Psychological treatments for mental disorders in adults: A review of the evidence of leading international organizations Juan Antonio Moriana, Mario Gálvez-Lara & Jorge Corpas Department of Psychology. University of Cordoba (Spain) IMIBIC & Reina Sofia University Hospital (Spain) This is your introductory slide – use it to introduce yourself and your paper

Summary The aim of this study was to analyze and compile list of evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides and lists provided by: D12 (APA) NICE Cochrane APS A total of 135 treatments were analyzed for 23 mental disorders in adults and compared to determine the level of agreement among the organizations. This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Methods The methodology in this review is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) We consulted the websites of the organizations described above to gather all the treatments, disorders and levels of evidence they report We collected the RCTs, reviews and meta-analyses presented by each organization. To analyze agreement among organizations, we have classified the different levels of evidence into an ordinal scheme: no evidence, weak evidence, moderate evidence and strong evidence. Inter-rater reliability (IRR) was performed using a two-way mixed, consistency, average-measures Intra-class correlation (ICC) to assess the level of agreement among organizations for each diagnosis This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Results Organizations Mental disorders included in accordande with the inclusión criteria Treatments D12 (APA) 15 64 NICE 16 73 Cochrane 51 APS 21 68 This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Results This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Results This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Results Intra-class correlation (ICC) obtained by each disorder Generalized Anxiety Disorder 0.889 Panic Disorder 0,485 Social Anxiety 0.435 Specific Phobias 0.816 Anorexia Nervosa 0.741 Bulimia Nervosa 0.819 Binge Eating Disorder 0.396 Posttraumatic Stress Disorder Adjustment Disorder -8.0 Depression 0.022 Obsessive-Compulsive Disorder 0.809 Bipolar Disorder 0.075 Schizophrenia 0.704 Borderline Personality Disorder 0.53 Antisocial Personality Disorder --- Insomnia -0.112 ADHD (Adults) 0.731 Hypocondriasis -1.39 Body Dysmorphic Disorder Sexual Disorder Somatization Disorder Dissociative Disorder Conversion Disorder This is your introductory slide – use it to introduce yourself and your paper Negative ICC estimates indicate systematic disagreement; ICC values less than 0.40 indicate IRR poor; ICC values between 0.40 and 0.59 indicate IRR fair; ICC values between 0.60 and 0.74 indicates IRR good; ICC values between 0.75 and 1 indicates IRR excelent

Discussion The main findings of this study highlight the existing discrepancies in the evidence presented by different organizations reporting on the effectiveness of psychological treatments. These discrepancies may be due to a combination of several reasons: the procedures or committees are biased, different studies were revised, different criteria are used by each organization or the reviews of existing evidence are made at different time periods. This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Discussion The procedures or committees are biased The fact that numerous treatments are considered effective by a single organization may support this theory. In most cases, these institutions only provide information on treatments they consider effective with a higher or lower level of evidence. Therefore, we cannot know why they do not recommend certain treatments. This is evident in depression, where 12 out of 23 treatments are considered effective by only one organization, as well as in post-traumatic stress disorder, where five out of seven treatments are considered effective only by D12. This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Discussion Different studies were revised The analysis of the main discrepancies shows that, in most cases, the institutions use different studies to determine the quality of the evidence. For example, in the case of generalized anxiety disorder, APS (2010) grants a Level II of evidence for psychodynamic therapy based on the RCT of Leichsenring et al. (2009) and the non-randomized controlled trial of Ferrero et al. (2007), while NICE (2011) does not recommend this therapy as a treatment for GAD based on the RCT of Durham et al. (1994) and the RCT of Crits-Christoph et al. (2005). This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Discussion Different criteria are used by each organization A comparison of the organizations showed that the requirements for granting, for example, the highest level of evidence to a certain treatment differed among organizations. The analysis of these discrepancies also shows that, in some cases, the studies which the institutions base themselves on to determine the quality of the evidence are the same. Therefore, in these cases, the reason for the discrepancies could be the criteria used For example, for social anxiety disorder interpersonal psychotherapy is deemed non-effective by NICE (2013a) based on the RCT of Lipsitz et al. (2008) and the RCT of Stangier et al. (2011), while APS (2010) considers this therapy to be effective based solely on the study of Lipsitz et al. (2008). This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Discussion The reviews of existing evidence are made at different time periods. The fact that a Cochrane review of the year 2000 (McGrath & Hayes, 2000) suggests there is no consistent evidence to support the use of cognitive remediation in schizophrenia, while D12 confers a strong level of evidence to this therapy based, among others, on five studies after the year 2000 indicate that these discrepancies in the observed evidence may be due to the different time periods in which the reviews were made. This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Conclusion There is no consensus regarding the evidence presented to support the effectiveness of psychological treatments for most mental disorders in adults. Although there are numerous treatment for many of the disorders mentioned (e.g., 23 treatments for depression), not all offer the same quality of evidence or studies to support them. We found that while similar evidence exists for some disorders (e.g., bulimia nervosa) for other there is a significant number of treatment for which the level o evidence varies greatly depending on the organization (e.g., depression), and some worrying divergences between organizations regarding the evidence presented for treatments for disorder (e.g., schizophrenia) This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults

Future directions We need to contribute to improving the quality of RCTs through more independent studies that promote and contemplate reproducibility as a much more important criterion that envisaged so far. Future studies should aim to reach a consensus on the scientific methods used to validate psychological treatments in order to unify the criteria among organizations, researchers and professionals on level of evidence and methodological approaches for improving the quality of the studies that support them. Moreover, performing studies similar to ours on mental disorders in children and adolescents, addictions, health psychology and other related areas not included in this study is both necessary and or interest. This is your introductory slide – use it to introduce yourself and your paper Psychological treatments for mental disorders in adults