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. 2023;1(6):389-401.
doi: 10.1038/s44220-023-00048-6. Epub 2023 May 15.

A transdiagnostic meta-analysis of acute augmentations to psychological therapy

Camilla L Nord  1 , Beth Longley  1   2 , Quentin Dercon  1   3 , Veronica Phillips  4 , Julia Funk  5 , Siobhan Gormley  1 , Rachel Knight  1 , Alicia J Smith  1 , Tim Dalgleish  1   6
Affiliations

A transdiagnostic meta-analysis of acute augmentations to psychological therapy

Camilla L Nord et al. Nat Ment Health. 2023.

Abstract

At least half of all patients with mental health disorders do not respond adequately to psychological therapy. Acutely enhancing particular biological or psychological processes during psychological therapy may improve treatment outcomes. However, previous studies are confined to specific augmentation approaches, typically assessed within single diagnostic categories. Our objective was to assess to what degree acute augmentations of psychological therapy reduce psychiatric symptoms and estimate effect sizes of augmentation types (for example, brain stimulation or psychedelics). We searched Medline, PsycINFO and Embase for controlled studies published between database inception and 25 May 2022. We conducted a preregistered random-effects meta-analysis (PROSPERO CRD42021236403). We identified 108 studies (N = 5,889). Acute augmentation significantly reduced the severity of mental health problems (Hedges' g = -0.27, 95% CI: [-0.36, -0.18]; P < 0.0001), particularly for the transdiagnostic dimensions 'Fear' and 'Distress'. This result survived a trim-and-fill analysis to account for publication bias. Subgroup analyses revealed that pharmacological, psychological and somatic augmentations were effective, but to varying degrees. Acute augmentation approaches are a promising route to improve outcomes from psychological therapy.

Keywords: Psychology; Translational research.

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Conflict of interest statement

Competing interestsThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow chart of screening protocol.
PRISMA flow diagram describing the process of study identification, de-duplication, and screening (note this occurred at two time-points due to the updated search in May 2022).
Fig. 2
Fig. 2. Synthesis of all studies included in the random-effects meta-analysis.
The primary outcome of our random-effects meta-analysis of the included acute augmentation studies, i.e. the difference between the two groups at post-treatment (standardised mean difference: SMD) and the 95% confidence interval (CI) around the effect size. Data from refs. –,–,,–,–.
Fig. 3
Fig. 3. Forest plots of study subcategories in the random-effects meta-analysis.
a, Pharmacological. b, Psychological. c, Somatic. Data from refs. –,–,,–,–.
Fig. 4
Fig. 4. Funnel plot of all studies.
a, To evaluate publication bias, we plotted the standardized mean difference of each study with respect to its standard error. We visually inspected the plot for asymmetry: 79.6% of studies fell within the funnel. b, We then ran a trim-and-fill analysis, which added seven studies.
See this image and copyright information in PMC

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