To manualize, or not to manualize: Is that still the question?

To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

Abstract
Objective: Institutional promotion of psychotherapy man- uals as a requirement for evidence‐based treatments (EBTs) yields the assumption that manualized treatment is more effective than nonmanualized treatment. This systematic review examines empirical evidence for this claim.
Methods: An electronic database search identified studies that directly or indirectly compared manual‐based and non‐manual‐based treatment.
Results: Six studies directly compared manualized and nonmanualized treatment (Hypothesis 1). None support manual superiority. Eight meta‐analyses indirectly assessed effect sizes of manual‐based treatment and control groups (Hypothesis 2). Three support manual superiority, five do not. One meta‐analysis and 15 further studies addressed manual adherence as an indirect indicator of manual efficacy (Hypothesis 3). The meta‐analysis concluded that manual adherence does not affect outcome, additional studies provided inconclusive results.
Conclusions: Manualized treatment is not empirically supported as more effective than nonmanualized treatment. While manual‐based treatment may be attractive as a research tool, it should not be promoted as being superior to nonmanualized psychotherapy for clinical practice.

Keywords
empirically supported treatment, evidence‐based treatment, manual‐based treatment, manualization, psychotherapy, treatment efficacy

Persbericht (In Dutch)
Persbericht To manualize or not to manualize, is that still the question

To cite this article
Truijens, F., Zühlke-van Hulzen, L., & Vanheule, S. (2018). To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment. Journal of Clinical Psychology, DOI: 10.1002/jclp.22712.

 

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The Ghent Psychotherapy Study (GPS)

The Ghent Psychotherapy Study (GPS) on the differential efficacy of supportive-expressive and cognitive behavioral interventions in dependent and self-critical depressive patients : study protocol for a randomized controlled trial

The_Ghent_Psychotherapy_Study_GPS_on_the_different

Abstract

Background: Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology.

Methods/design: This study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1:1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16–20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16–20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs.

Discussion: This trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients.

Trial registration: Isrctn.com, ISRCTN17130982. Registered on 2 February 2015.

Keywords
Major depressive disorder, Cognitive behavioral therapy, Short-term psychodynamic psychotherapy, Personality styles

 

To cite this article

 

Meganck, R., Desmet, M., Bockting, C., Inslegers, R., Truijens, F., De Smet, M., De Geest, R., et al. (2017). The Ghent Psychotherapy Study (GPS) on the differential efficacy of supportive-expressive and cognitive behavioral interventions in dependent and self-critical depressive patients : study protocol for a randomized controlled trial. TRIALS, 18(1), DOI: 10.1186/s13063-017-1867-x.

 

Do the numbers speak for themselves?

Do the numbers speak for themselves? A critical analysis of procedural objectivity in psychotherapeutic efficacy research

Abstract
Psychotherapyresearchisknownforitspursuitofevidence-basedtreatment (EBT). Psychotherapeutic efficacy is assessed by calculation of aggregated differences between pre treatment- and post treatment symptom levels. As this ‘gold standard methodology’ is regarded as ‘procedurally objective’, the efficacy number that results from the procedure is taken as a valid indicator of treatment efficacy. However, I argue that the assumption of procedural objectivity is not justified, as the methodology is build upon a problematic numerical basis. I use an empirical case study to show (1) how measurement problems practically occur in the first step of data collection, i.e. in individual symptom measurement. These problems have been discussed and acknowl- edged for decades, but still measurement is regarded as the best epistemic means to gain evidence on psychotherapeutic efficacy. Therefore, I show (2) how initial mea- surement problems are overlooked in the remainder of the methodological procedure, which harms the ‘evidence-base’ of psychotherapeutic EBT. Via this applied analy- sis, I exhibit concerns that are increasingly raised in the literature in an empirical way, to emphasize the need for a non-idealized consideration of the ‘gold standard methodology’ as a means towards its clinical end.

Keywords
Procedural objectivity · Psychotherapy research · Efficacy research ·Symptom measurement · Quantitative research · Evidence-based treatment ·Methodological validity

To cite this article

Truijens, F. L. (2017). Do the numbers speak for themselves? A critical analysis of procedural objectivity in psychotherapeutic efficacy research. Synthese, 194(12), 4721–4740.

Truijens (2016). Do the number speak for themselves?