the strength of evidence of EST efficacy. We describe the implications of our findings for practicing psychotherapists and offer recommendations for improving the evidential value of EST research moving forward.

Background Though hypertension is a commonly studied risk factor for white matter lesions (WMLs), measures of blood pressure may fluctuate depending on external conditions resulting in measurement error. Indicators of arterial stiffening and reduced elasticity may be more sensitive indicators of risk for WMLs in aging; however the interdependent nature of vascular indicators creates statistical complications. Objective The purpose of the study was to determine whether a factor score comprised of multiple vascular indicators would be a stronger predictor of WMLs than traditional measures of blood pressure. Methods In a sample of well-characterized nondemented older adults, we used a factor analytic approach to account for variance common across multiple vascular measures while reducing measurement error. The result was a single factor score reflecting arterial stiffness and reduced elasticity. We used this factor score to predict white matter lesion volumes acquired via fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging. Results The combined vascular factor score was a stronger predictor of deep WML (β = 0.42, p < 0.001) and periventricular WML volumes (β = 0.49, p < 0.001). After accounting for the vascular factor, systolic and diastolic blood pressure measurements were not significant predictors. Conclusions This suggests that a combined measure of arterial elasticity and stiffening may be a stronger predictor of WMLs than systolic and diastolic blood pressure accounting for the multicollinearity associated with a variety of interrelated vascular measures.