Munder, Thomas; Geisshüsler, Alessia; Krieger, Tobias; Zimmermann, Johannes; Wolf, Markus; Berger, Thomas; Watzke, Birgit (2022). Intensity of Treatment as Usual and Its Impact on the Effects of Face-to-Face and Internet-Based Psychotherapy for Depression: A Preregistered Meta-Analysis of Randomized Controlled Trials. Psychotherapy and psychosomatics, 91(3), pp. 200-209. Karger 10.1159/000521951
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INTRODUCTION
Treatment as usual (TAU) is the most frequently used control group in randomized trials of psychotherapy for depression. Concerns have been raised that the heterogeneity of treatments in TAU leads to biased estimates of psychotherapy efficacy and to an unclear difference between TAU and control groups like waiting list (WL).
OBJECTIVE
We investigated the impact of control group intensity (i.e., amount and degree to which elements of common depression treatments are provided) on the effects of face-to-face and internet-based psychotherapy for depression.
METHODS
We conducted a preregistered meta-analysis (www.osf.io/4mzyd). We included trials comparing psychotherapy with TAU or WL in patients with symptoms of unipolar depression. Six indicators were used to assess control group intensity.
PRIMARY OUTCOME
Standardized mean difference (SMD) of psychotherapy and control in depressive symptoms at treatment termination.
RESULTS
We included 89 trials randomizing 14,474 patients to 113 psychotherapy conditions and 89 control groups (TAU in 42 trials, WL in 47 trials). Control group intensity predicted trial results in preregistered (one-sided ps < 0.042) and exploratory analyses. Psychotherapy effects were significantly smaller (one-sided p = 0.002) in trials with higher intensity TAU (SMD = 0.324, CI 0.209 to 0.439) than in trials with lower intensity TAU (SMD = 0.628, CI 0.455 to 0.801). Psychotherapy effects against lower intensity TAU did not differ from effects against WL (two-sided p = 0.663).
CONCLUSIONS
Our results suggest that variation in TAU intensity impacts the outcome of trials. More scrutiny in the design of control groups for clinical trials is recommended.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
07 Faculty of Human Sciences > Institute of Psychology > Clinical Psychology and Psychotherapy |
UniBE Contributor: |
Krieger, Tobias, Berger, Thomas (B) |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0033-3190 |
Publisher: |
Karger |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
21 Feb 2022 13:46 |
Last Modified: |
29 Mar 2023 23:38 |
Publisher DOI: |
10.1159/000521951 |
PubMed ID: |
35158363 |
Uncontrolled Keywords: |
Depression Meta-analysis Psychotherapy Randomized controlled trial Treatment as usual |
BORIS DOI: |
10.48350/165806 |
URI: |
https://boris.unibe.ch/id/eprint/165806 |
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