A methodological review of meta-analyses of the effectiveness of clinical psychology treatments

Assessment of the Effects of Physiotherapy on Back Care and Prevention of Non-Specific Low Back Pain in Children and Adolescents: A Systematic Review and Meta-Analysis

Non-specific low back pain (NSLBP) in children and adolescents has increased in recent years, and the evidence of the physiotherapy interventions in back care needs to be updated. Our main goal was to quantify the effects of preventive physiotherapy interventions on improving behavior and knowledge related to back care and prevention of NSLBP in children and adolescents. Based on two previous meta-analyses, Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and IME databases and several journals were searched. Two researchers independently extracted data and assessed the risk of bias in the studies using the RoB2 tool. Data were described according to PRISMA guidelines. A total of 24 studies (28 reports) were included. In the posttest, the behavior variable obtained an overall effect size of d+ = 1.48 (95%CI: 0.40 to 2.56), and the knowledge variable obtained an effect size of d+ = 1.41 (95%CI: 1.05 to 1.76). Physiotherapy has demonstrated beneficial impacts on behavior and knowledge concerning back care and to prevent NSLBP in children and adolescents. Interventions focusing on postural hygiene and exercise should be preferred, especially those that are shorter in number of weeks, more intense, and incorporate as many intervention hours as possible.

Transparency in Cognitive Training Meta-analyses: A Meta-review

Meta-analyses often present flexibility regarding their inclusion criteria, outcomes of interest, statistical analyses, and assessments of the primary studies. For this reason, it is necessary to transparently report all the information that could impact the results. In this meta-review, we aimed to assess the transparency of meta-analyses that examined the benefits of cognitive training, given the ongoing controversy that exists in this field. Ninety-seven meta-analytic reviews were included, which examined a wide range of populations with different clinical conditions and ages. Regarding the reporting, information about the search of the studies, screening procedure, or data collection was detailed by most reviews. However, authors usually failed to report other aspects such as the specific meta-analytic parameters, the formula used to compute the effect sizes, or the data from primary studies that were used to compute the effect sizes. Although some of these practices have improved over the years, others remained the same. Moreover, examining the eligibility criteria of the reviews revealed a great heterogeneity in aspects such as the training duration, age cut-offs, or study designs that were considered. Preregistered meta-analyses often specified poorly how they would deal with the multiplicity of data or assess publication bias in their protocols, and some contained non-disclosed deviations in their eligibility criteria or outcomes of interests. The findings shown here, although they do not question the benefits of cognitive training, illustrate important aspects that future reviews must consider.

Active Video Game Interventions Targeting Physical Activity Behaviors: Systematic Review and Meta-analysis

BACKGROUND

Research on digital games designed to increase physical activity (PA), also known as exergames or active video games (AVGs), has proliferated over the past 2 decades. As a result, reviews of literature in this field can become outdated, revealing the need for updated high-quality reviews that identify overarching insights. Furthermore, given the significant heterogeneity in AVG research, study inclusion criteria may significantly influence conclusions. To the best of our knowledge, no prior systematic review or meta-analysis has specifically focused on studies of longitudinal AVG interventions targeting increases in PA behaviors.

OBJECTIVE

The aim of this study was to obtain insights into when and why longitudinal AVG interventions are more or less successful for sustained increases in PA, especially for public health.

METHODS

Six databases (PubMed, PsycINFO, SPORTDiscus, MEDLINE, Web of Science, and Google Scholar) were reviewed until December 31, 2020. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, randomized controlled trials had to prominently (>50% of intervention) feature AVG technology, involve repeated AVG exposure, and target changes in PA behavior. Experimental designs had to include ≥2 within- or between-participant conditions with ≥10 participants per condition.

RESULTS

A total of 25 studies published in English between 1996 and 2020 were identified, with 19 studies providing sufficient data for inclusion in the meta-analysis. Our findings indicated that AVG interventions had a moderately positive effect, thereby increasing overall PA (Hedges g=0.525, 95% CI 0.322-0.728). Our analysis showed substantial heterogeneity (I²=87.7%; Q=154.1). The main findings were consistent across all subgroup analyses. The comparison between PA assessment type groups showed a moderate effect for objective measures (Hedges g=0.586, 95% CI 0.321-0.852) and a small effect for subjective measures (Hedges g=0.301, 95% CI 0.049-0.554) but no significant difference between the groups (P=.13). The platform subgroup analysis indicated a moderate effect for stepping devices (Hedges g=0.303, 95% CI 0.110-0.496), combination of handheld and body-sensing devices (Hedges g=0.512, 95% CI 0.288-0.736), and other devices (Hedges g=0.694, 95% CI 0.350-1.039). The type of control group showed a wide range of effects sizes, ranging from a small effect size (Hedges g=0.370, 95% CI 0.212-0.527) for the passive control group (nothing) to a moderate effect size for the conventional PA intervention group (Hedges g=0.693, 95% CI 0.107-1.279) and ultimately to a large effect size for sedentary game as control groups (Hedges g=0.932, 95% CI 0.043-1.821). There was no significant difference among the groups (P=.29).

CONCLUSIONS

AVGs represent a promising tool for PA promotion among the general population and clinical subpopulations. However, significant variabilities in AVG quality, study design, and impact were also detected. Suggestions for improving AVG interventions and related research will be discussed.

TRIAL REGISTRATION

PROSPERO CRD42020204191; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204191.

The normality assumption on between-study random effects was questionable in a considerable number of Cochrane meta-analyses

BACKGROUND

Studies included in a meta-analysis are often heterogeneous. The traditional random-effects models assume their true effects to follow a normal distribution, while it is unclear if this critical assumption is practical. Violations of this between-study normality assumption could lead to problematic meta-analytical conclusions. We aimed to empirically examine if this assumption is valid in published meta-analyses.

METHODS

In this cross-sectional study, we collected meta-analyses available in the Cochrane Library with at least 10 studies and with between-study variance estimates > 0. For each extracted meta-analysis, we performed the Shapiro-Wilk (SW) test to quantitatively assess the between-study normality assumption. For binary outcomes, we assessed between-study normality for odds ratios (ORs), relative risks (RRs), and risk differences (RDs). Subgroup analyses based on sample sizes and event rates were used to rule out the potential confounders. In addition, we obtained the quantile-quantile (Q-Q) plot of study-specific standardized residuals for visually assessing between-study normality.

RESULTS

Based on 4234 eligible meta-analyses with binary outcomes and 3433 with non-binary outcomes, the proportion of meta-analyses that had statistically significant non-normality varied from 15.1 to 26.2%. RDs and non-binary outcomes led to more frequent non-normality issues than ORs and RRs. For binary outcomes, the between-study non-normality was more frequently found in meta-analyses with larger sample sizes and event rates away from 0 and 100%. The agreements of assessing the normality between two independent researchers based on Q-Q plots were fair or moderate.

CONCLUSIONS

The between-study normality assumption is commonly violated in Cochrane meta-analyses. This assumption should be routinely assessed when performing a meta-analysis. When it may not hold, alternative meta-analysis methods that do not make this assumption should be considered.

Effect of psychotherapy for adult depression on self-esteem: A systematic review and meta-analysis

BACKGROUND

There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based interventions. To examine this, we had two main aims; (1) to meta-analyze psychotherapy effects on (i) depression and (ii) self-esteem, and (2) to investigate the relationship between reductions in depression symptoms and improvements in self-esteem.

DESIGN

A systematic review and meta-analysis.

METHODS

Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of psychotherapy for adult depression, which included a self-esteem outcome at post-treatment. Nineteen studies with a total of 3423 participants met the inclusion criteria. For each comparison between psychotherapy and a control condition, we calculated Hedges' g both for depression and self-esteem and pooled them in two separate meta-analyses. Furthermore, meta-regression was used to explore the association between the effect of psychotherapy for depression and its effect on self-esteem.

RESULTS

The effects on depression were large and significant (Hedges' g = -0.95; [95 % CI: -1.27, -0.63]). We found evidence of smaller, albeit still moderate, effects on self-esteem (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with sustained effects at 6-12 months (Hedges'g = 0.70; [95 % CI: -0.03, 1.43]). We also found a strong inverse association between the effects of psychotherapy for depression and self-esteem (β = -0.60, p < 0.001).

LIMITATIONS

Heterogeneity was very high (I² = 97 %), and out of 19 trials, only 6 trials were rated as having a low risk of bias.

CONCLUSIONS

The results suggest that psychotherapy for depression may improve self-esteem to a moderate degree.

Heterogeneity estimation in meta-analysis of standardized mean differences when the distribution of random effects departs from normal: A Monte Carlo simulation study

BACKGROUND

Advantages of meta-analysis depend on the assumptions underlying the statistical procedures used being met. One of the main assumptions that is usually taken for granted is the normality underlying the population of true effects in a random-effects model, even though the available evidence suggests that this assumption is often not met. This paper examines how 21 frequentist and 24 Bayesian methods, including several novel procedures, for computing a point estimate of the heterogeneity parameter ([Formula: see text]) perform when the distribution of random effects departs from normality compared to normal scenarios in meta-analysis of standardized mean differences.

METHODS

A Monte Carlo simulation was carried out using the R software, generating data for meta-analyses using the standardized mean difference. The simulation factors were the number and average sample size of primary studies, the amount of heterogeneity, as well as the shape of the random-effects distribution. The point estimators were compared in terms of absolute bias and variance, although results regarding mean squared error were also discussed.

RESULTS

Although not all the estimators were affected to the same extent, there was a general tendency to obtain lower and more variable [Formula: see text] estimates as the random-effects distribution departed from normality. However, the estimators ranking in terms of their absolute bias and variance did not change: Those estimators that obtained lower bias also showed greater variance. Finally, a large number and sample size of primary studies acted as a bias-protective factor against a lack of normality for several procedures, whereas only a high number of studies was a variance-protective factor for most of the estimators analyzed.

CONCLUSIONS

Although the estimation and inference of the combined effect have proven to be sufficiently robust, our work highlights the role that the deviation from normality may be playing in the meta-analytic conclusions from the simulation results and the numerical examples included in this work. With the aim to exercise caution in the interpretation of the results obtained from random-effects models, the tau2() R function is made available for obtaining the range of [Formula: see text] values computed from the 45 estimators analyzed in this work, as well as to assess how the pooled effect, its confidence and prediction intervals vary according to the estimator chosen.

Published correlational effect sizes in social and developmental psychology

The distribution of effect sizes may offer insights about the research done and reported in a scientific field. We have evaluated 12 412 manually collected correlation effect sizes (Sample 1) and 31 157 computer-extracted correlation effect sizes (Sample 2) published in journals focused on social or developmental psychology. Sample 1 consisted of 243 studies from six journals published in 2010 and 2019. Sample 2 consisted of 5012 papers published in 10 journals between 2010 and 2019. The 25th, 50th and 75th effect size percentiles were 0.08, 0.17 and 0.33, and 0.17, 0.31 and 0.52 in Samples 1 and 2, respectively. Sample 2 percentiles were probably larger because Sample 2 only included effect sizes from the text but not from tables. In text authors may have emphasized larger correlations. Large sample sizes were associated with smaller reported correlations. In Sample 1 about 70% of studies specified a directional hypothesis. In 2010 no papers had power calculations, while in 2019 14% of papers had power calculations. These data offer empirical insights into the distribution of reported correlations and may inform the interpretation of effect sizes. They also demonstrate the importance of computation of statistical power and highlight potential reporting bias.

Long-term outcomes of cognitive behavioural therapy for social anxiety disorder: A meta-analysis of randomised controlled trials

Cognitive Behavioural Therapy (CBT) is effective in treating Social Anxiety Disorder (SAD). However, less is known about whether gains achieved in disorder-specific and secondary outcomes (e.g., depression, general anxiety, quality of life, and self-esteem) are maintained 12 months or longer. A systematic literature search yielded 25 relevant studies that administered CBT to participants with SAD. Multivariate meta-analyses of post-treatment assessments, found that CBT was superior to control conditions in reducing social anxiety (g =.74), depression (g =.52), general anxiety (g =.69) and improving quality of life (g =.39). The within-groups effect sizes revealed that 12 months or more after CBT treatment, symptoms continued to improve for social anxiety (g_av =.23) and quality of life (g_av =.17), and gains were maintained for depressive (g_av =.06) and general anxiety symptoms (g_av =.03). However, meta-analyses of long-term outcomes lack comparison groups. Moderation was non-significant for the treatment model, format, number of sessions, treatment duration, or inclusion of booster sessions. Future research may investigate what drives improvement after treatment cessation and how CBT affects other co-occurring symptomatology. Taken together, CBT produces many benefits for SAD and individuals with co-occurring symptoms can benefit from extant SAD-focused treatments.

The efficacy of interventions for behaviourally inhibited preschool-aged children: A meta-analysis

The current systematic review and meta-analyses examined the efficacy of psychological interventions targeting behavioural inhibition and anxiety in preschool-aged children, evaluated within randomised controlled trials. Web of Science, MEDLINE, PsycINFO and CINAHL were systematically searched from inception to March 2021. Ten studies (N = 1475 children, aged 3 - 7 years) were included in the current review. Separate analyses were conducted for behavioural inhibition, anxiety symptoms, and anxiety diagnosis as reported by parents, teachers, and observer-ratings. Pooled outcomes ranged from post-intervention to 12-month follow-up due to the limited number of studies. Meta-analyses revealed that intervention did not reduce behavioural inhibition as assessed by independent observers (SMD = -0.13, 95% CI = -0.63 to.38), but did reduce behavioural inhibition as reported by parents (SMC = -0.64, 95% CI = -1.00 to -0.27) and teachers (SMD = -0.69, 95% CI = -1.02 to -0.36). Additionally, intervention appeared to reduce the risk of anxiety disorders (RR =0.75, 95% CI =0.62 to.90), and parent-report anxiety symptoms (SMC = -0.47, 95% CI = -0.83 to -0.12) in preschool-aged children. Intervention may be efficacious in reducing anxiety in preschool-aged behaviourally inhibited children. It is less clear whether intervention leads to change in BI.

Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis

Background

Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective preventive physiotherapy interventions to improve back care in children and adolescents.

Methods

The study settings were children or adolescents aged 18 years or younger. Data were obtained from the Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, and PsycINFO databases and the specialized journals BMJ and Spine. The included studies were published between May 2012 and May 2020. Controlled trials on children and adolescents who received preventive physiotherapy for back care were considered. Data on all the variables gathered in each individual study were extracted by two authors separately. Two authors assessed risk of bias of included studies using the RoB2 and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines. To calculate the effect size, a standardized mean difference “d” was used and a random-effects model was applied for the following outcome variables: behaviour, knowledge, trunk flexion muscle endurance, trunk extension muscle endurance, hamstring flexibility and posture.

Results

Twenty studies were finally included. The most common physiotherapy interventions were exercise, postural hygiene and physical activity. The mean age of the total sample was 11.79 years. When comparing the change from baseline to end of intervention in treatment and control groups, the following overall effect estimates were obtained: behaviour d₊ = 1.19 (95% CI: 0.62 and 1.76), knowledge d₊ = 1.84 (0.58 and 3.09), trunk flexion endurance d₊ = 0.65 (-0.02 and 1.33), trunk extension endurance d₊ = 0.71 (0.38 and 1.03), posture d₊ = 0.65 (0.24 and 1.07) and hamstrings flexibility d₊ = 0.46 (0.36 and 0.56). At follow-up, the measurement of the behaviour variable was between 1 and 12 months, with an effect size of d₊ = 1.00 (0.37 and 1.63), whereas the knowledge variable obtained an effect size of d₊ = 2.08 (-0.85 and 5.02) at 3 months of follow-up.

Conclusions

Recent studies provide strong support for the use of physiotherapy in the improvement of back care and prevention of non-specific low back pain in children and adolescents. Based on GRADE methodology, we found that the evidence was from very low to moderate quality and interventions involving physical exercise, postural hygiene and physical activity should be preferred.

Supplementary information

The online version contains supplementary material available at 10.1186/s12891-022-05270-4.

Effects of Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: A Network Meta-Analysis

Gait disturbances are common in children and adolescents with cerebral palsy (CP). Robotic-assisted gait training (RAGT) is becoming increasingly widespread, and hence it is important to examine its effectiveness. A network meta-analysis (NMA) of clinical trials comparing treatments with RAGT vs. other physical therapy treatments was carried out. This study was conducted according to the NMA version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines and following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The outcome variables used were the D and E dimensions of the Gross Motor Function Measure (GMFM), gait speed, resistance, and stride length. Among 120 records, 8 trials were included. This NMA did not find statistically significant results for any of the comparisons examined in any of the outcomes studied and the magnitude of the effect size estimates was low or very low. Our NMA results should be interpreted with caution due to the high clinical heterogeneity of the studies included.

Systematic Review and Meta-Analysis of Effectiveness of Acceptance and Commitment Therapy in Patients With Breast Cancer

BACKGROUND

The physical and psychological well-being of patients with breast cancer is an important global issue. Acceptance and commitment therapy (ACT) aims to equip patients with the skills to respond and adapt to difficult circumstances. However, the extent of the physical and psychological outcomes of this therapy in patients with breast cancer remains unclear.

OBJECTIVES

The aim of the study was to summarize available evidence and assess the efficacy of ACT on physiological and psychological outcomes in patients with breast cancer.

METHODS

Published randomized controlled studies were identified in MEDLINE, PsycInfo, Embase, Web of Science, CINAHL, and CNKI from inception to December 2019 and Cochrane Library, AMED, and Clinical trials.gov from inception to September 2020. Methodological rigor was assessed by two reviewers using the Cochrane Handbook for Systematic Review of Interventions. Sufficient data were statistically pooled with review manager; otherwise, a narrative summary was used.

RESULTS

Thirteen trials were included in the review. Methodological quality varied across the studies. Meta-analyses demonstrated that ACT had moderate to large effects on reducing anxiety, depression, and stress and improving hope. Sensitivity analyses reached results similar to those of the meta-analyses. However, the effects of ACT on the physiological symptoms, fear of cancer recurrence, and psychological flexibility of patients with breast cancer remain inconclusive.

DISCUSSION

ACT has beneficial effects on the anxiety, depression, stress, and hope of patients with breast cancer. The evidence of ACT on physiological symptoms, fear of cancer recurrence, and psychological flexibility needs to be treated with caution. Further studies are needed and should consider different delivery forms and also explore the mechanisms of each component of ACT under different cultural contexts.

Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Adults with Prolonged Grief Disorder (PGD): A Study Protocol for a Randomized Feasibility Trial

INTRODUCTION

Grief is an emotional reaction to the loss of a loved one with a natural recovery. Approximately 10% of people who lose a loved one develop prolonged grief disorder (PGD). Internet-based and computer-based interventions (ie, internet-delivered cognitive-behavioural therapy, iCBT) are a cost-effective alternative that makes it possible to reach more people with PGD. The main aim of this study is to assess the feasibility of a new iCBT-called GROw-for PGD. As a secondary objective, the potential effectiveness of GROw will be explored.

METHODS AND ANALYSIS

This study is a two-arm feasibility randomised trial. A total of 48 adults with PGD who meet the eligibility criteria will be randomised to the experimental group (iCBT: GROw) or the active control group (face-to-face CBT treatment). The treatment is organised sequentially in eight modules in the iCBT format and 8-10 sessions in the face-to-face format, and both formats have the same therapeutic components. There will be five assessment points with qualitative and quantitative evaluations: screening, baseline, after the intervention, 3-month follow-up and 12-month follow-up. Consistent with the objectives, the measures are related to the feasibility outcomes for the main aim of the study (participant adherence, expectations and satisfaction with the treatment, preferences, alliance and utility) and psychological and mental health outcomes for secondary analyses (symptoms of grief, symptoms of depression, symptoms of anxiety, affectivity, quality of life, work and social adaptation, post-traumatic growth, purpose in life, mindfulness and compassion).

ETHICS AND DISSEMINATION

The Ethics Committee of the Universitat Jaume I (Castellón, Spain) granted approval for the study (CD/002/2019). Dissemination will include publications and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

NCT04462146.

A meta-review of transparency and reproducibility-related reporting practices in published meta-analyses on clinical psychological interventions (2000-2020)

Meta-analysis is a powerful and important tool to synthesize the literature about a research topic. Like other kinds of research, meta-analyses must be reproducible to be compliant with the principles of the scientific method. Furthermore, reproducible meta-analyses can be easily updated with new data and reanalysed applying new and more refined analysis techniques. We attempted to empirically assess the prevalence of transparency and reproducibility-related reporting practices in published meta-analyses from clinical psychology by examining a random sample of 100 meta-analyses. Our purpose was to identify the key points that could be improved, with the aim of providing some recommendations for carrying out reproducible meta-analyses. We conducted a meta-review of meta-analyses of psychological interventions published between 2000 and 2020. We searched PubMed, PsycInfo and Web of Science databases. A structured coding form to assess transparency indicators was created based on previous studies and existing meta-analysis guidelines. We found major issues concerning: completely reproducible search procedures report, specification of the exact method to compute effect sizes, choice of weighting factors and estimators, lack of availability of the raw statistics used to compute the effect size and of interoperability of available data, and practically total absence of analysis script code sharing. Based on our findings, we conclude with recommendations intended to improve the transparency, openness, and reproducibility-related reporting practices of meta-analyses in clinical psychology and related areas.

Denouncing the use of field-specific effect size distributions to inform magnitude

An effect size (ES) provides valuable information regarding the magnitude of effects, with the interpretation of magnitude being the most important. Interpreting ES magnitude requires combining information from the numerical ES value and the context of the research. However, many researchers adopt popular benchmarks such as those proposed by Cohen. More recently, researchers have proposed interpreting ES magnitude relative to the distribution of observed ESs in a specific field, creating unique benchmarks for declaring effects small, medium or large. However, there is no valid rationale whatsoever for this approach. This study was carried out in two parts: (1) We identified articles that proposed the use of field-specific ES distributions to interpret magnitude (primary articles); and (2) We identified articles that cited the primary articles and classified them by year and publication type. The first type consisted of methodological papers. The second type included articles that interpreted ES magnitude using the approach proposed in the primary articles. There has been a steady increase in the number of methodological and substantial articles discussing or adopting the approach of interpreting ES magnitude by considering the distribution of observed ES in that field, even though the approach is devoid of a theoretical framework. It is hoped that this research will restrict the practice of interpreting ES magnitude relative to the distribution of ES values in a field and instead encourage researchers to interpret such by considering the specific context of the study.

Web-based Acceptance and Commitment Therapy (ACT) for symptoms of anxiety and depression: Within-group effect size benchmarks as tools for clinical practice

COVID-19 has highlighted the need for evidence-based behavioural health interventions that can be delivered remotely. This article provides within-group effect size benchmarks for randomised controlled trials of Internet-based Acceptance and Commitment Therapy for the treatment of adults with anxiety and depression. Effect sizes were calculated using the Glass approach, adjusted using Hedges g, then aggregated to produce separate benchmarks for measures of anxiety and depression. These benchmarks can be used by community-based treatment providers to evaluate the effectiveness of their web-based Acceptance and Commitment Therapy intervention to determine if it should be continued, modified for the unique needs of their client population and practice setting, or discontinued.

Estimating outcome-specific effects in meta-analyses of multiple outcomes: A simulation study

In meta-analysis, primary studies often include multiple, dependent effect sizes. Several methods address this dependency, such as the multivariate approach, three-level models, and the robust variance estimation (RVE) method. As for today, most simulation studies that explore the performance of these methods have focused on the estimation of the overall effect size. However, researchers are sometimes interested in obtaining separate effect size estimates for different types of outcomes. A recent simulation study (Park & Beretvas, 2019) has compared the performance of the three-level approach and the RVE method in estimating outcome-specific effects when several effect sizes are reported for different types of outcomes within studies. The goal of this paper is to extend that study by incorporating additional simulation conditions and by exploring the performance of additional models, such as the multivariate model, a three-level model that specifies different study-effects for each type of outcome, a three-level model that specifies a common study-effect for all outcomes, and separate three-level models for each type of outcome. Additionally, we also tested whether the a posteriori application of the RV correction improves the standard error estimates and the 95% confidence intervals. Results show that the application of separate three-level models for each type of outcome is the only approach that consistently gives adequate standard error estimates. Also, the a posteriori application of the RV correction results in correct 95% confidence intervals in all models, even if they are misspecified, meaning that Type I error rate is adequate when the RV correction is implemented.

The Effect of Mindfulness-Based Intervention on Brain-Derived Neurotrophic Factor (BDNF): A Systematic Review and Meta-Analysis of Controlled Trials

Background: This systematic review aims to answer three questions. First, how much do mindfulness-based interventions (MBIs) affect peripheral brain-derived neurotrophic factor (BDNF)? Second, do mindfulness exercise-based interventions (exercise-MBIs) and mindfulness meditation-based interventions (meditation-MBIs) affect peripheral BDNF differently? Third, does the age of participants and the accumulative hours of MBI practice affect peripheral BDNF? Methods: We included randomized controlled trials comparing MBI and no intervention in adults (age >18 years) who reported peripheral BDNF. Database searches included PubMed, CINAHL, CENTRAL, PsyInfo, and Scopus. Two reviewers independently selected the studies and assessed the trial quality. We used the standardized mean difference (SMD) as the effect size index and conducted moderator analyses. Results: Eleven studies are included in this systematic review. Five studies applying exercise-MBI and three studies applying meditation-MBI are included in the meta-analysis (N = 479). The pooled effect size shows a significantly greater increase of peripheral BDNF in MBI groups compared to the control groups (k = 8, N = 479, SMD = 0.72, 95% CI 0.31-1.14, I ²= 78%). Significantly more increases of BDNF in the MBI groups are found in both subgroups of exercise-MBI and meditation-MBI. The effect sizes of both subgroups are not significantly different between subgroups (χ² = 0.02, p = 0.88). We find no significant correlation between the effect sizes and the age of participants (r = -0.0095, p = 0.45) or accumulative hours of MBI practice (r = 0.0021, p = 0.57). Conclusion: The heterogeneous data of this small sample-size meta-analysis suggests that MBI can increase peripheral BDNF. Either exercise-MBI or meditation-MBI can increase peripheral BDNF.

Music Therapy in the Psychosocial Treatment of Adult Cancer Patients: A Systematic Review and Meta-Analysis

Introduction: Music therapy is used as an adjunct oncological treatment aiming at the improvement of psychological and physical well-being through music. A growing body of randomized and non-randomized controlled trials has been published and reviewed recently. However, a global, quantitative assessment of the effectiveness of music therapy in adult cancer care is missing. The present study thus aims to synthesize the evidence of music therapy in different oncological treatment phases.

Methods: We conducted a pre-registered systematic review and meta-analysis (PROSPERO-ID: CRD42019133084) following standard guidelines. We searched electronic databases for studies on music therapy performed by a therapist with adult cancer patients.

Results: The narrative synthesis included thirty studies showing that music therapy overall had positive effects on a broad range of outcomes, with techniques and effects varying in different phases. During curative treatment, results were most promising with regard to anxiety, depression, and pain medication intake, while in palliative settings, improvements with regard to quality of life, spiritual well-being, pain, and stress were reported. Twenty-one studies were included in the meta-analysis which showed small but significant effects of music therapy on psychological well-being (d = 0.35, p < 0.001), physical symptom distress (d = −0.26, p = 0.017), and quality of life (d = 0.36, p = 0.023). Heterogeneity between effect sizes was small to medium. Moderator analyses identified studies with a single session of music therapy and the use of receptive techniques to produce larger effects regarding psychological well-being.

Conclusion: Music therapy can improve relevant health-outcomes in cancer patients and should therefore be offered in various treatment phases. Future research should include potential moderators such as individual information about patients to find out who benefits most from different kinds of music therapy.

Positive and Negative Affect Schedule (PANAS): psychometric properties of the online Spanish version in a clinical sample with emotional disorders

BACKGROUND

The Positive and Negative Affect Schedule (PANAS) is the most widely and frequently used scale to assess positive and negative affect. The PANAS has been validated in several languages, and it has shown excellent psychometric properties in the general population and some clinical samples, such as forensic samples, substance users, and adult women with fibromyalgia. Nevertheless, the psychometric properties of the scale have not yet been examined in clinical samples with anxiety, depressive, and adjustment disorders. In addition, the proliferation of Internet-based treatments has led to the development of a wide range of assessments conducted online with digital versions of pen and paper self-report questionnaires. However, no validations have been carried out to analyze the psychometric properties of the online version of the PANAS. The present study investigates the psychometric properties of the online Spanish version of the PANAS in a clinical sample of individuals with emotional disorders.

METHODS

The sample was composed of 595 Spanish adult volunteers with a diagnosis of depressive disorder (n = 237), anxiety disorder (n = 284), or adjustment disorder (n = 74). Factor structure, construct validity, internal consistency, and sensitivity to change were analyzed.

RESULTS

Confirmatory factor analysis yielded a latent structure of two independent factors, consistent with previous validations of the instrument. The analyses showed adequate convergent and discriminant validity, good internal consistency as well as sensitivity to change.

CONCLUSIONS

Overall, the results obtained in this study show that the online version of the PANAS has adequate psychometric properties for the assessment of positive and negative affect in a Spanish clinical population.

The influence of nonnormality from primary studies on the standardized mean difference in meta-analysis

In this study we investigated the influence of data nonnormality in the primary studies on meta-analysis of the standardized mean difference (SMD) for a two-independent-group design. The bias, mean squared error, and confidence interval coverage probability of the mean effect sizes under different types of population distributions were compared. Also, the performance of the Q test was examined. The results showed that oppositely skewed distributions (i.e., distributions skewed in different directions) showed poor performance for point and interval estimates of mean effect sizes in meta-analysis, especially when the tails were pointing toward each other. The previously found adverse impacts due to nonnormality in primary studies do not disappear when primary studies with nonnormal data are meta-analyzed, even when the average sample size and number of studies are large. The results also showed that, when the tails were pointing toward each other, the Type I error rates of the Q test were inflated. We suggest that the impact of violating the assumption of normality should not be ignored in meta-analysis.

The process and delivery of CBT for depression in adults: a systematic review and network meta-analysis

Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of -1.11 (95% credible interval -1.62 to -0.60) for face-to-face CBT, -1.06 (-2.05 to -0.08) for hybrid CBT, and -0.59 (-1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.

The Meaningfulness of Effect Sizes in Psychological Research: Differences Between Sub-Disciplines and the Impact of Potential Biases

Effect sizes are the currency of psychological research. They quantify the results of a study to answer the research question and are used to calculate statistical power. The interpretation of effect sizes—when is an effect small, medium, or large?—has been guided by the recommendations Jacob Cohen gave in his pioneering writings starting in 1962: Either compare an effect with the effects found in past research or use certain conventional benchmarks. The present analysis shows that neither of these recommendations is currently applicable. From past publications without pre-registration, 900 effects were randomly drawn and compared with 93 effects from publications with pre-registration, revealing a large difference: Effects from the former (median r = 0.36) were much larger than effects from the latter (median r = 0.16). That is, certain biases, such as publication bias or questionable research practices, have caused a dramatic inflation in published effects, making it difficult to compare an actual effect with the real population effects (as these are unknown). In addition, there were very large differences in the mean effects between psychological sub-disciplines and between different study designs, making it impossible to apply any global benchmarks. Many more pre-registered studies are needed in the future to derive a reliable picture of real population effects.

Brief psychosocial interventions improve quality of life of patients receiving palliative care: A systematic review and meta-analysis

Background:

Patients with a terminal disease report a high need for psychosocial and spiritual support. Previous literature reviews on psychosocial interventions in palliative care were restricted to certain subtypes of techniques, included a wide range of patients, conditions, and settings, or required a number of sessions unrealistic to be achieved in patients nearing the end of their lives.

Aim:

The aim of this study was to review and synthesize the evidence on brief psychosocial interventions (i.e. four sessions or less and less than 21 days) for patients receiving palliative treatment.

Design:

We performed a systematic review and meta-analysis in accordance with standard guidelines and a pre-registered protocol (PROSPERO: CRD42018082713).

Data sources:

Electronic databases, journals, and references were searched for controlled clinical trials. We used the Cochrane criteria to assess the risk of bias within studies.

Results:

In total, 15 studies met the eligibility criteria and reported the effects of 17 interventions and a total of 1248 patients. The most frequently used techniques were life review techniques and music therapy. After exclusion of outliers, psychosocial interventions showed to be superior with regard to the improvement of quality of life (effect size = 0.36, confidence interval = 0.08 to 0.64), and the reduction of emotional (effect size = −0.51, confidence interval = −0.77 to −0.26) and existential distress (effect size = −0.40, confidence interval = −0.71 to −0.07) compared to the control groups.

Conclusion:

Brief psychosocial interventions can improve clinically relevant health outcomes and should therefore be made available for patients receiving palliative care.

Recovering the variance of d' from hit and false alarm statistics

Sometimes the reports of primary studies that are potentially analyzable within the signal detection theory framework do not report sample statistics for its main indexes, especially the sample variance of d'. We describe a procedure for estimating the variance of d' from other sample statistics (specifically, the mean and variance of the observed rates of hit and false alarm). The procedure acknowledges that individuals can be heterogeneous in their sensitivity and/or decision criteria, and it does not adopt unjustifiable or needlessly complex assumptions. In two simulation studies reported here, we show that the procedure produces certain biases, but, when used in meta-analysis, it produces very reasonable results. Specifically, the weighted estimate of the mean sensitivity is very accurate, and the coverage of the confidence interval is very close to the nominal confidence level. We applied the procedure to 20 experimental groups or conditions from seven articles (employing recognition memory or attention tasks) that reported statistics for both the hit and false alarm rates, as well as for d'. In most of these studies the assumption of homogeneity was untenable. The variances estimated by our method, based on the hit and false alarm rates, approximate reasonably to the variances in d' reported in those articles. The method is useful for estimating unreported variances of d', so that the associated studies can be retained for meta-analyses.

A brief online transdiagnostic measure: Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among Spanish patients with emotional disorders

The Overall Anxiety Severity and Impairment Scale (OASIS) is a self-report questionnaire designed to evaluate the severity and functional impairment associated with anxiety. Given its transdiagnostic nature, it can be used indistinctly across anxiety and depressive disorders. In this study, the psychometric properties of the online version of the OASIS were evaluated in a Spanish clinical sample with emotional disorders. Patients (n = 583) with anxiety (n = 250) and depression (n = 333) with a mean age of 37.21 (SD = 12.22), underwent a diagnostic interview and questionnaires assessing anxiety, depression, positive and negative affect, and quality of life. Factorial structure, internal consistency, convergent and discriminant validity, cutoff scores, and sensitivity to change were analyzed. Confirmatory Factor Analysis yielded a unidimensional factor structure, consistent with previous validations of the instrument. The analyses showed good internal consistency and adequate convergent and discriminant validity, as well as sensitivity to change. A cutoff score of 7.5 was found to meet the criteria used in this study to select the optimal cutoff point. Overall, in this study, the psychometric properties of the online version of the OASIS were found to be appropriate. The brevity and ease of use of the OASIS support its adequacy as a valid measure of anxiety severity and impairment in Spanish clinical samples with anxiety and depression.