Non-directive supportive therapy is effective for adult depression, according to new meta-analysis


We know that various psychotherapies are effective in treating adult depression, but there remains quite a bit of uncertainty about which specific therapies work best and what factors within the treatments contribute most to the improvement.

This new meta analysis from a mixed group of researchers from the Netherlands, USA, Switzerland and Sweden, looks at non-directive supportive therapy (NDST), which it defines 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.

The research team are interested in testing out the estimates made by Lambert back in 1992 concerning the relative contribution that different aspects of treatment have on patients. 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.

A reliable search was carried out and 280 randomised controlled trials on psychotherapy for depression in adults were found, 31 of which were specifically investigating supportive therapy and therefore included in the analysis. These studies included 2,508 patients in total (1,018 in the NDST conditions, 437 in control conditions, 848 in other psychotherapy conditions, and 205 in drug therapy conditions).

The quality of the 31 included studies was variable:

  • 18 did not report adequate sequence generation
  • 17 used only self-report outcomes
  • 13 studies did not carry out an intention to treat analysis
  • Overall, 8 studies met all 4 quality criteria and 12 studies met 3 of the 4 criteria

Here’s what they found:

  • Non-directive supportive therapy was an effective treatment for adult depression (g = 0.58; 95% CI: 0.45–0.72)
  • But, NDST was less effective than other psychological treatments (differential effect size g=−0.20; 95% CI: −0.32 to −0.08, p b 0.01)
  • But, the differences disappeared after controlling for researcher allegiance
  • They estimated the contribution of different factors in improving depression symptoms and presented the following results with a note that the findings should be interpreted with caution:
    • Extra-therapeutic factors (those processes operating in waiting-list and care-as-usual controls) were responsible for 33.3% of the overall improvement
    • Non-specific factors (the effects of NDST compared with control groups) for 49.6%
    • Specific factors (the effects of NDST compared with other therapies) for 17.1%


  1. Cuijpers P, Driessen E, Hollon SD, van Oppen P, Barth J, Andersson G. The efficacy of non-directive supportive therapy for adult depression: A meta-analysis. Clin Psychol Rev. 2012 Feb 8;32(4):280-291. [Epub ahead of print] [PubMed abstract]
  2. 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

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, surrounded by dogs, elflings and lots of woodland!

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