The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta-analytic review

IF 2.5 3区心理学 Q2 PSYCHOLOGY, CLINICAL

Journal of Clinical Psychology Pub Date : 2024-02-07 DOI:10.1002/jclp.23649

Martin M. Smith, Paul L. Hewitt

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Abstract

Background

Meta-analyses on the relative efficacy of psychodynamic psychotherapy (PDT) and cognitive behavioral therapy (CBT) for depressive disorders are limited by heterogeneity in diagnostic samples and comparators and a lack of equivalence testing.

Objective

We addressed this through a meta-analytic test of the equivalence of manualized PDT and CBT in treating adults with depressive disorders as determined by diagnostic interviews. Sensitivity analyses evaluated the impact of pretreatment differences, mixed diagnostic samples, author allegiance, study quality, year of publication and outliers on findings.

Method

A comprehensive literature search across multiple databases using reliable screening methods identified nine randomized controlled trials directly comparing manualized PDT and CBT for diagnosed depressive disorders in adults. Following pre-registration, we employed random effect models for our meta-analyses and two one-sided test procedures for equivalence testing.

Results

Independent raters determined that all studies were of adequate quality. Immediately posttreatment, depressive symptoms were statistically equivalent across PDT and CBT (k = 9; g = −0.11, 90% confidence interval [90% CI]: −0.24 to 0.02, p_equivalence = .048, p_NHST = .212, I² = 32.7). At follow-up, the longest time point within a year, depressive symptoms were neither statistically equivalent nor statistically different (k = 6; g = −0.16, 90% CI: −0.31 to −0.02, p_equivalence = .184, p_NHST = .126, I² = 0.00).

Conclusion

The efficacy of manualized PDT is equal to manualized CBT immediately at posttreatment for depressive disorders in the adult general population. Nevertheless, insufficient data exists to reach a conclusion regarding equivalence at follow-up.

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查看原文本刊更多论文

心理动力学疗法和认知行为疗法治疗成人抑郁障碍的等效性：荟萃分析综述。

背景：心理动力学心理疗法（PDT）和认知行为疗法（CBT）治疗抑郁障碍的相对疗效的荟萃分析受到诊断样本和比较对象的异质性以及缺乏等效性测试的限制：我们通过荟萃分析测试了根据诊断访谈确定的手动PDT和CBT治疗成人抑郁障碍的等效性，从而解决了这一问题。敏感性分析评估了治疗前差异、混合诊断样本、作者忠诚度、研究质量、发表年份和异常值对研究结果的影响：我们使用可靠的筛选方法在多个数据库中进行了全面的文献检索，发现了九项随机对照试验，这些试验直接比较了针对成人抑郁障碍诊断的手动PDT和CBT。经过预先登记，我们采用随机效应模型进行荟萃分析，并采用两个单侧检验程序进行等效性检验：独立评定员认为所有研究的质量均合格。治疗后，PDT 和 CBT 的抑郁症状在统计学上是相同的（k = 9；g = -0.11，90% 置信区间 [90% CI]：-0.24 至 0.02，等效性 = .048，pNHST = .212，I2 = 32.7）。随访时，即一年内最长的时间点，抑郁症状既无统计学上的等同性，也无统计学上的差异（k = 6；g = -0.16，90% CI：-0.31 至 -0.02，等效性 = .184，pNHST = .126，I2 = 0.00）：结论：对于成年普通人群的抑郁障碍而言，手把手指导的 PDT 与手把手指导的 CBT 在治疗后的即时疗效相当。尽管如此，目前还没有足够的数据就随访时的疗效得出结论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Psychology PSYCHOLOGY, CLINICAL-

CiteScore

5.40

自引率

3.30%

发文量

177

期刊介绍： Founded in 1945, the Journal of Clinical Psychology is a peer-reviewed forum devoted to research, assessment, and practice. Published eight times a year, the Journal includes research studies; articles on contemporary professional issues, single case research; brief reports (including dissertations in brief); notes from the field; and news and notes. In addition to papers on psychopathology, psychodiagnostics, and the psychotherapeutic process, the journal welcomes articles focusing on psychotherapy effectiveness research, psychological assessment and treatment matching, clinical outcomes, clinical health psychology, and behavioral medicine.