Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials

Gloster, Andrew T.; Rinner, Marcia T. B.; Ιωάννου, Μαρία; Villanueva, Jeanette; Block, Victoria J.; Ferrari, Giovanna; Benoy, Charles; Bader, Klaus; Karekla, Maria

doi:10.1016/j.cpr.2019.101810

Cited by 33 publications

(16 citation statements)

References 60 publications

(46 reference statements)

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“…The majority of the individual trials included in our study had a large mean difference between the two interventions. Previous systematic reviews of behavioural interventions also reported large SDM [ 64 , 65 ]. For instance, Ekers et al had a SMD of −0.70 with a 95% CI of −1.00 to −0.39.…”

Section: Discussionmentioning

confidence: 97%

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis

et al. 2020

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Background Cognitive behavioural therapy (CBT) is a widely used treatment for depression. However, limited resource availability poses several barriers to patients seeking access to care, including lengthy wait times and geographical limitations. This has prompted health care services to introduce electronically delivered CBT (eCBT) to facilitate access. Although previous reviews have compared the effects of eCBT to face-to-face CBT, there is an overall lack of adequately powered and up-to-date evidence in the literature to provide a reliable comparison between the two modes of administration. The purpose of this study is to evaluate the effects of eCBT compared to face-to-face CBT through a systematic review of the literature. Methods To be eligible for this review, studies needed to be randomized controlled trials evaluating the clinical effectiveness of any form of eCBT compared to face-to-face CBT. These encompassed studies evaluating a wide range of outcomes including severity of symptoms, adverse outcomes, clinically relevant outcomes, global functionality, participant satisfaction, quality of life, and affordability. There were no restrictions on participant age or sex. We searched MEDLINE, EMBASE, Psych Info, Cochrane CENTRAL and CINAHL databases from inception to February 20th, 2020 using a comprehensive search strategy. All stages of literature screening and data extraction were completed independently in duplicate. Data extraction and risk of bias analyses, including GRADE ratings, were conducted on studies meeting inclusion criteria. Qualitative measures are reported in a narrative summary. We pooled quantitative data in meta-analyses to provide an estimated summary effect. This review adheres to PRISMA reporting guidelines. Findings In total, we included 17 studies in our analyses. Our results demonstrated that eCBT was more effective than face-to-face CBT at reducing depression symptom severity (Standardized mean difference [SMD]: −1.73; 95% confidence interval [CI]: −2.72, −0.74; GRADE: moderate quality of evidence). There were no significant differences between the two interventions on participant satisfaction (SMD 0.13 95%; CI −0.32, 0.59; GRADE: low quality of evidence). One RCT reported eCBT to be less costly than face-to-face CBT (GRADE: low quality of evidence). Results did not differ when stratified by subgroups such as participant age and study location. Interpretation Although we found eCBT to have moderate evidence of effectiveness in reducing symptoms of depression, high heterogeneity among studies precludes definitive conclusions for all outcomes. With the current reliance and accessibility of technology to increasing number of people worldwide, serious consideration in utilizing technology should be given to maximize accessibility for depression treatments. Our results found eCBT is at least as effective as face to face CBT, thus eCBT should be offered if preferred by p...

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Section: Discussionmentioning

confidence: 97%

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis

et al. 2020

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“…Psychotherapy differs from pharmacological treatments in terms of potential success after modification of the treatment plan: No HTE was found for antidepressant medication in previous studies (Plöderl & Hengartner, 2019; C. Volkmann et al, 2020), so it is not surprising that switching antidepressants has no effect in nonresponding patients (Bschor et al, 2018) while switching from antidepressants to psychotherapy following nonresponse is effective (Gloster et al, 2020). Indeed, the working mechanism behind pharmacological interventions may be the same in all patients, whereas this may not be the case for psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of treatment effects in trials on psychotherapy of depression.

Kaiser¹,

Volkmann²,

Volkmann³

et al. 2022

Clinical Psychology: Science and Practice

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Practitioners and researchers alike assume that there is individual variability in the effects of treatments for mental disorders. However, for psychotherapy, up to now this assumption has never been empirically tested. Using a large database of randomized-controlled trials on psychotherapy of depression in adults (306 trials including a total of 51,853 patients), we performed a Bayesian variance ratio metaregression. For the entire sample, we found a 9% higher variance in the intervention groups compared with the control groups. Depending on the depression scale used, this corresponds to a standard deviation of the individual treatment effect of 3 to 4 points. Subgroup analyses revealed that the effect variability of some types of therapy is larger than others. Our results are the first to indicate that patients do benefit differently from psychotherapy. We conclude that there is a sound basis for the paradigm of personalized psychotherapy, which brings about implications for both research and clinical practice. Public Health Significance StatementIn recent years, studies with high methodological quality have pointed out that the efficacy of psychotherapy in the treatment of depression is less satisfactory than previous research suggested. To optimize psychotherapy for non-responders, the paradigm of personalized therapy is coming into the research focus. In this study, we show for the first time that the effects of psychological interventions vary more than those of control conditions. This shows that differential response to treatments is inherent to intervention effects. Thus, it could indeed be beneficial to better tailor psychotherapy to individual patients. In practice, session-by-session outcome monitoring should be used to detect non-responding cases in ongoing treatments. Statistical methods guiding the selection of treatment components capitalize on the heterogeneity of treatment effects and are thus likely to improve outcomes. These findings pave the way for broad research and implementation of approaches that support personalization (e.g., monitoring and feedback systems) as well as a new shaping of training beyond the traditional schools of thought in psychotherapy.

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“…Adopting a strong emphasis on well-being also diminishes the reliance on using outcomes of distress and illness as the only indicators of treatment effectiveness. For instance, a poor response to psychological interventions is not uncommon, with nonresponder estimates of 30%-40% being documented [ 67 ]. Nonresponse in outcomes of distress is often seen as a lack of treatment impact, particularly in treatment models where the main focus is elimination of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study

Agteren¹,

Ali²,

Fassnacht³

et al. 2021

JMIR Ment Health

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Background During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness.

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Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials

Cited by 33 publications

References 60 publications

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis

A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis

Heterogeneity of treatment effects in trials on psychotherapy of depression.

Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study

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