On this week’s episode of the Evidence Based Therapist – where we read so you don’t have to (but we hope you do), Bridger and Caleb discuss a meta-analysis comparing 15 evidence-supported therapies for adult depression.

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Cognitive-Behavioral Therapies 

  • Focused on how the patient’s dysfunctional thoughts impact behavior and functioning 
  • Three specific types:
    • Beck’s Manual
    • A Coping with Depression Course
    • A guided self-help book
  • Importantly, the analysis found they all had a significant impact on depression
  • However, we may need to reevaluate how we assess for depression
  • Because a book should not have the same effect as therapy with human interaction
  • Short-term studies can misses outcomes

Behavioral Activation Therapies 

  • Core: “registration of pleasant activities and the increases of positive interactions between a person and their environment”
  • Four specific types
  • However, only two have sufficient trials to be reported:
    • Pleasant activity scheduling
    • Contextual behavioral activation 
  • The patient may need motivational interviewing to maintain practices 

Problem-Solving Therapy

  • Involves defining problems and figuring out a plan to implement the best solution 
  • Three specific types:
    • Extended problem-solving therapy
    • Brief problem-solving therapy
    • Self-examination therapy

Third-Wave CBTs

  • Heterogenous groups of therapies that introduced new techniques to cognitive therapies
  • Less rigid than classic CBT
  • Two specific types:
    • Acceptance and Commitment therapy
    • Mindfulness CBT
  • Importantly, feelings are meaningful 
  • Additionally, there was a decrease in reporting bias with newer therapies 

Interpersonal Psychotherapy (IPT)

  • Highly-structured therapy that addresses interpersonal issues and depression 
  • Three specific types:
    • Psychodynamic Therapy
    • Non-Directive Supportive Therapy
    • Life-Review Therapy 

“The human relationship- that’s what forms and shapes the brain and so that’s what is going to heal a brain that’s become dysregulated. That’s become traumatized. That’s become stuck in these patterns.”

  • The meta-analysis is not going to tell you with certainty what to do
  • Because there is no one thing that will heal everything 

Discussion

  • The types of therapies reviewed in this article are very different from each other 
  • And they were statistically supported as treatments for depression
  • However, there was a range of effectiveness among the different therapies 
  • Because of  potential issues with publication bias and other biases, 
  • The effects may be overestimated when all studies are taken together 
  • This can mislead practitioners
  • Because they expect to see a larger effect than they may actually get  
  • While all the therapies had comparable results, they don’t necessarily work in the same way
  • Which is a limitation of meta-analyses
  • Unless there is consideration for the relationship between therapist and patient, the effect of the therapeutic relationship can’t be statistically observed 
  • While there are limits to quantitative research, it can be a very important source of aid and support 

Season 2 Articles

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Credits 

Executive Directors: Jennifer and Ryan Savage, Melissa Bentinnedi, Bridger Falkenstein
Hosts: Bridger Falkenstein, Caleb Boston, and  Melissa Benintendi
Filmographer: Tyler Wassam
Podcast Editor: Jamie Eggert
Original Music Composers: Bridger Falkenstein and Caleb Boston
Show Notes: Jamie Eggert & Jordan Murray