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Cited by 388Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

Open access
Cuijpers, Pim, Quero, Soledad, Noma, Hisashi, Ciharova, Marketa, Miguel, Clara, Karyotaki, Eirini, Cipriani, Andrea, Cristea, Ioana A. +1 more·2021·World Psychiatry
DOI 10.1002/wps.20860PMC PMC8129869
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Abstract

The effects of psychotherapies for depression have been examined in several hundreds of randomized trials, but no recent network meta‐analysis (NMA) has integrated the results of these studies. We conducted an NMA of trials comparing cognitive behavioural, interpersonal, psychodynamic, problem‐solving, behavioural activation, life‐review and “third wave” therapies and non‐directive supportive counseling with each other and with care‐as‐usual, waiting list and pill placebo control conditions. Response (50% reduction in symptoms) was the primary outcome, but we also assessed remission, standardized mean difference, and acceptability (all‐cause dropout rate). Random‐effects pairwise and network meta‐analyses were conducted on 331 randomized trials with 34,285 patients. All therapies were more efficacious than care‐as‐usual and waiting list control conditions, and all therapies – except non‐directive supportive counseling and psychodynamic therapy – were more efficacious than pill placebo. Standardized mean differences compared with care‐as‐usual ranged from –0.81 for life‐review therapy to –0.32 for non‐directive supportive counseling. Individual psychotherapies did not differ significantly from each other, with the only exception of non‐directive supportive counseling, which was less efficacious than all other therapies. The results were similar when only studies with low risk of bias were included. Most therapies still had significant effects at 12‐month follow‐up compared to care‐as‐usual, and problem‐solving therapy was found to have a somewhat higher long‐term efficacy than some other therapies. No consistent differences in acceptability were found. Our conclusion is that the most important types of psychotherapy are efficacious and acceptable in the acute treatment of adult depression, with few significant differences between them. Patient preference and availability of each treatment type may play a larger role in the choice between types of psychotherapy, although it is possible that a more detailed characterization of patients with a diagnosis of depression may lead to a more precise matching between individual patients and individual psychotherapies.

AI snapshot

Written from the paper’s full text.

TL;DR

This network meta-analysis of 331 randomized trials (34,285 patients) found that all main psychotherapies for adult depression were more efficacious than care-as-usual and waiting list, with few significant differences between therapies. Non-directive supportive counseling was the main exception, being less efficacious than other therapies, while acceptability differences were not consistent.

Key findings

  • Across 331 trials and 34,285 patients, all therapies were more efficacious than care-as-usual and waiting list; all except non-directive supportive counseling and psychodynamic therapy were more efficacious than pill placebo.
  • Standardized mean differences versus care-as-usual ranged from −0.81 for life-review therapy to −0.32 for non-directive supportive counseling. Individual psychotherapies did not differ significantly from each other, except non-directive supportive counseling was less efficacious than all other therapies (response ORs 0.49–0.65).
  • At 12 (±6) months, among 90 studies, CBT, behavioural activation, problem-solving, interpersonal, and psychodynamic therapy had significant effects versus care-as-usual; problem-solving therapy was significantly more effective than CBT, “third wave” therapies, and non-directive supportive counseling at follow-up.
  • No consistent acceptability differences were found between therapies. The paper reports that acceptability of all therapies except interpersonal psychotherapy and life-review therapy was significantly lower than waiting list (ORs 0.49–0.67), and psychodynamic therapy was significantly less acceptable than care-as-usual (OR=0.64).

Methods

  • Network meta-analysis of randomized trials comparing eight major psychotherapy types (CBT, behavioural activation, problem-solving, “third wave,” interpersonal, psychodynamic, non-directive supportive counseling, life-review) with each other and with waiting list, care-as-usual, or pill placebo. Searches covered 1966 to January 1, 2020; 24,647 abstracts were examined, 2,914 full texts retrieved, and 331 trials included.
  • Primary outcome was treatment response (≥50% reduction in depressive symptoms); also assessed remission, standardized mean difference, and acceptability (all-cause dropout). Random-effects pairwise and network meta-analyses were conducted, with SUCRA rankings, inconsistency tests, sensitivity analyses (low risk of bias, excluding life-review, excluding pill placebo), meta-regression, and GRADE/CINeMA certainty ratings.
  • Risk of bias was assessed with four Cochrane criteria; 102 studies (30.8%) had low overall risk of bias, 148 (44.7%) moderate, and 81 (24.4%) high.

Limitations

  • The paper states that the proportion of low-risk-of-bias studies was still relatively small (30.8%), that direct and indirect evidence showed discrepancies until 37 influential outliers were excluded, and that relatively few trials reported longer-term outcomes, making those effects uncertain.
  • The paper also notes that pill placebo comparisons were based on a small number of studies (10 studies; 3.0%) and that life-review therapy is mostly used in older adults, which may violate the transitivity assumption; pill placebo studies could also include antidepressant randomization, another possible transitivity concern.
  • Evident from the text: most evidence focused on CBT (211 trials; 63.7%), care-as-usual, and waiting list, while some therapies and comparisons had few trials, limiting precision for those nodes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/wps.20860

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 10 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    No consistent differences in acceptability were found.

    “No consistent differences in acceptability were found.”
    • Also stated in: § Network meta-analyses · plain
      “No significant differences for acceptability were found between any of the therapies.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.
  • Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    Findings changed little in the analysis restricted to studies at low risk of bias.

    “The results were similar when only studies with low risk of bias were included.”
    • Also stated in: § Sensitivity and meta-regression analyses · plain
      “In the sensitivity analyses in which we only included studies with low risk of bias, we found outcomes comparable to the main analyses.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.
  • Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    All therapies except non-directive supportive counseling and psychodynamic therapy were more efficacious than pill placebo.

    “all therapies -except non-directive supportive counseling and psychodynamic therapy -were more efficacious than pill placebo.”
    • Also stated in: § Network meta-analyses · plain
      “All therapies, except non-directive supportive counseling and psychodynamic therapy, were also more efficacious than pill placebo.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.
  • Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    Problem-solving therapy had somewhat higher long-term efficacy than some other therapies.

    “problem-solving therapy was found to have a somewhat higher long-term efficacy than some other therapies.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.
  • Findingown data

    Every main psychotherapy category had at least ten trials comparing it with a control condition.

    “Each of these major types of psychotherapy was examined in at least ten trials comparing the therapy with a control condition.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 16
  • May combine two claims. 29

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A diagnostic interview established depressive disorder in 179 studies (54.1%), while 152 studies (45.9%) used a self-rating scale cutoff.

    “In 179 studies (54.1%), participants met criteria for a depressive disorder according to a diagnostic interview, while the other studies (152; 45.9%) included participants who scored above a cutoff on a self-rating depression scale.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    At 12-month follow-up, CBT, behavioural activation, problem-solving, interpersonal, and psychodynamic therapies still showed significant benefits relative to care-as-usual.

    “Most therapies still had significant effects at 12-month follow-up compared to care-as-usual”
    • Also stated in: § Long-term effects · hedged
      “The results indicated that CBT, behavioural activation therapy, problem-solving therapy, interpersonal psychotherapy, and psychodynamic therapy had significant effects compared with care-as-usual at follow-up.”
    • Also stated in: § Long-term effects · plain
      “One important finding of this study is that several psychotherapies still have significant effects at one-year follow-up, including CBT, behavioural activation therapy, problem-solving therapy, interpersonal psychotherapy, and psychodynamic therapy.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • May combine two claims.

    Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    The standardized mean difference versus care-as-usual was -0.81 for life-review therapy and -0.32 for non-directive supportive counseling.

    “Standardized mean differences compared with care-as-usual ranged from -0.81 for life-review therapy to -0.32 for non-directive supportive counseling.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most studies aimed at adults in general (145; 43.8%).

    “Most studies were aimed at adults in general (145; 43.8%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    Individual psychotherapies did not differ significantly from each other, except non-directive supportive counseling was less efficacious than all other therapies.

    “Individual psychotherapies did not differ significantly from each other, with the only exception of non-directive supportive counseling, which was less efficacious than all other therapies.”
    • Also stated in: § Network meta-analyses · plain
      “Only non-directive supportive counseling was less efficacious than all other therapies, with ORs ranging between 0.49 to 0.65.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • May combine two claims.

    Findingown data

    The review included 331 randomized trials and 34,285 patients.

    “A total of 331 randomized controlled trials (with 34,285 patients) met inclusion criteria.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    SUCRA placed life-review and behavioural activation highest for response and SMD, behavioural activation and problem-solving highest for remission, non-directive supportive counseling and psychodynamic lowest for response, remission and SMD, psychodynamic lowest for acceptability, and life-review and interpersonal highest for acceptability.

    “Life-review and behavioural activation therapy ranked highest for response and SMD; behavioural activation and problem-solving therapy ranked highest for remission; while non-directive supportive counseling and psychodynamic therapy ranked lowest for response, remission and SMD.Psychodynamic therapy ranked lowest for acceptability, while life-review and interpersonal psychotherapy ranked highest.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • May combine two claims.

    Findingown data

    Every therapy had links to care-as-usual and waiting list, but none to pill placebo.

    “All therapies were connected to care-as-usual and waiting list, but not to pill placebo.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Low risk of bias was found in 102 studies (30.8%), moderate in 148 (44.7%), and high in 81 (24.4%).

    “The risk of bias was low (total score: 4) in 102 studies (30.8%), moderate (total score: 2 or 3) in 148 studies (44.7%), and high (total score: 0 or 1) in 81 studies (24.4%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pairwise comparisons found no therapy differences except that non-directive supportive counseling was inferior to CBT, problem-solving therapy, and psychodynamic therapy.

    “There were no significant differences between therapies, except that non-directive supportive counseling was less efficacious than CBT, problem-solving therapy, and psychodynamic therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    CBT was examined in 211 trials (63.7%).

    “CBT was examined in the majority of studies (211 trials; 63.7%)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After excluding 37 influential outliers, global inconsistency was no longer significant (p=0.11; global tau-squared 0.03), and NMA results were similar to main analyses.

    “Through the bootstrap-based evaluation, 37 trials were detected as influential outliers.After excluding these outliers, global inconsistency was no longer significant (p for the null hypothesis of consistency in the network = 0.11; global tau-squared: 0.03).The results of the NMA after excluding these outliers were similar to the main analyses”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • May combine two claims.

    Findingown data

    Non-directive supportive counseling was less effective than the other therapies, but this difference lost significance when the analysis was restricted to studies with low risk of bias.

    “Non-directive supportive counseling was less effective than the other therapies, but these findings were no longer significant when we only included studies with low risk of bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Heterogeneity was low in most comparisons, but several comparisons had I2 above 50%.

    “Although heterogeneity was low in most comparisons, several comparisons (especially involving care-as-usual or non-directive supportive counseling) had an I 2 above 50%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Because only nine studies had outcomes beyond 18 months, no analysis was done for that period.

    “Only nine studies reported outcomes at more than 18 months after randomization.Because of the small number of studies and different periods, we did not conduct any analyses with these studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In meta-regression, five predictors were statistically significant: diagnosed depressive disorder for CBT vs IPT and CBT vs waiting list; number of sessions for CBT vs BAT; Western vs non-Western countries for CBT vs CAU; and risk of bias for CBT vs BAT.

    “In meta-regression analyses, only five predictors were found to be statistically significant (diagnosed depressive disorder for CBT vs. interpersonal psychotherapy, and CBT vs. waiting list; number of sessions for CBT vs. behavioural activation therapy; Western vs. non-Western countries for CBT vs. care-as-usual; and risk of bias for CBT vs. behavioural activation therapy)”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • May combine two claims.

    Findingown data

    The response network was well connected and had no isolated node.

    “The network plot for response (Figure 2) indicated a wellconnected network, with no stand-alone node.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pairwise analyses showed every therapy beat care-as-usual except psychodynamic therapy, and every therapy beat waiting list except non-directive supportive counseling and psychodynamic therapy.

    “In pairwise meta-analyses (see Table 2), all therapies were more efficacious than care-as-usual (except psychodynamic therapy) and waiting list (except non-directive supportive counseling and psychodynamic therapy).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the network meta-analysis, the examined psychotherapies did not differ significantly from one another in efficacy, with the exception that non-directive supportive counseling was less effective than every other therapy.

    “The effects of the therapies did not differ significantly from each other, except for non-directive supportive counseling, that was less effective than all the other types of therapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the low-risk-only sensitivity analysis, results matched the main analysis except that non-directive supportive counseling no longer differed significantly from most other therapies and no longer beat care-as-usual or waiting list.

    “In the sensitivity analyses in which we only included studies with low risk of bias, we found outcomes comparable to the main analyses.Only the differences between non-directive supportive counseling and most other therapies were no longer significant, and non-directive supportive counseling was no longer significantly better than care-as-usual and waiting list.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study protocol was registered with the Open Science Foundation.

    “The protocol for the current NMA has been registered at the Open Science Foundation (https://osf.io/nxvye).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Transitivity was checked statistically through local and global inconsistency tests.

    “The statistical examination of the transitivity assumption was conducted using tests of local and global inconsistency 20 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent researchers assessed risk of bias and resolved disagreements by discussion.

    “Assessment of risk of bias was conducted by two independent researchers, and disagreements were solved through discussion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types

    The main psychotherapy types are effective and acceptable for acute adult depression, and they differ little from one another.

    “Our conclusion is that the most important types of psychotherapy are efficacious and acceptable in the acute treatment of adult depression, with few significant differences between them.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The analysis treated randomized patients missing from responder analyses as non-responders and kept them in the intention-to-treat set.

    “Patients randomized but not included in the analyses of responders in the original reports were assumed to be non-responders and included in the current analyses in order to abide the intention-to-treat principle.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Randomized patients absent from the original responder analyses are non-responders.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    When response rates were missing, they were imputed with a method described as validated.

    “When not reported, we imputed response rates using a validated method 16 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent researchers screened all records and decided on inclusion, resolving disagreements by discussion.

    “All records were screened by two independent researchers, and all papers potentially meeting inclusion criteria according to one of the researchers were retrieved as full text.The decision to include or exclude a study in the database was also done by the two independent researchers, and disagreements were solved through discussion.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Experts developed definitions for the eight main psychotherapy categories after critically reading and analysing comparative outcome trials.

    “The definitions of the eight major types of psychotherapy were developed by experts in the field, based on the critical reading and analysis of therapies described in comparative outcomes trials of psychotherapy for depression 10 .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two independent raters classified the psychotherapies, and disagreements were settled by discussion.

    “The classification of psychotherapies was made by two independent raters.Any disagreement was resolved through discussion of the two and/or in consultation with the first author.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Sensitivity analyses restricted to low-risk studies, omitted life-review therapy, and omitted pill placebo studies.

    “We performed several sensitivity analyses: a) analyses with only studies with low risk of bias; b) analyses excluding life-re-view therapy (this is only used in older adults, and may violate the transitivity assumption); and c) analyses in which studies with pill placebo were excluded (because in these studies patients could also be randomized to antidepressant medication, which may violate the tr”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    GRADE was used to rate certainty for the network estimates of the primary outcome.

    “We assessed the certainty of evidence in network estimates of the main outcome in accordance with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    That NMA also found combined treatment and psychotherapy alone more acceptable than pharmacotherapy.

    “Combined treatment and psychotherapy alone were also more acceptable than pharmacotherapy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Direct and indirect evidence disagreed until outliers were removed, after which they aligned.

    “Another important limitation is that we found some discrepancies between direct and indirect evidence, and only after excluding outliers the direct and indirect evidence pointed in the same direction.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The finding that non-directive supportive counseling was less effective than other therapies is consistent with previous meta-analytic work.

    “This is in line with previous meta-analytic work 26 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Life-review therapy has been used successfully in cancer patients.

    “This psychotherapy is mostly used in older adults, but it has also been used successfully in cancer patients 27,28”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] source

      Not checked in the free run.

    • cites [28] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    This network meta-analysis included a considerable number of low-risk-of-bias studies, and the main results were broadly confirmed when these studies were considered.

    “However, in contrast to previous meta-analyses, we could include a considerable number of studies with low risk of bias, which broadly confirmed the main results of this NMA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The findings of this network meta-analysis are consistent with prior meta-analytic research on psychotherapies for depression.

    “These findings are in line with previous meta-analytic research on psychotherapies for depression 7,10 .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] source

      Not checked in the free run.

    • cites [10] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Low risk of bias was relatively uncommon (30.8%), but the number sufficed for sensitivity analyses.

    “One important limitation is that the proportion of studies with low risk of bias was still relatively small (30.8%), although this was enough to conduct sensitivity analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Life-review therapy can be regarded as a promising intervention that is probably efficacious in treating depression.

    “However, life-review therapy can be considered a promising intervention that is probably efficacious in depression.”
    Quote in the paperSubstantial claim
39 of 39

  • The authors state this as an assumption.

    The network meta-analysis assumes transitivity, meaning that studies comparing different treatments are similar enough to combine direct and indirect evidence.

    “The statistical examination of the transitivity assumption was conducted using tests of local and global inconsistency 20 .”
    “may violate the transitivity assumption”

  • The authors state this as an assumption.

    Randomized patients absent from the original responder analyses are non-responders.

    “Patients randomized but not included in the analyses of responders in the original reports were assumed to be non-responders and included in the current analyses in order to abide the intention-to-treat principle.”

  • The paper relies on this without support.

    Previous meta-analyses omitted life-review therapy due to an insufficient number of studies.

    “Life-review therapy was not included in previous metaanalyses, because the number of studies was too small.”
3 of 3

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Authors
Cuijpers, P., Quero, S., Noma, H., Ciharova, M., Miguel, C., Karyotaki, E., Cipriani, A., Cristea, I. A., & Furukawa, T. A.
Affiliations
  • Amsterdam Public Health (NL)
  • Universitat Jaume I (ES)
  • The Institute of Statistical Mathematics (JP)
  • Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
  • Oxford Health NHS Foundation Trust (GB)
  • University of Pavia (IT)
  • Kyoto University (JP)
ORCID
Venue
World Psychiatry
Publisher
Wiley
Published
2021-05-18
Volume
20
Issue
2
Pages
283-293
ISSN
  • 1723-8617 (ISSN-L)
  • 2051-5545
DOI
10.1002/wps.20860
PMC
PMC8129869
OpenAlex
W3112767874
Semantic Scholar
7e19034e6fce88ccb2ea46b92848240ec126f3ab
Cited by
388
References
33
Citations by year
2026: 87 · 2025: 79 · 2024: 92 · 2023: 66 · 2022: 49 · 2021: 15
FWCI
37.83
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • World Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (submittedVersion, other-oa)
  • Padua Research Archive (University of Padova) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
National Institute for Health and Care Research (RP-2017-08-ST2-006)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
depression, psychotherapy, cognitive behavioral therapy, interpersonal psychotherapy, psychodynamic psychotherapy, problem-solving therapy, behavioral activation, life review therapy, third-wave therapies, treatment efficacy, treatment acceptability, long-term outcomes, remission, placebo response

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