Affiliation:
1. Department of Psychology University of British Columbia Vancouver BC Canada
Abstract
AbstractBackgroundMeta‐analyses on the relative efficacy of psychodynamic psychotherapy (PDT) and cognitive behavioral therapy (CBT) for depressive disorders are limited by heterogeneity in diagnostic samples and comparators and a lack of equivalence testing.ObjectiveWe addressed this through a meta‐analytic test of the equivalence of manualized PDT and CBT in treating adults with depressive disorders as determined by diagnostic interviews. Sensitivity analyses evaluated the impact of pretreatment differences, mixed diagnostic samples, author allegiance, study quality, year of publication and outliers on findings.MethodA comprehensive literature search across multiple databases using reliable screening methods identified nine randomized controlled trials directly comparing manualized PDT and CBT for diagnosed depressive disorders in adults. Following pre‐registration, we employed random effect models for our meta‐analyses and two one‐sided test procedures for equivalence testing.ResultsIndependent raters determined that all studies were of adequate quality. Immediately posttreatment, depressive symptoms were statistically equivalent across PDT and CBT (k = 9; g = −0.11, 90% confidence interval [90% CI]: −0.24 to 0.02, pequivalence = .048, pNHST = .212, I2 = 32.7). At follow‐up, the longest time point within a year, depressive symptoms were neither statistically equivalent nor statistically different (k = 6; g = −0.16, 90% CI: −0.31 to −0.02, pequivalence = .184, pNHST = .126, I2 = 0.00).ConclusionThe efficacy of manualized PDT is equal to manualized CBT immediately at posttreatment for depressive disorders in the adult general population. Nevertheless, insufficient data exists to reach a conclusion regarding equivalence at follow‐up.