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Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials.

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Title: Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials.
Authors: Dragioti, E
Karathanos, V
Gerdle, B
Evangelou, E
Item Type: Journal Article
Abstract: OBJECTIVE: To map and evaluate the evidence across meta-analyses of randomized controlled trials (RCTs) of psychotherapies for various outcomes. METHODS: We identified 173 eligible studies, including 247 meta-analyses that synthesized data from 5157 RCTs via a systematic search from inception to December 2016 in the PubMed, PsycINFO and Cochrane Database of Systematic Reviews. We calculated summary effects using random-effects models, and we assessed between-study heterogeneity. We estimated whether large studies had significantly more conservative results compared to smaller studies (small-study effects) and whether the observed positive studies were more than expected by chance. Finally, we assessed the credibility of the evidence using several criteria. RESULTS: One hundred and ninety-nine meta-analyses were significant at P-value ≤ 0.05, and almost all (n = 196) favoured psychotherapy. Large and very large heterogeneity was observed in 130 meta-analyses. Evidence for small-study effects was found in 72 meta-analyses, while 95 had evidence of excess of significant findings. Only 16 (7%) provided convincing evidence that psychotherapy is effective. These pertained to cognitive behavioural therapy (n = 6), meditation therapy (n = 1), cognitive remediation (n = 1), counselling (n = 1) and mixed types of psychotherapies (n = 7). CONCLUSIONS: Although almost 80% meta-analyses reported a nominally statistically significant finding favouring psychotherapy, only a few meta-analyses provided convincing evidence without biases.
Issue Date: 27-Feb-2017
Date of Acceptance: 27-Jan-2017
URI: http://hdl.handle.net/10044/1/45822
DOI: https://dx.doi.org/10.1111/acps.12713
ISSN: 1600-0447
Publisher: Wiley
Start Page: 236
End Page: 246
Journal / Book Title: Acta Psychiatrica Scandinavica
Volume: 136
Issue: 3
Copyright Statement: © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. This is the accepted version of the following article: Dragioti E, Karathanos V, Gerdle B, Evangelou E. Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials, which has been published in final form at https://dx.doi.org/10.1111/acps.12713
Keywords: Science & Technology
Life Sciences & Biomedicine
Psychiatry
psychotherapy
meta-analysis
treatment
randomized controlled trial
COGNITIVE-BEHAVIORAL THERAPY
STATISTICAL SIGNIFICANCE
COMPLEX INTERVENTIONS
PUBLICATION BIAS
CLINICAL-TRIALS
DEPRESSION
EFFICACY
DISEASE
EXCESS
ASSOCIATIONS
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status: Published
Appears in Collections:School of Public Health