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Efficacy of cognitive–behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias
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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 & Tweedie's procedure, and tested the symmetry of the funnel plots using the Begg & Mazumdar rank correlation test and Egger's 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 & Mazumbar's test and Egger's test were highly significant (P<0.001). Conclusions: The effects of psychotherapy for adult depression seem to be overestimated considerably because of publication bias.
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“There is considerable indirect evidence of publication bias in psychotherapy research, based on excess publication of small studies with large effect sizes 16 .”
From How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence (2016) · cites this paper as [16]
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“Distress disorders evidence comparatively inferior acute and enduring response with CBTs [27–29].”
From All together now: utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies (2019) · cites this paper as [28]
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“PP interventions have been used in over 4000 mostly healthy subjects and have been found to increase well-being and decrease depression [41, 43], with effect sizes comparable to other psychological interventions [44, 45].”
From Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development (2015) · cites this paper as [45]
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Self-citationComparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis
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BackgroundSelf-citationDevelopment of Clinical Practice Guidelines
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“Figure 5 depicts just such a distribution based on studies comparing psychotherapy for depression to relevant controls (Cuijpers et al. 2010).”
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“This remission rate is similar to rates seen with antidepressant medications(69) and cognitive behavioral therapy.(70) Furthermore, there was a significant relation between the ability to regulate the amygdala and the degree of improvement in clinical symptoms, providing additional support for the causal role between…”
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Cybulski, Ł., Mayo‐Wilson, E., & Grant, S. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000115 · Cited by 94
Effects of cognitive bias modification on social anxiety: A meta-analysis
Liu, H., Li, X., Han, B., & Liu, X. (2017) · PLoS ONE · doi:10.1371/journal.pone.0175107 · Cited by 106
“rigorous guidance (just as for internet-delivered CBT, see [92]) for participants receiving CBM interventions delivered by the Internet, which would help guarantee consistency and quietness in the treatment environment without distractors.”
BackgroundKarlin, B. E., Walser, R. D., Yesavage, J., Zhang, A., Trockel, M., & Taylor, C. B. (2013) · Aging & Mental Health · doi:10.1080/13607863.2013.789002 · Cited by 89
Hennemann, S., Farnsteiner, S., & Sander, L. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.09.001 · Cited by 86
“Above that, the existence of a publication bias needs to be considered as a major concern in social sciences (Cuijpers et al., 2010; Rothstein, 2005).”
BackgroundDysbiotic drift: mental health, environmental grey space, and microbiota
Logan, A. C. (2015) · Journal of PHYSIOLOGICAL ANTHROPOLOGY · doi:10.1186/s40101-015-0061-7 · Cited by 80
“Given that medication and psychotherapy interventions provide only modest benefit, and estimated value may be over-inflated by publication bias [327-333], a new frontier of therapeutic hope, one that might act in synergy with first-line interventions, is most welcome.”
BackgroundBiases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research
Leichsenring, F., Abbass, A. A., Hilsenroth, M. J., Leweke, F., Luyten, P., Keefe, J. R., Midgley, N., Rabung, S., Salzer, S., & Steinert, C. (2016) · Psychological Medicine · doi:10.1017/s003329171600324x · Cited by 94
“According to two recent meta-analyses, the effects of psychotherapy for depressionalso seemtobeoverestimateddue topublication bias (Cuijpers et al. 2010; Driessen et al. 2015).”
MethodTwomey, C. D., O’Reilly, G., Bültmann, O., & Meyer, B. (2020) · PLoS ONE · doi:10.1371/journal.pone.0228100 · Cited by 79
Ebert, D. D., Harrer, M., Apolinário-Hagen, J., & Baumeister, H. (2019) · Advances in Experimental Medicine and Biology · doi:10.1007/978-981-32-9721-0_29 · Cited by 76
Approaches for synthesising complex mental health interventions in meta-analysis
Caldwell, D. M., & Welton, N. J. (2016) · Evidence-Based Mental Health · doi:10.1136/eb-2015-102275 · Cited by 79
Furukawa, T. A., Weitz, E. S., Tanaka, S., Hollon, S. D., Hofmann, S. G., Andersson, G., Twisk, J., DeRubeis, R. J., Dimidjian, S., Hegerl, U., et al. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.187773 · Cited by 73
Self-citationde Jonge, P., Wardenaar, K. J., Hoenders, R. H. J., Evans-Lacko, S. E., Kovess–Masféty, V., Aguilar‐Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Benjet, C. L., et al. (2017) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796017000774 · Cited by 77
“These data suggest that patients rate the usefulness of unconventional therapies at least similarly to conventional therapies, which is in line with the literature (Kessler et al. 2001a, b; Demling et al. 2002; D’Silva et al. 2012).”
ResultShould treatment for depression be based more on patient preference?
Winter, S., & Barber, J. (2013) · Patient Preference and Adherence · doi:10.2147/ppa.s52746 · Cited by 73
“However, there is some evidence that publication bias may be inflating estimates of effect size for psychological treatments for depression, and the true effect size may be more moderate.(14) When meta-analyses have been conducted comparing different forms of psychotherapy in the treatment of depression, results have…”
Haushofer, J., Mudida, R., & Shapiro, J. (2020) · National Bureau of Economic Research · doi:10.3386/w28106 · Cited by 76
“This compares favorably to typical effect sizes of psychotherapy on psychological outcomes, which are around 0.6–0.7 SD in the literature as a whole (Cuijpers et al. 2010; Cuijpers et al. 2013), 0.49 SD across low- and middle income countries (Singla et al. 2017), and 0.57 SD in a previous study of…”
InfluentialPositive Psychological Characteristics in Diabetes: A Review
Celano, C. M., Beale, E. E., Moore, S. V., Wexler, D. J., & Huffman, J. C. (2013) · Current Diabetes Reports · doi:10.1007/s11892-013-0430-8 · Cited by 69
David, D., Costescu, C. A., Cardoș, R. A.-I., & Mogoaşe, C. (2020) · Child & Youth Care Forum · doi:10.1007/s10566-020-09566-1 · Cited by 70
Richards, D. A., Bower, P., Chew-Graham, C. A., Gask, L., Lovell, K., Cape, J. D., Pilling, S., Araya, R., Kessler, D. S., Barkham, M., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20140 · Cited by 69
Psychotherapies for adult depression: recent developments
Cuijpers, P. (2015) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000121 · Cited by 64
Self-citationInternet-Based Interventions for Psychosis
Álvarez-Jiménez, M., Gleeson, J. F., Bendall, S., Lederman, R., Wadley, G., Killackey, E., & McGorry, P. D. (2012) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2012.06.011 · Cited by 67
No role for initial severity on the efficacy of antidepressants: results of a multi-meta-analysis
Fountoulakis, K. Ν., Veroniki, A. A., Siamouli, M., & Möller, H. (2013) · Annals of General Psychiatry · doi:10.1186/1744-859x-12-26 · Cited by 67
“authorities did not take into consideration that, peculiarly, similar findings were reported concerning psychotherapy [13-16].”
Karlin, B. E., Trockel, M., Brown, G. K., Gordienko, M., Yesavage, J. A., & Taylor, C. B. (2013) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbt096 · Cited by 65
Wanmaker, S., Geraerts, E., & Franken, I. H. A. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.12.027 · Cited by 68
Bias in emerging biomarkers for bipolar disorder
Carvalho, A. F., Köhler, C. A., Fernandes, B. S., Quevedo, J., Miskowiak, K. W., Brunoni, A. R., Machado-Vieira, R., Maes, M., Vieta, E., & Berk, M. (2016) · Psychological Medicine · doi:10.1017/s0033291716000957 · Cited by 63
“…of brain volume abnormalities (Ioannidis & Panagiotou, 2011), voxel-based morphometry neuroimaging studies (Fusar-Poli et al. 2014), the field of cognitive neurosciences (Fusar-Poli et al. 2014), and in psychotherapy trials for major depressive disorder (Cuijpers et al. 2010; Flint et al. 2015).”
BackgroundAlbus, C., Beutel, M. E., Deter, H., Fritzsche, K., Hellmich, M., Jordan, J., Juenger, J., Krauth, C., Ladwig, K., Michal, M., et al. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.02.013 · Cited by 64
“A Cochrane review [14] on various psychosocial interventions for depressive symptoms in patients with CAD found antidepressant effects comparable to those seen in the adult population in general as documented in two recent meta-analyses [15,16], when publication bias and quality of studies are accounted”
MethodClinical relevance of findings in trials of CBT for depression
Lepping, P., Whittington, R., Sambhi, R. S., Lane, S., Poole, R., Leucht, S., Cuijpers, P., McCabe, R., & Waheed, W. (2017) · European Psychiatry · doi:10.1016/j.eurpsy.2017.07.003 · Cited by 60
“It is known that there is significant publication bias in the psychotherapy literature [18], and that this may be greater than the corresponding bias in the antidepressant literature.”
BackgroundSelf-citation
Metadata
- Authors
- Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., & Andersson, G.
- Affiliations
- Amsterdam Public Health (NL)
- Trimbos Institute (NL)
- Vanderbilt University (US)
- Linköping University (SE)
- Corresponding author
- Cuijpers, Pim
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-03
- Volume
- 196
- Issue
- 3
- Pages
- 173-178
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2156110385
- Cited by
- 391
- References
- 160
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 16 · 2023: 15 · 2022: 15 · 2021: 19 · 2020: 16 · 2019: 27 · 2018: 30 · 2017: 32 · 2016: 34 · 2015: 33 · 2014: 37 · 2013: 30 · 2012: 22
- FWCI
- 8.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion)
- University of Twente Research Information (publishedVersion)
- University of Twente Research Information (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- publication bias, cognitive behavioral therapy, psychotherapy, adult depression, effect size overestimation, funnel plot asymmetry
- MeSH terms
- Adolescent, Adult, Child, Depressive Disorder, Female, Humans, Research, Statistics as Topic, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Publication Bias
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