Evidence-Based Psychological Interventions: A Literature Review

Introduction

Numerous years of research and clinical psychology studies have illustrated that how individuals process received information — particularly with an attentional bias toward threatening information and a tendency to interpret ambiguous information negatively (interpretation bias) — plays a significant role in the onset and maintenance of depression and anxiety (Hughes et al., 2016). There is growing interest in health psychology in the application of experimental techniques to evaluate possible cognitive processing biases in health conditions such as chronic pain, irritable bowel syndrome, cancer, and chronic fatigue syndrome, as well as health behaviors like smoking, eating, and alcohol abuse. Experimental studies in these fields could inform theoretical development by allowing access to the types and levels of information processing that may underpin unhelpful disease representations and influence health behaviors. This paper aims to review evidence-based practices and programs within psychological health through a literature review of existing studies on this subject.

Background and Context

When it comes to the treatment and management of depressive disorders, psychological interventions play a key role as an alternative form of treatment. Several treatments have been developed, primarily based on cognitive-behavioral, psychodynamic, humanistic, or interpersonal approaches. According to one large network meta-analysis involving 198 randomized trials conducted on patients with depression, although the volume of evidence differed across individual treatments, the health outcomes appeared to be of similar magnitude (Barth et al., 2016).

The majority of trials included in this meta-analysis were conducted in specialized mental healthcare settings. Two important questions arise regarding the treatment and management of depression, particularly in primary care.

First, can findings from trials conducted in specialized mental healthcare settings be generalized to primary care? Patients with depression in primary care sometimes present with more somatic or less severe symptoms compared to those referred to specialty mental healthcare.

Second, the limited number and uneven geographic distribution of qualified specialists makes it challenging to provide individualized, face-to-face psychological therapy to a broad population. As a result, several interventions have been developed in which contact time with the healthcare professional is reduced and treatment is delivered electronically, by telephone, or via printed materials. It is important to understand how these less intensive psychological treatment approaches compare to more intensive conventional methods.

Description of Intervention

Cognitive behavioral therapy (CBT) is a structured approach based on the principle that cognitions influence behaviors and feelings, and that resulting emotions and behaviors can in turn affect cognitions. CBT comprises two distinct components: cognitive therapy and behavioral therapy. Behavioral therapy is founded on the concept that behavior is learned and can therefore be changed. Examples of behavioral techniques include relaxation, activity scheduling, behavior modification, and exposure.

Cognitive therapy is based on the idea that maladaptive behaviors and distressing emotions result from faulty thinking patterns. Therapeutic techniques such as self-instructional training and cognitive restructuring are therefore aimed at replacing dysfunctional thoughts and emotions with more adaptive cognitions, leading to reductions in problematic emotions, behaviors, and thoughts. In this paper, metacognitive therapy is included as a component within the broader cognitive-behavioral framework. Skills training — such as anger management, stress management, and social skills training — is another important element of CBT (Hofmann et al., 2012).

Research Method

A two-stage procedure was used for this review. In the first stage, a keyword search was conducted to identify relevant studies. The keywords used were "evidence-based psychology practice," "evidence-based cognitive biases," "evidence-based psychology health," and "evidence-based psychological interventions." A comprehensive cross-search was also carried out using various keyword combinations through the EBSCO database, which allowed for simultaneous searching across multiple databases including Alt HealthWatch, Academic Search Premier, MEDLINE, CINAHL, PsycINFO, and PsycArticles, among others. Additional searching was performed via Google Scholar and the ISI Web of Knowledge. This supplementary search included all studies that referenced psychological interventions in the abstract or title. Further relevant studies were identified from the reference lists of selected articles.

In the second stage, every identified reference was screened according to two criteria: first, the research had to be empirically grounded and evaluate the impact of evidence-based practices and programs on psychological health outcomes; and second, each study's quality was assessed in terms of research method and design, and whether the journal was peer-reviewed.

Summary of Findings

The findings from Linde et al. (2015) illustrate that, while several randomized trials have explored psychological treatments among primary care patients with depression, it remains difficult to determine whether some treatments are more effective than others. In network meta-analyses, face-to-face cognitive behavioral therapy, other individual treatments, guided self-help CBT, remote therapist-led CBT, and minimal or no-contact CBT were found to be superior to placebo or usual care. Individual problem-solving therapy (PST), individual psychodynamic therapy, remote therapist-led PST, and individual interpersonal psychotherapy did not differ significantly from placebo or usual care.

With one exception — remote therapist-led CBT was superior to individual interpersonal psychotherapy — the individual treatments did not differ significantly from one another. For CBT specifically, several delivery formats have been examined, and the results suggest that less intensive interventions produce comparable outcomes to conventional face-to-face CBT.

Although depression treatment guidelines position group CBT between high- and low-intensity evidence-based psychological interventions, the validity of this placement remains uncertain. The systematic review by Okumura and Ichikura (2014) sought to appraise the acceptability and efficacy of group cognitive-behavioral therapy for depression relative to the four psychological intervention intensity levels. Their findings revealed a moderate effect in favor of group CBT compared with inactive controls. However, there was insufficient evidence to determine whether group CBT was more effective than high- or low-intensity interventions due to the limited number of randomized controlled trials comparing these conditions.

Many individuals experience treatment-resistant depression, defined as limited or absent response to currently recommended therapies. Papageorgiou and Wells (2015) assessed the efficacy of group metacognitive therapy among patients who had not responded to either CBT or antidepressants. Following a no-treatment baseline monitoring period, ten patients received twelve two-hour weekly sessions and two post-treatment sessions, and were followed up at six months. Results indicated that metacognitive therapy was associated with significant improvements across all outcomes, including depression. Recovery rate analyses showed that 70 percent of participants were classified as recovered and 20 percent as improved.

Lenz, Hall, and Bailey Smith (2016) conducted a study to estimate the treatment effect of mindfulness-based cognitive therapy (MBCT) in a group format compared with alternative or no-treatment control conditions. A large treatment effect size favoring MBCT over waitlist control was demonstrated. Additionally, the four studies reporting follow-up data produced large effect sizes, suggesting that treatment gains were maintained over time. In comparison to alternative group interventions — such as group CBT and group psycho-education — MBCT was significantly more effective at reducing depressive symptoms, with a moderate effect size reported. This effect diminished to a small treatment advantage over time, suggesting that the relative superiority of MBCT may level out in the longer term.

Kirkham, Choi, and Seitz (2016) assessed the efficacy of PST for the treatment of major depressive disorder (MDD) in older adults through a meta-analysis and systematic review. Compared with pooled control conditions, there was a significant reduction in mean depression scores for PST participants, with a correspondingly large effect size. In studies that included a disability outcome measure, PST significantly reduced disability relative to pooled controls. Studies involving up to eight PST sessions showed greater treatment efficacy than those with eight or more sessions, with no between-group differences observed at that threshold. This review supports the existing PST literature indicating that it is an effective treatment for older adults with MDD, while also recommending further research into long-term outcomes and comparative efficacy relative to other therapies.

References

Australian Psychological Society. (2010). Evidence-based psychological interventions in the treatment of mental disorders: A literature review. Victoria: Australian Psychological Association.

Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., ... & Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. Focus, 14(2), 229–243.

Castelnuovo, G. (2017). New and old adventures of clinical health psychology in the twenty-first century: Standing on the shoulders of giants. Frontiers in Psychology, 8, 1214.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive-behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.

Hughes, A. M., Gordon, R., Chalder, T., Hirsch, C. R., & Moss-Morris, R. (2016). Maximizing the potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. British Journal of Health Psychology, 21(4), 764–780.

Kirkham, J. G., Choi, N., & Seitz, D. P. (2016). Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. International Journal of Geriatric Psychiatry, 31(5), 526–535.

Lenz, A. S., Hall, J., & Bailey Smith, L. (2016). Meta-analysis of group mindfulness-based cognitive therapy for decreasing symptoms of acute depression. The Journal for Specialists in Group Work, 41(1), 44–70.

Linde, K., Rücker, G., Sigterman, K., Jamil, S., Meissner, K., Schneider, A., & Kriston, L. (2015). Comparative effectiveness of psychological treatments for depressive disorders in primary care: Network meta-analysis. BMC Family Practice, 16(1), 103.

Okumura, Y., & Ichikura, K. (2014). Efficacy and acceptability of group cognitive behavioral therapy for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 164, 155–164.

Papageorgiou, C., & Wells, A. (2015). Group metacognitive therapy for severe antidepressant and CBT resistant depression: A baseline-controlled trial. Cognitive Therapy and Research, 39(1), 14–22.