Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis

Pim Cuijpers; Clara Miguel; Marketa Ciharova; Mathias Harrer; Djordje Basic; Ioana A Cristea; Nino de Ponti; Ellen Driessen; Jessica Hamblen; Sadie E Larsen; Minoo Matbouriahi; Davide Papola; Darin Pauley; Constantin Y Plessen; Rory A Pfund; Kim Setkowski; Paula P Schnurr; Wouter van Ballegooijen; Yingying Wang; Heleen Riper; Annemieke van Straten; Marit Sijbrandij; Toshi A Furukawa; Eirini Karyotaki

doi:10.1002/wps.21203

Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis

World Psychiatry. 2024 Jun;23(2):267-275. doi: 10.1002/wps.21203.

Authors

Pim Cuijpers^{1

2}, Clara Miguel¹, Marketa Ciharova¹, Mathias Harrer³, Djordje Basic¹, Ioana A Cristea⁴, Nino de Ponti¹, Ellen Driessen^{5

6}, Jessica Hamblen^{7

8}, Sadie E Larsen^{7

9}, Minoo Matbouriahi¹, Davide Papola^{10

11}, Darin Pauley¹, Constantin Y Plessen^{1

12}, Rory A Pfund¹³, Kim Setkowski^{14

15}, Paula P Schnurr^{7

8}, Wouter van Ballegooijen^{1

16}, Yingying Wang¹, Heleen Riper^{1

16}, Annemieke van Straten¹, Marit Sijbrandij¹, Toshi A Furukawa¹⁷, Eirini Karyotaki¹

Affiliations

¹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
² International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
³ Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany.
⁴ Department of General Psychology, University of Padua, Padua, Italy.
⁵ Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
⁶ Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, The Netherlands.
⁷ National Center for PTSD, White River Junction, VT, USA.
⁸ Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
⁹ Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁰ Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
¹¹ Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
¹² Department of Psychosomatic Medicine, Charité Universitätsmedizin Berlin; Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
¹³ Tennessee Institute for Gambling Education & Research, Department of Psychology, University of Memphis, Memphis, TN, USA.
¹⁴ Research Department, 113 Suicide Prevention, Amsterdam, The Netherlands.
¹⁵ Department of Pedagogical and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands.
¹⁶ Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹⁷ Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

Abstract

Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.

Keywords: Psychotherapies; borderline personality disorder; depression; generalized anxiety disorder; obsessive‐compulsive disorder; panic disorder; post‐traumatic stress disorder; response rates; social anxiety disorder; specific phobia.