Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons

ObjectiveThe aim of this study was to examine the relative efficacy of evidence-based treatments (EBTs) versus treatment-as-usual (TAU) in routine care for anxiety and depression in adults.MethodA computerized search of studies that directly compared an EBT with a TAU was conducted. Meta-analytic methods were used to estimate effectiveness of EBTs relative to TAU and to model how various confounding variables impacted the results of this comparative research.ResultsA total of 14 studies were included in the final meta-analysis. There was significant heterogeneity in the TAU conditions, which ranged from unknown and/or minimal mental health treatment to psychotherapeutic interventions provided by trained professionals. Although the effect for EBT vs. TAU was significantly greater than zero, the effect for EBT vs. TAUs that were psychotherapeutic interventions was not statistically different from zero.ConclusionsHeterogeneity of TAU conditions in this meta-analysis highlight the importance of clarifying the research questions being asked when investigating and drawing conclusions from EBT–TAU comparisons. Researchers need to clarify if they are comparing an EBT to psychotherapeutic services in routine care or to minimal mental health services. Extant research on EBT versus TAU reveals that there is insufficient evidence to recommend the transportation of EBTs for anxiety and depression to routine care, particularly when the routine care involves psychotherapeutic services.

► Compared evidence-based treatments and treatment-as-usual for anxiety and depression.
► Implementing evidence-based treatments could improve the quality of care.
► The definition of treatment-as-usual varies considerably.
► Evidence-based treatments are superior to treatment-as-usual without psychotherapy.
► Evidence-based treatments are not superior to psychotherapy services.