The efficacy of evidence-based psychotherapies versus usual care for youths: Controlling confounds in a meta-reanalysis

Abstract

In the present meta-analysis, the authors examined how several confounding moderator variables may relate to the advantage of evidence-based psychological treatments (EBTs) over usual care (UC) in the treatment of youths, including the extent to which each therapy was bona fide, supervision provided to therapists, therapist caseload, whether EBT was provided by research therapists, and whether specialized training was provided for EBT therapists. When comparing EBT with bona fide UC while controlling for each confound individually, the advantage for EBT was small and nearly always statistically nonsignificant. Additionally, an increasing total number of confounds favoring EBT was significantly predictive of a greater effect size advantage for EBT. The superior efficacy of EBTs for youths may be an artifact of confounded research designs.

The Relationship: How It Works

“…The results from this meta-analysis indicated that the treatments were all approximately equally effective. Since that time, meta-analyses have shown similar findings when focused on specific disorders, for example, post-traumatic stress disorder (Benish et al 2008), alcohol-use disorders (Imel et al 2008), depression (Cuijpers et al 2005), and childhood disorders (Spielmans et al 2010;Miller et al 2008).…”

Performance of Evidence-Based Youth Psychotherapies Compared With Usual Clinical Care

“…Following several researchers in the field, 15 we coded whether study authors had a likely allegiance to the EBP being tested, based on whether or not the EBP developer was an author of the article or a committee member for the dissertation. Although mean ES appeared somewhat larger when investigator allegiance was evident (d=.32 vs. .21; both mean ESs were significant), the difference between them was not significant…”

“…This study collection is larger and meets more rigorous inclusion standards than any previous work on the topic. 14,15 We conducted a meta-analysis of these 52 studies, assessing the effect of EBPs relative to usual care and testing candidate moderators of treatment benefit. To strengthen the analyses, we used a recently-developed multilevel approach to research synthesis that has not previously been applied to psychotherapy research.…”

What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice.

“…We examined the Dodo bird hypothesis using youth treatment vs. control condition RCTs and tested whether the effect of treatment type might depend on other factors, such as the source of outcome data. (Spielmans, Gatlin, & McFall, 2010;Weisz et al, 2013) have suggested that "usual care" is an important externally valid control condition to evaluate. We compared effects for passive control conditions and four kinds of active controls, including usual care.…”