| 1. |
- Andersson, Gerhard, et al.
(författare)
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The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression : a meta-analysis.
- 2010
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 121:6, s. 415-23
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Although there is sufficient evidence that combined treatments of psychotherapy and pharmacotherapy are more effective for depression in adults than each of the treatments alone, it remains unclear what the exact contribution of active medication is to the overall effects of combined treatments. This paper examines the contribution of active medication to combined psychotherapy and pharmacotherapy treatments. METHOD: Meta-analysis of randomised controlled trials comparing the combination of psychotherapy and pharmacotherapy with the combination of psychotherapy and placebo. RESULTS: Sixteen identified studies involving 852 patients met our inclusion criteria. The standardised mean difference indicating the differences between the combination of psychotherapy and pharmacotherapy and the combination of psychotherapy and placebo was 0.25 (95% CI: 0.03-0.46), which corresponds to a numbers-needed-to-be-treated of 7.14. No significant differences between subgroups of studies were found. CONCLUSION: Active medication has a small but significant contribution to the overall efficacy of combined treatments.
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| 2. |
- Andersson, Gerhard
(författare)
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The promise and pitfalls of the internet for cognitive behavioral therapy
- 2010
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Ingår i: BMC Medicine. - : BioMed Central. - 1741-7015. ; 8:82
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Internet-administered cognitive behavior therapy is a promising new way to deliver psychological treatment. There are an increasing number of controlled trials in various fields such as anxiety disorders, mood disorders and health conditions such as headache and insomnia. Among the advantages for the field of cognitive behavior therapy is the dissemination of the treatment, being able to access treatment from a distance, and possibilities to tailor the interventions. To date, studies in which large effects have been obtained have included patient support from a clinician. Recent trials suggest that this support may come from non-clinicians and that therapist effects are minimal. Since studies also suggest that internet-delivered cognitive behavior therapy can be equally effective as face-to-face cognitive behavior therapy, this is a finding that may have implications for CBT practitioners. However, there are other aspects to consider for implementation, as while clinicians may hold positive attitudes towards internet-delivered CBT a recent study suggested that patients are more skeptical and may prefer face-to-face treatment. In the present work, I argue that internet-delivered CBT may help to increase adherence to treatment protocols, that training can be facilitated by means of internet support, and that research on internet interventions can lead to new insights regarding what happens in regular CBT. Moreover, I conclude that internet-delivered CBT works best when support is provided, leaving an important role for clinicians who can incorporate internet treatment in their services. However, I also warn against disseminating internet-delivered CBT to patients for whom it is not suitable, and that clinical skills may suffer if clinicians are trained and practice mainly using the internet.
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| 3. |
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| 4. |
- Bergström, Jan, 1976-, et al.
(författare)
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Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting : a randomised trial
- 2010
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Ingår i: BMC Psychiatry. - : BioMed Central Ltd. - 1471-244X. ; 10:54
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internet administered cognitive behaviour therapy (CBT) is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internetand group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions. Methods: Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition. Results: Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS) after treatment. For the Internet treatment the within-group effect size (pre-post) on the PDSS was Cohen's d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up. Conclusions: This study provides support for the effectiveness of Internet CBT in a psychiatric setting for patients with panic disorder, and suggests that it is equally effective as the more widely used group administered CBT in reducing panic-and agoraphobic symptoms, as well as being more cost effective with respect to therapist time.
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| 5. |
- Cuijpers, Pim, et al.
(författare)
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Continuous and dichotomous outcomes in studies of psychotherapy for adult depression: A meta-analytic comparison
- 2010
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Ingår i: JOURNAL OF AFFECTIVE DISORDERS. - : Elsevier Science B.V., Amsterdam.. - 0165-0327 .- 1573-2517. ; 126:3, s. 349-357
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Forskningsöversikt (refereegranskat)abstract
- Background: In treatment research on depressive disorders, outcomes can be based on continuous outcomes but also on dichotomous outcomes. Although it is possible to convert the two types of outcomes to each other, it has not been tested whether this results in systematic differences. Method: We selected studies on psychotherapy for adult depression from an existing database, in which both continuous and dichotomous outcomes were presented. We calculated effect sizes using both types of outcomes, and compared the results. Results: Although there were considerable differences between the two types of outcomes in individual studies, both types of outcomes resulted in very similar pooled effect sizes. The pooled effect size based on the continuous outcome were somewhat more conservative (d = 0.59: OR = 2.92) than the one based on the dichotomous outcome (d = 0.64; OR = 3.17). Heterogeneity was higher in the analyses based on the continuous outcomes than in those based on the dichotomous outcomes. Sensitivity analyses and subgroup analyses confirmed that the pooled effect sizes were very similar, that the effect sizes were somewhat smaller when the continuous outcomes are used, and that heterogeneity was higher in the analyses based on the continuous outcomes. Conclusion: Overall, the two types of outcomes result in comparable pooled effect sizes and can both be used in meta-analyses. However, the results of the two types of outcomes should not be used interchangeably, because there may be systematic differences in heterogeneity and subgroup analyses.
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| 6. |
- Cuijpers, Pim, et al.
(författare)
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Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias
- 2010
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 196:3, s. 173-178
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Forskningsöversikt (refereegranskat)abstract
- Background: It is not clear whether the effects of cognitive-behavioural therapy and other psychotherapies have been overestimated because of publication bias. Aims: To examine indicators of publication bias in randomised controlled trials of psychotherapy for adult depression. Method: We examined effect sizes of 117 trials with 175 comparisons between psychotherapy and control conditions. As indicators of publication bias we examined funnel plots, calculated adjusted effect sizes after publication had been taken into account using Duval & Tweedies procedure, and tested the symmetry of the funnel plots using the Begg & Mazumdar rank correlation test and Eggers test. Results The mean effect size was 0.67, which was reduced after adjustment for publication bias to 0.42 (51 imputed studies). Both Begg & Mazumbars test and Eggers test were highly significant (Pandlt;0.001). Conclusions: The effects of psychotherapy for adult depression seem to be overestimated considerably because of publication bias. Declaration of interest: None.
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| 7. |
- Cuijpers, P, et al.
(författare)
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Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies
- 2010
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Ingår i: PSYCHOLOGICAL MEDICINE. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 40:12, s. 1943-1957
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Forskningsöversikt (refereegranskat)abstract
- Background. Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments. Method. We conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants. Results. The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=-0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats. Conclusions. It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.
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| 8. |
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| 9. |
- Cuijpers, Pim, et al.
(författare)
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Psychotherapy for chronic major depression and dysthymia: A meta-analysis
- 2010
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Ingår i: Clinical Psychology Review. - : Elsevier BV. - 0272-7358 .- 1873-7811. ; 30:1, s. 51-62
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Forskningsöversikt (refereegranskat)abstract
- Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depression and dysthymia. We found that psychotherapy had a small but significant effect (d=0.23) on depression when compared to control groups. Psychotherapy was significantly less effective than pharmacotherapy in direct comparisons (d=-031), especially SSRIs, but that this finding was wholly attributable to dysthymic patients (the studies examining dysthymia patients were the same studies that examined SSRIs). Combined treatment was more effective than pharmacotherapy alone (d=0.23) but even more so with respect to psychotherapy alone (d=0.45), although again this difference may have reflected the greater proportion of dysthymic samples in the latter. No significant differences were found in drop-out rates between psychotherapy and the other conditions. We found indications that at least 18 treatment sessions are needed to realize optimal effects of psychotherapy. We conclude that psychotherapy is effective in the treatment of chronic depression and dysthymia but probably not as effective as pharmacotherapy (particularly the SSRIs).
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| 10. |
- Cuijpers, Pim, et al.
(författare)
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Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis
- 2010
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Ingår i: CLINICAL PSYCHOLOGY REVIEW. - : Elsevier Science B.V., Amsterdam.. - 0272-7358 .- 1873-7811. ; 30:6, s. 768-778
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Forskningsöversikt (refereegranskat)abstract
- It is not well-known whether self-report measures and clinician-rated instruments for depression result in comparable outcomes in research on psychotherapy. We conducted a meta-analysis in which randomized controlled trials were included examining the effects of psychotherapy for adult depression. Only studies were included in which both a self-report and a clinician-rated instrument were used. We calculated the effect size (Hedges g) based on the self-report measures, the effect size based on the clinician-rated instruments, and the difference between these two effect sizes (Delta g). A total of 48 studies including a total of 2462 participants was included in the meta-analysis. The differential effect size was Delta g=0.20 (95% CI: 0.10-0.30), indicating that clinician-rated instruments resulted in a significantly higher effect size than self-report instruments from the same studies. When we limited the effect size analysis to those studies comparing the HRSD with the BDI, the differential effect was somewhat smaller, but still statistically significant (Delta g=0.15; 95% CI: 0.03-0.27). This meta-analysis has made it clear that clinician-rated and self-report measures of improvement following psychotherapy for depression are not equivalent. Different symptoms may be more suitable for self-report or ratings by clinicians and in clinical trials it is probably best to include both.
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