The effects of psychotherapies for depression on response, remission, reliable change, and deterioration: A meta‐analysis

Abstract

Objective Meta‐analyses of psychotherapies usually report effects sizes, while clinicians and patients need to know the proportion of patients who benefit from therapy. We conducted a meta‐analysis of therapies for depression reporting the rates of response (50% symptom reduction), remission (HAM‐D <7), clinical significant deterioration for psychotherapy, and control conditions (CAU, waitlist, and pill placebo), as well as the relative risk of these outcomes and the numbers‐needed‐to‐be‐treated (NNTs). Methods We searched bibliographic databases and included 228 randomized trials comparing psychotherapy for depression against control conditions (75 with low risk of bias). Only therapies with at least 10 trials were included. We extracted outcomes from the studies, and for those studies not reporting the outcomes, we used a validated method to estimate the rates. Results The overall response rate in psychotherapies at 2 (±1) months after baseline was 41% (95% CI: 38~43), 17% (15~20) for usual care (CAU), and 16% (95% CI: 14~18) for waitlist. No significant differences between types of therapy were found. The NNT for therapy versus CAU was 5.3 and versus waitlist 3.9. About one third of patients remitted after therapy compared with 7%–13% in control conditions. The rates of deterioration were 5% versus 12%–13%, respectively. Most sensitivity analyses supported the general findings. Conclusion Psychotherapies for depression may be effective compared with control conditions, but more than half of patients receiving therapy do not respond and only one third remitted. More effective treatments and treatment strategies such as sequencing and combining treatments are clearly needed.

Internet-based interventions for loneliness : Efficacy and latent psychopathological profiles of treatment seekers

“…Study III indicated that this number was up to 60 % two years after the conclusion of the first RCT. The percentage of reliably improved respondents in Study IV is lower than the roughly 60 % found in a meta-analysis of the effects of psychotherapeutic interventions on depression by Cuijpers et al (2021). It is worth mentioning that the calculation of reliable clinical change made use of the one-year testretest coefficient for the ULS-3 (0.73) which is rather low.…”

Negative effects in internet-based interventions for depression: A qualitative content analysis

“…However, this does not necessarily have to be the result of the treatment but may be related to other causes ( Dimidjian and Hollon, 2010 ), illustrating the importance to compare these rates with those in control conditions. The results of a recent meta-analysis on the effects of psychotherapy for depression indicate that deterioration rates are below 5% in the treatment condition and between 7% and 13% in control conditions (care-as-usual, waitlist, or pill placebo; Cuijpers et al, 2021 ). Being aware of various definitions existing in the literature today, the current article uses the term negative effect as a description of every possible event a participant might encounter during the course of treatment that is experienced as negative and perceived as related to the treatment by the participant.…”

Modular-Based Psychotherapy (MoBa) versus Cognitive Behavioural Therapy (CBT) for patients with comorbid depression and a history of childhood maltreatment: Study protocol for a randomised controlled feasibility trial

“…According to the most recent meta-analysis, only approximately 5% of patients deteriorate while in psychotherapeutic treatment [3]. Adverse Events (AE; e.g.…”

“…This has led to the development of several disorderspecific approaches such as the Cognitive Behavioural Therapy (CBT) [1] and the Interpersonal Psychotherapy (IPT) [2]. While these approaches (among others) have proven efficacy in unipolar major depression, there is a large proportion of patients who do not respond (more than 50%) or do not reach full remission (about two thirds) with first line treatment [3], even when the procedure is in accordance with treatment guidelines [4,5]. Major reasons for individual non-response and non-remission include interindividual heterogeneity of etiological mechanisms of depression and high rates of comorbid disorders of up to 80% in clinical and epidemiological studies [6][7][8].…”