E Dragioti1,2, V Karathanos1, B Gerdle2, E Evangelou1,3. 1. Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece. 2. Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden. 3. Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
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.
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.
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