Comps Afternoon Session cheat sheet
I. DEPRESSION
Psychotherapy in general: combination w/ Rx significantly better than Rx alone, with potentially
greater efficacy in more severe or chronic major depression (Cuijpers, 2011, m-a) IPT: (Cuijpers,
2011) vs control groups, medium to large effects on acute tx of depression. Combined w/ Rx = only
slightly more efficacious than Rx alone (small effect). No more efficacious than CBT ERP:
combined w/ CR, is efficacious, d= 0.84 Emotion-focused: modest Mindfulness-based interventions
(MBIs): Associated with medium-large effect sizes (d = .59) for those with depression in improving
depressive symptoms compared to no tx post-treatment. (Goldberg, 2018, sys rev & m-a) GAPS:
Lack of RCTs for other psychotherapies, antidepressant medication, combination txs,
telepsychology.
Major Depressive disorder [101 RTCs] (Hollon & Ponniah, 2010 review of meta-analyses)
Dynamic Psychotherapy (PE). Enhanced outcomes with Rx but not better than Rx when alone.
Improvements above routine care. Evidence is lacking for geriatric depression Interpersonal
psychotherapy (~ES). Improvements in interpersonal functioning > Rx. Delayed gains (ie. slower)
relative to Rx. Recent studies inconsistent with past. Canadian and New Zealand study showed IPT
< Rx, CT, respectively, but other studies show efficacy reducing relapse/recurrence while maintained
Cognitive behavioural (ES). CT and RE(rational emotive)BT = Rx efficacy, but more cost effective.
CT enhances Rx and usual care. CT efficacious and specific for remission and recurrence.
(Hofmann, 2012, rev of m-a’s) More effective than control (waitlist and no tx), medium effect size;
compared to other txs: mixed, equally effective in some studies, evidence that superior to relaxation
technique at post-tx Behavioural (ES). Only one Prob-sol (PST) study used placebo-pill control,
leading to ‘E + possibly specific.’ Behavioral Activation (BA) more efficacious than CT and
supportive psychotherapy with severe/inpatient MDD (BA is ‘ES’). Behavioral Marital therapy
(BMT) only more effic than CBT if marital problems present, more effic at reducing marital stress
than CT (overall BMT is ‘PE’, due to small samples and few studies) Experiential-humanistic (PE).
EFT superior outcomes to client-centered (CCT), and less relapse. When humanistic and
interpersonal strategies integrated into standard CT, integrative approach > WL and unintegrated
CT. CT = process experiential (PET) Marital/family (NES). Too few with mixed results.
Dysthymic Disorder [9 RCTs] (Hollon & Ponniah, 2010 review of meta-analyses)
Dynamic Psychotherapy (NES). Brief dynamic (BDT) and Brief Supportive (BSP) > WL in
9month+ of Treatment; BDT > BSP after 6-month follow-up. *Only 1/3 of sample met criteria for
dysthymic disorder Interpersonal Psychotherapy (PE). IPT < Rx alone, and IPT+Rx did not
enhance efficacy over Rx alone compared to brief supportive control. Another study found IPT >
BSP for dysthymia w secondary substance abuse or dependence Cognitive behavioural (NES).
Traditional CBT little Rx enhancement. Not different from placebo in large sample study. No Rx
difference in smaller trials. CBT modifications are under development and testing. (Hofmann, 2012)
More effective than control (waitlist and no tx), medium effect size. Compared to other txs: mixed,
equally effective in some studies, evidence that superior to relaxation technique at post-tx
Behavioural (NES). 6-sessions of PST same as Rx (both better than placebo) for dysthymia and
minor depression, but < Rx in geriatric sample study.
Bipolar [15 RCTs](Hollon & Ponniah, 2010 review of meta-analyses)
Psychoeducational (E for mania, PE for depression). Adding to Rx, and giving to caregivers, both
found to reduce risk for relapse/ recurrence with respect to mania/hypomania but not depression.
One study found psychoEd > non-specific support group for prevention of depression.
IPT (PE). Interpersonal social rhythms (IPSRT) as adjunct to Rx showed same time to sx
stabilization as intensive clinical management, but IPSRT showed longer delay to next mood episode
in 2yr follow-up study. A second study found when 3 psychotherapies, including IPSRT were pooled
vs a collaborative care condition, the psychotherapies were superior collectively on time to recovery
Comps Afternoon Session cheat sheet
and proportion recovered CBT (E). CT added to Rx improved global functioning and reduced
depressive symptoms and relapse. One large study found contrary evidence that CBT was no more
efficacious than TAU (Rx), however the attrition rate was 40%. (Hofmann, 2012) generally
small-medium effect sizes at post-tx, gradually diminishing at f/u, no evidence that it is effective as
standalone. Evidence for CBT preventing or delaying relapse Family Focused (E). FFT >
collaborative care control in the treatment of depression. 9-month FFT reduced depressive
symptoms and risk for relapse up to 2yrs relative crisis management intervention. Better Rx
adherence and reduced recurrence hospitalizations at 1yr follow-up Systematic Care: strong support
for mania symptom management
II. ANXIETY DISORDERS
CBT: reliable first-line tx in general (Hofmann, 2012) Mindfulness-based interventions (MBIs):
Associated with large effect sizes (d = 0.89) for those with anxiety disorders in improving anxiety
symptoms compared to no tx post-treatment. (Goldberg, 2018)
Generalized Anxiety Disorder (Cuijpers, 2014, m-a) waitlist controls, outcome= symptoms
Psychotherapy in general: Large effect, Hedges’ g of 0.84; odds ratio (OR) for + outcome = 1.53
CBT: Large effect, Hedges’ g of 0.90 (28 studies). (Hofmann, 2012) superior to pill placebo and
control conditions. Occupational stress: CBT, especially when focused on psycho-social outcomes,
more effective compared to other interventions (large effect size); unclear if CBT alone best, or in
combination with other components Behavioral: Minimal evidence (3), medium effect, Hedges’ g of
0.57 ERP: large effect (d= 1.64), (Abramowitz, 1996) Applied Relaxation: Minimal evidence (3),
large effect, Hedges’ g of 0.86 CBT vs. Relax f/u’s: CBT better for all f/u times (OR= 1.97)
Panic Disorder
CBT: Combination w/ applied relaxation equal in efficacy to either alone, all superior to use of
medications. For Panic disorder w/ agoraphobia, in vivo exposure effective, & interoceptive exposure
moderately effective and superior to control/pill placebo txs and applied relaxation Applied
Relaxation: modest support; large improvements found at post-tx & f/u, no diff w/CBT
Psychoanalytic: modest support, but controversial; unclear if improvements are from mechanism
(reduction of unconscious conflicts) Gap: research examining DSM-5 Agoraphobia (sep from PD)
Specific Phobia
CBT/exposure therapies: Strong support. Multiple techniques (systematic desensitization, exposure,
CT) with large effect sizes post-tx and long-term. As effective as applied relaxation and applied
muscle tension. (Hofmann, 2012). In vivo exposure, applied muscle tension, VR exposure, systematic
desensitization.
Social Anxiety Disorder
CBT: (Hofmann, 2012) medium to large effect sizes immediately post-tx (vs control or waitlist tx),
lasting effects at f/u’s. Superior performance over psychopharmacology in long-term
(Mayo-Wilson et al., 2014, systematic review and meta-analysis)—waitlist
*Individual CBT. Waitlist—greater effects on outcome (symptoms), large (standardized mean
difference= 1.19, effects on recovery (Risk Ratio= 6.32)). Placebo psychotherapy—medium (.56,
RR= 2.02). Placebo pill—medium-large (.72, RR= 2.64). Greater effect compared to Psychodynamic
Psychotherapy (.56), IPT and Mindfulness (.82) Group CBT. Waitlist—greater effects on outcome,
large (effect SMD= .92). Placebo pill—small-medium (.45, RR= 1.89) Exposure and Social Skills.
Waitlist—greater effects on outcome, large (effect SMD= .86). Exposure in vivo: large effect (.83);
Social skills training (1 trial): large effect (.88) Psychodynamic Psychotherapy. Waitlist—greater
effects on outcome, medium (.62) IPT, Mindfulness: Waitlist—little data, gen small effects
PTSD (Cusack et al., 2016 systematic review & meta-analysis)
CT. Efficacy: Moderate strength of evidence (SOE) for improving PTSD symptoms, loss of PTSD
diagnosis, improving depression and anxiety symptoms, reducing disability. Cognitive processing
Comps Afternoon Session cheat sheet
therapy (CPT) in particularly, moderate SOE for loss of diagnosis, but insufficient for remission,
anxiety symptoms, QOL, disability or functioning, return to work/active duty.
Relaxation/stress inoculation training. Efficacy: Insufficient evidence *Exposure therapy.
Efficacy: High SOE for improving PTSD symptoms, moderate loss of dx, high improving
depressive symptoms. Includes mainly Prolonged Exposure (imaginal + in vivo exposure).
Insufficient evidence for remission, anxiety, QOL, disability/functional impairment, return to
work/active duty, though PE found to have lasting effects (up to 5 yrs post-tx; Foa & McLean, 2016)
CBT-mixed. Efficacy: Moderate SOE for improving PTSD symptoms, loss of dx, remission, and
reduction of depressive symptoms. Low SOE for reducing disability/functional impairment and
anxiety symptoms EMDR. Efficacy: Low SOE for reduction of PTSD symptoms. Moderate for loss
of dx and improving depressive symptoms. Insufficient for remission, anxiety, QOL,
disability/functional impairment, return to work/active duty Narrative Exposure Therapy (NET).
Efficacy: Moderate SOE for PTSD symptoms, low for loss of dx. Insufficient for depressive
symptoms Brief Eclectic Psychotherapy (BEP). Efficacy: Low for PTSD symptoms, dx, depression,
anxiety, returning to work.
III. OBSESSIVE-COMPULSIVE DISORDERS (OCD)
CBT: large effect, especially with combination of in vivo and imaginal exposures > in vivo only.
Similar efficacy to some medications. (Hofmann, 2012) Exposure and response prevention: Vs.
controls, large effects (d=1.35) post-tx (Olatunji, 2013). Vs. CT, no sig diff, d=0.07 (Öst, 2015). Vs.
Rx, more efficacious, not sig enhanced w/ Rx. Therapist-guided exposure > therapist-assisted
self-exposure. Individual = group Acceptance & Commitment Therapy (ACT): modest support
IV. EATING DISORDERS
CBT: (Hofmann, 2012) Bulimia—medium sized effect (vs control tx). CBT higher remission
response rate compared to control tx, medium relative risk ratio. Significantly better remission
response rates compared to other psychotherapies (IPT, dialectical behavioral therapy,
hypno-behavioral therapy, supportive psychotherapy, beh weight loss tx, & self-monitoring).
Binge-eating disorder—mixed results. Psychotherapy (19/23 trials used CBT) and structured
self-help 🡪 large effects (vs. pharmacotherapy); combination of psychotherapy + medication did not
enhance B-E outcomes, but may have enhanced weight loss outcomes. Anorexia—modest support
for post-hospitalization relapse prevention, controversial for acute weight gain Behavior therapy:
Mixed. (Hofmann, 2012): Bulimia—large effect sizes; but Shapiro et al. 2007 found no additional
benefit of ERP when added to CT
Mindfulness-based interventions (MBIs): Associated with large effect sizes (d = 0.79) for those
with eating disorders in improving outcome compared to no tx post-treatment. (Goldberg, 2018)
Healthy-weight Program: Bulimia—controversial IPT: Bulimia—strong. Tho remission rates from
tx lower than for CBT, post-tx & f/u, & slower. Binge-eating—strong support, equivalent recovery
rates post-tx & 1-yr f/u w/CBT.
V. PAIN DISORDERS/CHRONIC PAIN (fibromyalgia, lower back, headache, rheumatologic)
CBT: Small to medium effect for chronic pain. Superior to other psych tx for decreasing pain
intensity (Hofmann, 2012). Strong support for all types Acceptance and Commitment Therapy:
similar effects of CBT, improvements in pain interference, depression, pain-related anxiety; higher
satisfaction compared to CBT (Wetherell, 2011) Mindfulness-based interventions (MBIs):
Associated with medium effect sizes (d = 0.45) for those with pain disorders in improving outcome
compared to no tx post-treatment. (Goldberg, 2018)
VI. SUBSTANCE ABUSE DISORDERS
Behavioral Couples Therapy for Alcohol Use Disorders (ABCT): strong support; Moderate
Drinking (MD) for Alcohol Use Disorders: modest support Prize-based Contingency Management
Comps Afternoon Session cheat sheet
for Alcohol Use Disorders: modest (also for cocaine), strong for mixed Smoking Cessation w/
Weight Gain Prevention: modest Friends Care for Mixed Substance Abuse/Dependence: modest
Guided Self-change for Mixed Substance Abuse/Dependence: modest Motivational Interviewing,
Motivational Enhancement Therapy (MET), MET+CBT: strong Seeking Safety: strong for adults
VII. SCHIZOPHRENIA
Assertive Community Treatment (ACT): strong Cognitive Adaptation Training (CAT): modest
CBT: strong ACT: modest Cognitive Remediation: strong Family Psychoeducation: strong Illness
Management & Recovery (IMR): modest Social Learning/Token Economy Programs: strong
Social Skills Training (SST): strong Supported Employment: strong
VIII. INSOMNIA
Biofeedback-Based Txs: modest; often coupled w/ relaxation training CBT: strong; modification of
behaviors/cognitions interfering w/ sleep (~6 sessions) Paradoxical Intention: strong; staying
awake instead of trying to fall asleep (perf anx); alt: sleep restriction Relaxation Training: strong;
reduction of somatic tension (muscle rel), intrusive thoughts (medit); little diff b/w relax modalities
Sleep Restriction Therapy: strong; systematically alter sleep window🡪increase sleep efficiency
Stimulus Control Therapy: strong; reduce anx/conditioned arousal by going to bed only when
sleepy, out bed when unable to sleep, use bedroom only for sleep/sex, arise same time every
morning, avoiding naps.
IX. INPATIENT VS. OUTPATIENT
Mixed. For group psychotherapy in general, differences in pre- to post-tx improvement between
inpatient and outpatient (greater gains found for outpatient) (Burlingame, 2003; m-a) – however,
very few inpatient trials examined. General dearth of inpatient compared to outpatient. For tx of
personality disorders, inpatient > outpatient (Bartak, 2011 study). Similar improvement from
psychotherapy in inpatient setting as in outpatient: depression and anxiety > mixed, psychosomatic,
PTSD, Schizophrenia (Kosters, 2006; m-a). Inpatient > outpatient for severe psychiatric conditions,
substance abuse/addiction, and poor support systems. GAP: inpatient-outpatient direct comps
RESEARCH STUDY
Gaps: cross-cultural outcomes; 3rd wave tx for population, comorbidities/transdiagnostic research,
evaluation of other txs using same scientific rigor as more established txs
Waitlist controls and CBT group: Waitlist: control for confounding effects (events, seasons,
repeated testing (self-help initiative), measurement unreliability). CBT group because it is generally
an established, effective tx (gold standard); Follow-up period 🡪 unethical to withhold tx if there
were waitlist controls; Practically difficult to control for no “tx” (unofficial forms, e.g. religion); No
tx --> negative expectancy --> exaggeration of tx efficacy; Instead of “tx-as-usual”, CBT group
limits variability of TAU Participants. Diversity: Include wide range of demographics—allow for
variables predicting outcome, generalization, recruitment of target sample size; issue of
heterogeneity Inclusion criteria: dx of disorder, age range Exclusion criteria: PTSD--psychosis,
substance abuse/dependence, bipolar disorder, and suicidal ideation Recruitment: through media
advertisement and in treatment centers (variables) Sample size: 30 per group for large effect size;
attrition. Outcome measures: symptoms; loss of dx; remission (f/u); assessment tool w/ high
reliability, validity, sensitivity to change Intervention: standardized; keep track of competence,
adherence (+/-) (good interrater reliability); 10-12 weeks long, weekly. Procedure: f/u at 6 months
post-tx, and at 12 months; outcome ratings blind; f/u for Tx and CBT groups only. General
analysis. Ethical: access to proven intervention (for tx group) and access to potentially better tx
(CBT group), and any tx at all (waitlist); f/u (CBT instead of waitlist); return to tx during f/u
window (return does not nec mean relapse); participant diversity: for underserved, minority groups