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Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types
Open accessAbstract
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.
Overview
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.
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Claims the paper makes
0 of 10 cited sources checked · 0 supported · 0 flagged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
- Also stated in: § Network meta-analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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.
- Also stated in: § Sensitivity and meta-regression analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
- Also stated in: § Network meta-analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“problem-solving therapy was found to have a somewhat higher long-term efficacy than some other therapies.”
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Each of these major types of psychotherapy was examined in at least ten trials comparing the therapy with a control condition.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Identification and selection of studies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All therapies were more efficacious than care-as-usual and waiting list control conditions”
- Also stated in: § Network meta-analyses · hedged
“The results for response indicate that all therapies are more efficacious than care-as-usual and waiting list, with few significant differences between therapies.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
- Also stated in: § Network meta-analyses · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The acceptability of all therapies (except interpersonal psychotherapy and life-review therapy) was significantly lower than waiting list, with ORs ranging between 0.49 to 0.67.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CBT was the best examined therapy and was connected to all other nodes (except life-review therapy).”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network plot
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only non-directive supportive counseling was less efficacious than all other therapies, with ORs ranging between 0.49 to 0.65.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Psychodynamic therapy was significantly less acceptable than care-asusual (OR=0.64).”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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. 16
- It may state two separate claims as one. 29
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Characteristics and risk of bias of included studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
- Also stated in: § Long-term effects · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Standardized mean differences compared with care-as-usual ranged from -0.81 for life-review therapy to -0.32 for non-directive supportive counseling.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most studies were aimed at adults in general (145; 43.8%).”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Characteristics and risk of bias of included studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
- Also stated in: § Network meta-analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 331 randomized controlled trials (with 34,285 patients) met inclusion criteria.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Selection and inclusion of studies
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All therapies were connected to care-as-usual and waiting list, but not to pill placebo.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network plot
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%).”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Characteristics and risk of bias of included studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no significant differences between therapies, except that non-directive supportive counseling was less efficacious than CBT, problem-solving therapy, and psychodynamic therapy.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Pairwise meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CBT was examined in the majority of studies (211 trials; 63.7%)”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Characteristics and risk of bias of included studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Pairwise meta-analyses
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Long-term effects
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Sensitivity and meta-regression analyses
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The network plot for response (Figure 2) indicated a wellconnected network, with no stand-alone node.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network plot
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Pairwise meta-analyses
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Sensitivity and meta-regression analyses
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The protocol for the current NMA has been registered at the Open Science Foundation (https://osf.io/nxvye).”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Identification and selection of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The statistical examination of the transitivity assumption was conducted using tests of local and global inconsistency 20 .”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
What the sources say
- Not checked yetcites [20] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Assessment of risk of bias was conducted by two independent researchers, and disagreements were solved through discussion.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Quality assessment
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Outcome measures
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- The authors state this as an assumption: Randomized patients absent from the original responder analyses are non-responders.
In the paper
“When not reported, we imputed response rates using a validated method 16 .”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Outcome measures
What the sources say
- Not checked yetcites [16]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Identification and selection of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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 .”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Identification and selection of studies
What the sources say
- Not checked yetcites [10] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Identification and selection of studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
- 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Network meta-analyses
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Combined treatment and psychotherapy alone were also more acceptable than pharmacotherapy.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Long-term effects
What the sources say
- Not checked yetcites [31] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Long-term effects
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“This is in line with previous meta-analytic work 26 .”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
What the sources say
- Not checked yetcites [26] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“This psychotherapy is mostly used in older adults, but it has also been used successfully in cancer patients 27,28”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“These findings are in line with previous meta-analytic research on psychotherapies for depression 7,10 .”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Long-term effects
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, life-review therapy can be considered a promising intervention that is probably efficacious in depression.”
§ Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types > Additional information
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Network meta-analyses exist that directly focus on psychotherapy7 and pharmacotherapy,25 and these combined for treating depression.6”
From Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [7]
Citations
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Ramfjord, L. S., Kahn, N., Langsrud, K., Halvorsen, J. Ø., Morken, G., Saksvik, S. B., Engvik, L. S. S., Lydersen, S., & Kallestad, H. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-076039 · Cited by 1
The Efficacy of Interpersonal Psychotherapy
Weissman, M. M., & Mootz, J. J. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780197652084.003.0003 · Cited by 1
Nassan, M. M. (2024) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000399 · Cited by 1
Ravitz, P., Heeney, N. D., Lawson, A., McAnanama, E. P., Pain, C., Kiss, A., Watson, P., Malát, J., Grigoriadis, S., Vigod, S. N., et al. (2024) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2024.100863 · Cited by 1
Perceptions and emotions in postoperative recovery of patients with perianal diseases
Priego-Parra, B. A., & Remes-Troche, J. M. (2024) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i1.101563 · Cited by 1
Glynn, D., Saramago, P., Ahmed, N., Afaq, S., Aslam, F., Basit, A., Ekers, D., Fawwad, A., Gibbs, N., Fottrell, E. F., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-092158 · Cited by 1
Psychotherapy for depression is effective, but not for the reasons provided in a recent review
Cuijpers, P. J. (2025) · Tidsskrift for Norsk psykologforening · doi:10.52734/xzbd1002 · Cited by 1
Self-citationNissen‐Lie, H. A. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70043 · Cited by 3
Depressive and Anxiety Disorders
Tonini, E., Hickie, I. B., & Crouse, J. J. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99967-0.00189-7 · Cited by 1
Li, Y., Liu, X., Guo, Z., Lai, L., Bryant, R. A., Zhang, T., Song, H., Mi, T., & Ren, Z. (2025) · Stress and Health · doi:10.1002/smi.70124
Cuijpers, P. J., Sanz, C. M., Čihařová, M., Karyotaki, E., Noma, H., Thombs, B. D., & Furukawa, T. A. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3759715
Self-citationMünder, T., Geisshüsler, A., Krieger, T., Zimmermann, J., Wolf, M., Berger, T., & Watzke, B. (2021) · doi:10.31219/osf.io/5s6ap
Aemissegger, V., López‐Alcalde, J., Witt, C. M., & Barth, J. (2022) · doi:10.2196/preprints.36978
Exploring the role of health apps in supporting young people with depression: a mixed methods study
Martinengo, L. (2021) · DR-NTU (Nanyang Technological University) · doi:10.32657/10356/157124
The Promise of Behavioral Activation to Treat Depression in Nursing Homes
Cuijpers, P. J. (2022) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2022.06.001
Self-citationDucousso‐Lacaze, A., Keller, P.-H., Giroux-Gonon, A., & Gonon, F. (2023) · Revue française de psychanalyse · doi:10.3917/rfp.872.0445
Facilitating Behavioral Activation
Cuijpers, P. J., Karyotaki, E., Harrer, A. M., & Stikkelbroek, Y. A. J. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197611012.003.0021
Self-citationManagement of Depression in Hemodialysis Patients: a Pilot Study
Mawaddah, N., Mujiadi, M., & utomo, R. W. (2023) · Psychiatry Nursing Journal (Jurnal Keperawatan Jiwa) · doi:10.20473/pnj.v5i2.48054 · Cited by 1
Kuzminskaite, E. (2023) · doi:10.5463/thesis.371
Cecchetto, C., Bò, E. D., Eliasson, E. T., Vigna, E., Natali, L., Scilingo, E. P., Greco, A., Francesco, F. D., Hadlaczky, G., Lundström, J. N., et al. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4591481
Sourander, A., Matinolli, H., Korpilahti-Leino, T., Ristkari, T., Koffert, T., Arrhenius, B., Ståhlberg, T., Hinkka‐Yli‐Salomäki, S., Berglund, M., Upadhyaya, S., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-3644682/v1
Dean, J. A., van der Werf-Eldering, M. J., Schoevers, R. A., & van Driel, C. M. G. (2024) · British Journal of Clinical Psychology · doi:10.1111/bjc.12454
Sex differences in the association between peripheral inflammation and melancholia symptoms
Sharpley, C. F., Bitsika, V., Arnold, W. M., Evans, I. D., Jesulola, E., & Agnew, L. L. (2024) · Psychiatry Research Communications · doi:10.1016/j.psycom.2024.100163
Pinquart, M., & Forstmeier, S. (2024) · Psychotherapie: Praxis · doi:10.1007/978-3-662-68077-3_3
Depression and Suicide Among College Students
Hayes, J. A. (2024) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-83549-194-220241004
Sahker, E., Luo, Y., Omae, K., Tajika, A., Ferreira, M. L., Chevance, A., Leucht, S., Markham, S., Ede, R., Cipriani, A., et al. (2024) · medRxiv · doi:10.1101/2024.10.31.24316524
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Metadata
- 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
- 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
- bronze
- doi.org
- 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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