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- Furukawa, Toshi A., et al.
(författare)
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Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials
- 2017
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Ingår i: British Journal of Psychiatry. - : ROYAL COLLEGE OF PSYCHIATRISTS. - 0007-1250 .- 1472-1465. ; 210:3, s. 190-196
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Forskningsöversikt (refereegranskat)abstract
- Background The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive behavioural therapy (CBT) in comparison with pill placebo. Aims To synthesise evidence regarding the influence of initial severity on efficacy of CBT from all randomised controlled trials (RCTs) in which CBT, in face-to-face individual or group format, was compared with pill-placebo control in adults with major depression. Method A systematic review and an individual-participant data meta-analysis using mixed models that included trial effects as random effects. We used multiple imputation to handle missing data. Results We identified five RCTs, and we were given access to individual-level data (n=509) for all five. The analyses revealed that the difference in changes in Hamilton Rating Scale for Depression between CBT and pill placebo was not influenced by baseline severity (interaction P=0.43). Removing the non-significant interaction term from the model, the difference between CBT and pill placebo was a standardised mean difference of 0.22 (95% CI 0.42 to 0.02, P=0.03, l(2)=0%). Conclusions Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.
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- Rozental, Alexander, et al.
(författare)
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Negative effects in psychotherapy : Current understanding and future research directions
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Psychotherapy can help alleviate mental distress and improve quality of life, but little is known about the potential negative effects of psychotherapy and how to determine their frequency and characteristics. Meanwhile, many researchers and clinicians are unfamiliar to the idea of patients faring worse or experiencing adverse and unwanted events during treatment. The present report thus intends to provide an overview of the current understanding and future research directions of negative effects in psychotherapy. Method: An anonymous survey was distributed to a selection of highly renowned researchers, using an analytical framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Results: The researchers recognize an increased awareness of negative effects in psychotherapy in recent years, but also describe many issues related to their definition, assessment, and reporting, e.g., the lack of a clear and coherent terminology. Both qualitative methods and naturalistic designs are regarded as important to find out what negative effects exist and how to prevent them, although a number of methodological obstacles associated with such methods are identified and need to be resolved. Discussion: Negative effects of psychotherapy are multifaceted, warranting careful considerations in order to be monitored and reported in both routine care and research settings.
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