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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 ( IF 22.8 ) Pub Date : 2022-02-14 , DOI: 10.1159/000521951
Thomas Munder 1 , Alessia Geisshüsler 1 , Tobias Krieger 2 , Johannes Zimmermann 3 , Markus Wolf 1 , Thomas Berger 2 , Birgit Watzke 1
Affiliation  

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 #x3c; 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.
Psychother Psychosom


中文翻译:

照常治疗的强度及其对面对面和基于互联网的抑郁症心理治疗效果的影响:随机对照试验的预注册荟萃分析

简介:照常治疗 (TAU) 是抑郁症心理治疗随机试验中最常用的对照组。有人担心 TAU 治疗的异质性会导致对心理治疗效果的估计有偏差,并导致 TAU 与等待名单 (WL) 等对照组之间存在不明确的差异。目的:我们调查了对照组强度(即提供常见抑郁症治疗的数量和程度)对面对面和基于互联网的抑郁症心理治疗效果的影响。方法:我们进行了预先注册的荟萃分析 (www.osf.io/4mzyd)。我们纳入了在有单相抑郁症状的患者中比较心理治疗与 TAU 或 WL 的试验。六个指标用于评估对照组的强度。主要结果:治疗终止时心理治疗和抑郁症状控制的标准化平均差 (SMD)。结果:我们纳入了 89 项试验,将 14,474 名患者随机分配到 113 种心理治疗条件和 89 个对照组(42 项试验中为 TAU,47 项试验中为 WL)。对照组强度预测预注册(单侧p s #x3c;0.042)和探索性分析的试验结果。心理治疗效果明显更小(单侧p= 0.002)在 TAU 强度较高的试验中(SMD = 0.324,CI 0.209 至 0.439)比在 TAU 强度较低的试验中(SMD = 0.628,CI 0.455 至 0.801)。针对较低强度 TAU 的心理治疗效果与针对 WL 的效果没有差异(双侧p = 0.663)。结论:我们的结果表明,TAU 强度的变化会影响试验的结果。建议对临床试验对照组的设计进行更仔细的审查。
心理治疗师
更新日期:2022-02-14
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