Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis.

Journal article

Publication Details

Author(s): Mohr DC, Hofmann SG, Berking M, Andersson G, Coyne J, Turner EH, Cuijpers P
Journal: Psychological Medicine
Publisher: Cambridge University Press (CUP)
Publication year: 2014
Volume: 44
Journal issue: 4
Pages range: 685-695
ISSN: 0033-2917
Language: English



The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo.


Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges' g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses.


The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14-0.36, I² = 0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size.


Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.


FAU Authors / FAU Editors

Berking, Matthias Prof. Dr.
Lehrstuhl für Klinische Psychologie und Psychotherapie

External institutions with authors

Boston University
Linköping University
Northwestern University
University of Groningen / Rijksuniversiteit Groningen
Veterans Affairs Medical Center (VA Portland)
Vrije Universiteit Amsterdam (VU) / University Amsterdam

How to cite

Mohr, D.C., Hofmann, S.G., Berking, M., Andersson, G., Coyne, J., Turner, E.H., & Cuijpers, P. (2014). Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis. Psychological Medicine, 44(4), 685-695.

Mohr, D. C., et al. "Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis." Psychological Medicine 44.4 (2014): 685-695.


Last updated on 2018-07-08 at 06:41