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Control condition design and implementation features in controlled trials: a meta-analysis of trials evaluating psychotherapy for depression

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Mohr, David C, Ho, Joyce, Hart, Tae L, Baron, Kelly G, Berendsen, Mark, Beckner, Victoria, Cai, Xuan, Cuijpers, Pim +4 more·2014·Translational Behavioral Medicine
DOI 10.1007/s13142-014-0262-3PMC PMC4286544
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Abstract

ABSTRACT: Control conditions are the primary methodology used to reduce threats to internal validity in randomized controlled trials (RCTs). This meta-analysis examined the effects of control arm design and implementation on outcomes in RCTs examining psychological treatments for depression. A search of MEDLINE, PsycINFO, and EMBASE identified all RCTs evaluating psychological treatments for depression published through June 2009. Data were analyzed using mixed-effects models. One hundred twenty-five trials were identified yielding 188 comparisons. Outcomes varied significantly depending control condition design (p < 0.0001). Significantly smaller effect sizes were seen when control arms used manualization (p = 0.006), therapist training (p = 0.002), therapist supervision (p = 0.009), and treatment fidelity monitoring (p = 0.003). There were no significant effects for differences in therapist experience, level of expertise in the treatment delivered, or nesting vs. crossing therapists in treatment arms. These findings demonstrate the substantial effect that decisions regarding control arm definition and implementation can have on RCT outcomes.

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Authors
Mohr, D. C., Ho, J., Hart, T. L., Baron, K. G., Berendsen, M., Beckner, V., Cai, X., Cuijpers, P., Spring, B., Kinsinger, S. W., Schroder, K. E., & Duffecy, J.
Affiliations
  • Northwestern University (US)
  • Toronto Metropolitan University (CA)
  • University of California, San Francisco (US)
  • Vrije Universiteit Amsterdam (NL)
Corresponding author
Mohr, David C
ORCID
Venue
Translational Behavioral Medicine
Publisher
Oxford University Press (OUP)
Published
2014-05-02
Volume
4
Issue
4
Pages
407-423
ISSN
  • 1613-9860 (ISSN-L)
  • 1869-6716
DOI
10.1007/s13142-014-0262-3
PMC
PMC4286544
OpenAlex
W2015937454
Cited by
139
References
31
Citations by year
2026: 8 · 2025: 15 · 2024: 18 · 2023: 12 · 2022: 14 · 2021: 17 · 2020: 12 · 2019: 17 · 2018: 10 · 2017: 4 · 2016: 5 · 2015: 6 · 2014: 1
FWCI
0.81
Type
journal article
Language
en
Open access
Locations
  • Translational Behavioral Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Multilingual Matters (Channel View Publications) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
National Institute of Mental Health (R01MH095753, R01MH059708)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
control conditions, depression, psychotherapy, psychological intervention, internal validity, manualization, therapist training, therapist supervision, therapist experience

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