Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials

• Published in: Clinical psychology review 2020-02, Vol.75, p.101810-101810, Article 101810
• Main Authors: Gloster, Andrew T., Rinner, Marcia T.B., Ioannou, Myria, Villanueva, Jeanette, Block, Victoria J., Ferrari, Giovanna, Benoy, Charles, Bader, Klaus, Karekla, Maria
• Format: Article
• Language: English
• Subjects: Anxiety; Depression; Meta-analysis; Nonresponse; Psychotherapy; Treatment-resistant
• ISSN: 0272-7358; 1873-7811
• DOI: 10.1016/j.cpr.2019.101810

Non-responsiveness to treatment occurs in approximately one third of patients. Randomized clinical trials of psychotherapy options for these patients are scarce and systematic knowledge about whether psychotherapy is a viable option is lacking. This meta-analysis aimed to 1) determine the amount of evidence available for treatment non-response using psychotherapy relative to pharmacological procedures; 2) systematically review randomized controlled psychotherapy trials (RCTs) used to treat non-responders; and 3) examine whether some psychotherapies are more efficacious than others. Online databases were systematically examined and references of relevant systematic reviews were hand-searched. RCTs that administered a psychotherapy new to non-responders were considered. All Mood and Anxiety Disorders were considered. No limitations were made with respect to type of treatment. A meta-analytic review of the psychotherapy RCTs for treatment non-responders. Results showed that psychotherapy was successful in treating treatment non-responders with a medium to large effect size. Between-group comparisons did not reveal significant differences in treatment effects for any of the assessed disorder or treatment types. Effects were maintained at follow-up. Psychotherapy is a viable treatment option for treatment non-responders. More attention to this group of patients is needed and more research with better quality studies is warranted. Recommendations are discussed. •RCTs demonstrate a medium effect size for psychotherapies targeting treatment non-responders.•Psychotherapies are efficacious for improving symptoms and quality of life.•Psychotherapy should be considered and further studied as an option for treatment non-response.