Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials.

BACKGROUND: Non-responsiveness to treatment occurs in approximately one third of patients. Randomized clinical trials of psychotherapy options for these patients are scarce and systematic knowledge about whether psychotherapy is a viable option is lacking. OBJECTIVES: This meta-analysis aimed to 1) determine the amount of evidence available for treatment non-response using psychotherapy relative to pharmacological procedures; 2) systematically review randomized controlled psychotherapy trials (RCTs) used to treat non-responders; and 3) examine whether some psychotherapies are more efficacious than others. DATA SOURCES: Online databases were systematically examined and references of relevant systematic reviews were hand-searched. STUDY ELIGIBILITY CRITERIA: RCTs that administered a psychotherapy new to non-responders were considered. All Mood and Anxiety Disorders were considered. No limitations were made with respect to type of treatment. REVIEW METHOD: A meta-analytic review of the psychotherapy RCTs for treatment non-responders. RESULTS: Results showed that psychotherapy was successful in treating treatment non-responders with a medium to large effect size. Between-group comparisons did not reveal significant differences in treatment effects for any of the assessed disorder or treatment types. Effects were maintained at follow-up. CONCLUSIONS: Psychotherapy is a viable treatment option for treatment non-responders. More attention to this group of patients is needed and more research with better quality studies is warranted. Recommendations are discussed.