Are the specific techniques used by different psychotherapists likely to help people with depression?

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Non-directive supportive therapy (NDST) has been defined as “a psychological treatment in which therapists do not engage in any therapeutic strategies other than active listening and offering support, focusing on participants’ problems and concerns” (Arean et al., 2010).

We know from research studies that there are many types of psychological therapy that work well in treating depression in adults. These include cognitive behaviour therapy, interpersonal psychotherapy, behavioural activation therapy and problem-solving therapy.

However, the meta-analyses that have been conducted over recent years have failed to show any significant differences in the effectiveness of these different treatments, which has led some researchers to speculate that most effects of psychological treatments are caused by common, non-specific factors and not by particular techniques (Cuijpers, 1998).

In 1992 Michael Lambert published a book in which he estimated that 40% of the improvement in clients was caused by extra-therapeutic change, 30% by the therapeutic relationship, 15% by client expectations, and the remaining 15% by specific techniques (Lambert, 1992).

This new study is the first meta-analysis to compare non-directive supportive therapy (NDST) with controls and other psychotherapies in the treatment of adult depression. A main objective of the research was to estimate the contribution that different factors had on recovery.

The research team found 31 studies (involving 2,508 patents in total) to include in their analysis. They searched the www.evidencebasedpsychotherapies.org database, which is a continuously updated database of randomised controlled and comparative studies examining the effects of psychotherapy for adult depression. The quality of the included studies was varied, with 8 of the 31 studies meeting all of the quality criteria and 12 meeting 3 out of 4.

Here’s what they found:

  • NDST is effective in the treatment of depression in adults (g = 0.58; 95% CI: 0.45–0.72)
  • NDST appears to be less effective than other psychological therapies, but these differences disappear when the analysis controls for researcher allegiances. Put another way, studies written by researchers who have a vested interest in a specific therapy tend to over-estimate the effects of that treatment (surprise surprise)
  • The research team estimated that:
    • Extra-therapeutic factors (including spontaneous recovery and community resources) are responsible for 33.3% of improvement
    • Non-specific factors are responsible for 49.6% of improvement
    • Specific factors are responsible for 17.1% of improvement

The researchers concluded:

Despite it’s limitations, this study has made it clear that NDST has a considerable effect on mild to moderate depression, that most of the effects of therapy for adult depression is accounted for by non-specific factors, and that the contribution of specific techniques in these patients is limited at best and may in fact be absent for many.

Links

  1. Cuijpers, P et al. The efficacy of non-directive supportive therapy for adult depression: A meta-analysis. Clinical Psychology Review 32, 2012, 280–291. [PubMed abstract]
  2. Arean, P. A. et al (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. The American Journal of Psychiatry, 167, 1391–1398.
  3. Cuijpers, P. (1998). Minimising interventions in the treatment and prevention of depression: Taking the consequences of the ‘Dodo bird verdict’. Journal of Mental Health, 7, 355–365. [Abstract]
  4. Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross, & M. R. Goldfield (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books.
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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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