REVIEW OF: Cuijpers P et al, J Pers Med 2022;12(1):93

STUDY TYPE: Systematic review

In 1964, William Schofield coined the term “YAVIS” to describe the ideal psychotherapy patient: “young, attractive, verbal, intelligent, and successful.” But if the conclusions of this new systemic review are correct, we’ve been getting it wrong for over half a century.

This systematic review included 10 meta-analyses looking at predictors of psychotherapy outcomes in depression. All trials in these meta-analyses compared therapy with another form of treatment or control. Each analysis included three to 39 trials (median 12), and each trial involved 482–8,107 patients (median 1,943). Seven of the meta-analyses looked at cognitive behavioral therapy (CBT), and the other three looked at psychodynamic therapy, cognitive behavioral analysis system of psychotherapy, and internet-based prevention programs. The systematic review identified predictors and moderators for each meta-analysis and integrated the results in a narrative form. Some of the trials were included in more than one meta-analysis, and the authors did not adjust for this duplication of data.

Six of the meta-analyses concluded that therapy was more effective when patients had a higher severity of depression (measured by clinical interview or rating scales). Two found that older individuals benefited more from therapy for depression. Gender, education level, and relationship status did not seem to make a difference, but no other predictors were examined, which is one limitation of this review. Additional limitations include the lack of long-term outcomes and the overrepresentation of CBT.

Both of these findings are a challenge to conventional wisdom. The American Psychiatric Association gives psychotherapy a higher level of recommendation for mild to moderate depression than severe depression in their 2010 Practice Guidelines. YAVIS emphasizes youth and attractiveness, a paradigm that seems more rooted in outdated biases than empirical evidence.

CARLAT TAKE

Contrary to common beliefs, older and more severe illness predicted psychotherapy response among patients with depression in this large analysis.