Reviewing Psychological Treatments for Adult Depression
Notice bibliographique
Résumé
AbbreviationsAD antidepressantBA behavioural activationCAU care as usualCBT cognitive-behavioural therapyES effect sizeEXP experiential psychotherapyIPT interpersonal psychotherapyPST problem-solving therapyRCT randomized controlled trialThe 2 articles that comprise this In Review1·2 use different methods to review their respective literatures. In the first, Dr Pim Cuijpers and colleagues' conduct a meta-analysis of RCTs involving CBT in the treatment of adult depression and find CBT superior to various control conditions, comparable to alternative interventions, and better than medication alone when added in combination. In the second, Dr Jan Spijker and colleagues2 chose to do a qualitative review, given the limited number of relevant RCTs that focused on chronic major depressive disorder, and concluded that treatment was superior to its absence but that multiple successive interventions may be necessary. Both sets of conclusions seem reasonable given the available data.We come from different traditions and have different levels of comfort with the approaches used in the reviews. Dr Hollon has spent his career doing RCTs and prefers reviews that emphasize the findings from well-conducted studies. Dr Cuijpers is an experienced quantitative researcher who deals with concerns regarding study quality, using meta-regressions to explore the study characteristics that influence the estimated effects. As we concur that both reviews were nicely implemented examples of their genres, we chose to use this editorial to comment on differences arising from our different perspectives.Do quantitative reviews obscure differences between different treatments? Dr Cuijpers and colleagues' concluded, based on their meta-analysis, that CBT was superior to control conditions and not different than alternative interventions. Hollon and Ponniah1 arrived at similar but not identical conclusions in a recent qualitative review that required a minimum number of well-conducted studies to draw an inference regarding treatment impact. Using the criteria adapted from US Food and Drug Administration guidelines to identify empirically supported treatments, a treatment was said to be efficacious if it was better than its absence in at least 2 studies conducted by different research groups (possibly if only one) and specific if it was superior conditions that controlled for the generic effects of simply going into treatment.4 Using these criteria, Hollon and Ponniah1 concluded that CBT was efficacious and specific, and came to the same conclusions regarding IPT, and ADs. Where they differed from Dr Cuijpers and colleagues' was in concluding that both psychodynamic psychotherapy and EXP were only possibly efficacious (owing to the paucity of supportive trials in fully clinical populations) and drew no conclusions at all regarding supportive psychotherapy (to the extent that it differed from EXP). Quantitative reviews that estimate the average magnitude of effect across all published studies in a literature typically find no differences among bona fide therapies, whereas qualitative reviews that look for high-quality studies sometimes do. For example, ADs represent the current standard of treatment for depression and pill-placebos a particularly rigorous control. We can find studies in which the psychotherapy of interest was as efficacious as medications and superior pill-placebo for CBT/'' IPT,7 BA, and PST, but not for other kinds of psychotherap.ies.If we were to choose among the different psychotherapies, do we choose one that has been shown to be at least the equal of the AD (when it is superior to the pill-placebo)? The typical quantitative review suggests that this does not matter. The 2 approaches especially diverge when translated into treatment guidelines. Although quantitative reviews suggest that all bona fide treatments are equally effective, guidelines tend to emphasize the best-supported treatments. …
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,039 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,005 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,005 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».