The new Caucus-race: Methodological considerations for meta-analyses of psychotherapy outcome.

Abstract

The Dodo Bird Verdict (DBV)-the proposition that all psychotherapies are equally effective-remains bitterly contested by researchers, who have mainly used meta-analyses as the primary tool to adjudicate the disagreements about relative psychotherapy efficacy. However, the meta-analytic literature remains inconclusive and contradictory, due in part to heterogeneity in researchers' methodological and statistical decisions. We undertake a review of a number of recent meta-analyses of psychotherapy outcomes to highlight key methodological issues in the DBV meta-analytic literature. Issues under consideration include the inclusion of direct versus indirect comparisons; the restriction of analyses to bona fide rather than intent-to-fail treatments; the outcomes to be included and distinguished in the analysis (e.g., primary and secondary outcomes, outcomes at termination and at follow-up, intent-to-treat and completer analyses); methods for effect size aggregation; the question of what constitutes a clinically significant effect size; search strategies for locating primary studies; statistical considerations; and possible moderators for use in metaregression analysis, including treatment class, disorder, allegiance, and methodological quality. We conclude with recommendations for ensuring that meta-analytic assessments of the DBV are both accurate and even-handed. Public Significance StatementTo reduce the burden of mental health difficulties and maximize clients' well-being, it is critical to be able to determine which, if any, psychotherapies should be considered first-line treatment options. Meta-analyses undertaken with consistent and accurate methodologies will be key to making such determinations.

The moderating and mediating role of telepresence and cognitive change in cognitive behaviour therapy delivered via videoconference

“…This hypothesis is inconsistent with our results. Assertions about the predominant role of common psychotherapy factors have been criticized because they are often based on the findings of meta‐analyses that aggregate very different disorders (e.g., Sanders & Hunsley, 2018). There is no question that a sound working alliance is a necessary condition for effective psychotherapy, including CBT (e.g., Beck et al, 1985; Castonguay & Beutler, 2006).…”

Does Researcher Allegiance Bias Outcomes in Psychotherapy Research? A Quasi‐Experimental Secondary Analysis

“…To generate a pool of RCTs that could be paired, we reviewed the reference sections of studies that had meta‐analysed treatment comparison studies. Both Sanders and Hunsley (2018) and Wampold and Imel (2015) reviewed such meta‐analyses. These reviews along with a search of PsycINFO and the Publicly Available Content Database on 5 May 2019 using the search terms ‘meta‐analysis of comparative outcome studies’, ‘meta‐analysis of direct comparisons’ and ‘therapy versus therapy meta‐analysis’ were used to identify relevant meta‐analyses.…”

The practice of psychotherapy in Quebec: What have we learned from clinicians, and where should we take it from here.

“…Researchers have examined it from every angle and have demonstrated that it has positive effects on mental health, and can reduce the economic burden of mental illness (American Psychological Association, 2013; Australian Psychological Society, 2010; Fansi, Jehanno, Lapalme, Drapeau, & Bouchard, 2016; Hunsley, Elliott, & Therrien, 2014; Vasiliadis, Dezetter, Latimer, Drapeau, & Lesage, 2017), while many psychologists and other clinicians have made it the core of their clinical practice (Hunsley, Ronson, & Cohen, 2013; Ionita & Fitzpatrick, 2014). The November 2018 issue of Canadian Psychology , which was entirely dedicated to psychotherapy, illustrates the richness of the literature on psychotherapy, with papers that discuss such critical issues as the need for publicly funded psychotherapy and for greater access to psychotherapy, including in remote areas, the importance of self-care and of well-being amongst therapists, change and improvement with psychotherapy, the economic implications of offering therapy, the legal and ethical considerations related to treating specific populations, differences between various groups of practitioners, or the strengths and weaknesses of the methods used to examine the efficacy of therapy (Gajic-Veljanoski et al, 2018; Jimenez-Arista, Tracey, & Levy, 2018; Kalegeropoulos, Roquet, Sztopa, Bradley, & Drapeau, 2018; Laverdière, Kealy, Ogrodniczuk, & Morin, 2018; Lints-Martindal, Carlson, Goodwin, & Thompson, 2018; Maranzan et al, 2018; Mathews, 2018; McPhail, Stephens, & Heasman, 2018; Sanders & Hunsley, 2018; Tasca, Town, Abbass, & Clark, 2018). More importantly perhaps, psychotherapy has also recently received attention from policymakers.…”