Non-directive supportive therapy for depression: A meta-analytic review

Abstract

Background: Non-directive supportive therapy (NDST) is an important treatment of adult depression, but no recent meta-analysis has integrated the randomized trials examining its effects.

Methods: We conducted a meta-analysis comparing NDST to control conditions and to other therapies, by using an existing database of randomized trials of psychological treatments of depression in adults. This database was built through searches in PubMed, PsycINFO, Embase and the Cochrane Library.

Results: 48 randomized controlled trials (5075 participants), with 20 comparisons between NDST and a control group and 49 comparisons between NDST and another psychotherapy were included. Random effects meta-analyses found an effect size of NDST compared with control conditions of g = 0.53 (95 % CI, 0.34; 0.72) with moderate heterogeneity (I² = 51; 95 % CI: 18; 71; PI = -0.02 to 1.09). NDST was less effective than other therapies (g = -0.21; 95 % CI: -0.31; -0.11). The difference with other therapies was significantly larger in studies in which NDST was used as a control group (p = .003). There was no significant difference between NDST and other therapies in which NDST was not used as a control group (k = 14; g = -0.05; 95 % CI: -0.17; 0.07).

Conclusions: NDST probably is an effective treatment of depression. The effects may be somewhat smaller than those of other therapies, but that may also be an artefact, because NDST is often used as a control group and may be designed as an "intent-to-fail" intervention in some studies.

Keywords: Depression; Major depressive disorder; Non-directive counseling; meta-analysis.