Comprehensive comparative reviews of psychotherapeutic approaches have been conducted.
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Peer-reviewed literature demonstrates that comprehensive comparative reviews and network meta-analyses of psychotherapeutic interventions have been conducted for conditions such as depression.
<h4>Background</h4>Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.<h4>Methods and findings</h4>We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = -0.62 to d = -0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = -0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = -0.30, 95% credibility interval [CrI] [-0.54 to -0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [-0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [-0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.<h4>Conclusions</h4>Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.
Background
Achieving positive outcomes in comparative RCTs examining psychotherapy interventions may be moderated by other factors than treatments alone, namely allegiance and treatment quality (bona fide, adherence). Using the study sample of a recent comprehensive review on humanistic interventions by the German Scientific Board of Psychotherapy, we assumed that higher allegiance towards non-humanistic approaches and lower treatment quality in the humanistic intervention arm would result in worse outcomes for the humanistic groups.
Method
We included studies in which a humanistic psychotherapy (sub-)approach was compared to another type of psychotherapy. Data was extracted independently by the authors. A priori defined meta-regression analyses were performed with allegiance and treatment quality as main moderators and study quality (risk of bias), type of active control, humanistic psychotherapy and target population (children/adolescents; adults) as exploratory.
Results
The majority of studies showed non-allegiance towards humanistic intervention arms; only about half of the humanistic interventions were bona fide treatments demonstrating high percentages of potential biases in these comparative intervention studies. However, allegiance and bona fide were significant moderators only for two (allegiance) resp. one (bona fide) of five outcome comparison. Type of active control (cognitive behavioural therapy) and disorder group (anxiety disorders) emerged as further moderators.
Conclusion
We found no clear evidence for allegiance or treatment quality impacting upon treatment outcome in this re-examination. Allegiance and treatment quality were not as relevant for outcomes in this meta-analysis of RCTs as expected.
Parents experience stress that manifests itself as a negative reaction to the situation when the demands of being a parent exceed the expectations of oneself as a parent. Stress level in parents of children with disabilities is significantly higher than in standard families. Schema therapy is an effective psychological intervention for managing this stress. The paper reviews foreign and Russian publications on schema therapy for parents of children with special needs. The comparative analysis showed that schema-therapy approach might have higher efficacy in managing this type of stress than other popular psychotherapeutic approaches, e.g., CBT, MCT, PST, etc. These approaches often focus on teaching specific parenting skills or changing parents' behavior and attitude but leave behind their emotional well-being. Schema therapy develops effective parenting skills and behavioral practices while teaching emotion management strategies. A comprehensive schema therapy program may reduce stress in parents of children with disabilities.
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