Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials.
Acta Psychiatr Scand
; 136(3): 236-246, 2017 09.
Article
em En
| MEDLINE
| ID: mdl-28240781
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Psicoterapia
/
Ensaios Clínicos Controlados Aleatórios como Assunto
/
Metanálise como Assunto
/
Avaliação de Resultados em Cuidados de Saúde
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Acta Psychiatr Scand
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Grécia