Cuijpers, P.

P. Cuijpers

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Epidemiology and Psychiatric Sciences

The future of psychotherapy research: stop the waste and focus on issues that matter

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VU Research PortalThe future of psychotherapy research: stop the waste and focus on issues that matterCuijpers, P.published inEpidemiology and Psychiatric Sciences2016DOI (link to publisher)10.1017/S2045796015000785document versionPublisher's PDF, also known as Version of recordLink to publication in VU Research Portalcitation for published version (APA)Cuijpers, P. (2016). 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May. 2021Epidemiology and Psychiatric Scienceshttp://journals.cambridge.org/EPSAdditional services for Epidemiology and Psychiatric Sciences:Email alerts: Click hereSubscriptions: Click hereCommercial reprints: Click hereTerms of use : Click hereThe future of psychotherapy research: stop the waste and focus onissues that matterP. CuijpersEpidemiology and Psychiatric Sciences / FirstView Article / September 2015, pp 1 - 4DOI: 10.1017/S2045796015000785, Published online: 09 September 2015Link to this article: http://journals.cambridge.org/abstract_S2045796015000785How to cite this article:P. Cuijpers The future of psychotherapy research: stop the waste and focus on issues that matter. Epidemiology andPsychiatric Sciences, Available on CJO 2015 doi:10.1017/S2045796015000785Request Permissions : Click hereDownloaded from http://journals.cambridge.org/EPS, IP address: 31.138.156.224 on 10 Sep 2015The future of psychotherapy research: stop the wasteand focus on issues that matterP. Cuijpers1,21 Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands2 EMGO Institute for Health and Care Research, Amsterdam, The NetherlandsKey words: Antidepressants, behaviour therapy, cognitive therapy, depression, psychotherapy.It is well-established that psychotherapies can effect-ively treat depression. In the past four decades, morethan 400 randomized controlled trials have been con-ducted (Cuijpers, 2015), showing that different typesof psychotherapy are effective (Barth et al. 2013), thatthe effects do not or only marginally differ from eachother, that they are comparable with those of antide-pressants, and that combined treatment is more effect-ive than psychotherapy or medication alone (Cuijpers,2014). However, psychotherapies are probably lesseffective in chronic depression and dysthymia, whenpatients have comorbid alcohol problems, and in sub-threshold depression, although in these patients ther-apies can prevent the onset of full-blown majordepressive disorders (Cuijpers et al. 2014).The two Editorials in this issue give interesting per-spectives onwherewearewith researchon these therap-ies andwhat should happen in the future (Hollon, 2015;Solomonov & Barber, 2015). The first thing that standsout is that both agree that although psychotherapiesare effective, there is still considerable room forimprovement. The Editorials point at the problem thatthe effects of psychotherapy have been overestimatedbecause of publication bias, but also that the longerterm effects of psychotherapies are not well known,except maybe for cognitive-behavioural therapy wherelonger-term effects have been shown (Karyotaki et al.2014) in several trials. The small effects of psychothera-pies and treatments in general in chronic andtreatment-resistant depression (Cuijpers et al. 2010d)and the high relapse rates after successful recovery(Vittengl et al. 2007) are also important problems.I want to underscore that although therapies areeffective, there is still much room for improvement.The effect sizes found for treatments for mental disor-ders do not differ very much from those in generalmedical disorders (Leucht et al. 2012), but still it is esti-mated that current treatments cannot take away morethan one-third of the disease burden of depression,and then only in optimal conditions (Andrews et al.2004). And then there is the problem that more than40% of the patients do not or only partially respondto treatment and less than one-third of the patientsare completely recovered after treatment (Hollonet al. 2002). And after successful response the relapserates are estimated to be 50% after 2 years and upto 80% after 5 years (Vittengl et al. 2007). These pro-blems are in addition to the problem that much ofthe earlier research has considerably overestimatedthe effects of acute treatments of depression, not onlybecause of publication bias, but also because of thelow quality of many trials in the field (Cuijpers et al.2010c) and probably researcher allegiance (Munderet al. 2013).Both articles give indications for how futureresearch can contribute to a further reduction of thedisease burden. In addition to that, however, I wouldlike to stress that there is also much research that isnot needed anymore in the future. In the broader bio-medical field it is estimated that about 85% of researchis wasted, because of irrelevant questions, inappropri-ate designs and methods, and biased reporting(Chalmers & Glasziou, 2009). There is no reason toassume that this is very different in randomised trialsof psychotherapies for depression. We found earlierthat of 115 trials in this field only 11 met all nine gen-erally accepted quality criteria, and that the effects ofthese 11 studies were considerably smaller than thoseof lower-quality studies (Cuijpers et al. 2010c). Wealso found that adjusting for unpublished trialsreduces the effect size of psychotherapies with morethan one-third (Cuijpers et al. 2010b), and reportingin these trials also is often biased (Flint et al. 2014).Address for correspondence: Professor P. Cuijpers, Department ofClinical Psychology, VU University Amsterdam, Van derBoechorststraat 1, 1081 BT Amsterdam, The Netherlands.(Email: p.cuijpers@vu.nl)Epidemiology and Psychiatric Sciences, page 1 of 4. © Cambridge University Press 2015doi:10.1017/S2045796015000785EDITORIALS IN THIS ISSUEIn addition to that, a considerable number of studiesreport on the effects of newly developed psychothera-pies for depression (e.g., Bédard et al. 2014; Giosanet al. 2014) and on comparative trials comparing twotypes of psychotherapies. It is well-established, how-ever, that all therapies for depression are about equallyeffective (Barth et al. 2013) and that if a new therapywould indeed be more effective than an existing ther-apy, it would take a new trial with about 800 patientsto show its superiority (Cuijpers & van Straten, 2011).If a therapy is found to be superior to an existing ther-apy in an underpowered trial that would rather raisedoubts about the validity of the trial than trust thatthis new therapy is indeed more effective.Other trials have focused on examining psy-chotherapies for depression in specific target popula-tions, like older adults, women with postpartumdepression and patients with comorbid general medic-al disorders. However, meta-analyses consistentlyshow that psychotherapies are effective in all such tar-get groups (Cuijpers et al. 2008). By far the majority oftrials examining psychotherapies for depression findpositive effects, whether these are in specific targetgroups or in unselected populations of adults. Itseems therefore not necessary to spend resources onexamining these therapies in all such specific targetgroups.In the same way it can be argued that it is no longerneeded to examine different treatment formats in ran-domised controlled, because all research consistentlysuggests that individual, group, guided self-help andguided Internet-based therapies formats result in com-parable outcomes (Cuijpers et al. 2010a; Anderssonet al. 2014).In order to reduce the disease burden of depressionmuch research is needed in many areas. The two arti-cles give several directions for future directions inresearch on psychological treatments, includingresearch how to reduce drop-out rates for psychothera-pies, because they use considerable resources withapparently little benefits (Solomonov & Barber, 2015).But also more research on the long-term effects oftherapies, treatment-resistant and chronic depression,the high relapse rates and more knowledge on whobenefits from which treatment are important goalsfor future research, as justly indicated in these twoarticles in this issue.In this context it could be added that it is alsoimportant to examine how treatments work, becauseif we understand the processes of how therapieswork we may finally start improving the effects oftherapies. However, examining working mechanismsof treatments is notoriously complicated (Kazdin,2007), and requires different types of research, includ-ing not only research on mediators in randomisedtrials, but also experimental studies, theoretical workand animal studies. Although this will require quitesome resources, it will be one of the few ways howwe can improve the effects of treatments. It has beenshown that all pharmacological therapies are aboutequally effective, that all psychological treatments areequally effective, and that pharmacological and psy-chological treatments are also equally effective. Thatmeans that all treatments we have are about equallyeffective, while we hardly know anything about whobenefits from which treatment. This basically impliesthat the effects of treatments have not been improvedsince the 1950s when the tricyclic antidepressants(TCAs) were first tested.The other approach to a further reduction of the dis-ease burden of depression is to focus on improvementof how to apply treatments better in routine care andhow to scale treatment up. Although the effects oftreatments may not have improved since their firstdevelopment, mental health care has made consider-able progress in terms of reaching depressed patientsand applying therapies to people who can benefitfrom therapies. That is important because largegroup of patients who may benefit from treatmentstill do not use these services enough, like adolescents,older adults, minority and lower socioeconomicgroups. And in low- and middle income countriestreatments are hardly available at all. It is importanttherefore to simplify therapies and make them moreaccessible.The suggestion by Solomonov and Barber todevelop stepwise treatment models offers thereforean interesting perspective, with the simplest andcheapest treatments first, followed by more compli-cated and intensive therapies. That is in line withmore generic models that are aimed at improvingexisting treatments and making them more efficient,like stepped care (van Straten et al. 2015) and collabora-tive care models (Coventry et al. 2014). But there arealso other ways to improve access and simplify treat-ments without reducing their effects, like using trainedlay health counsellors for the delivery of treatments inlow-resourced countries, as has been done in India(Patel et al. 2010), or using Internet-based guided self-help therapies which cost much less time than trad-itional, individual therapies (Andersson & Cuijpers,2009).Psychotherapies and other treatments for adultdepression are effective, but there is also much roomfor improvement. The two Editorials in this issuegive a nice overview of where we are and where weshould be heading. We need much research, on thelong-term effects, on treatments of chronic andtreatment-resistant depression, on relapse, and onworking mechanisms. But there is also much research2 P. Cuijperswhich we no longer need because it has been examinedsufficiently, like new therapies that promise superioreffects over existing therapies while they always showequal effects. Resources are scarce and using them forunnecessary research will slow down progress and letpatients with depression suffer more than needed.AcknowledgementNone.Financial SupportThis research received no specific grant from any fund-ing agency, commercial or not-for-profit sectors.Conflict of InterestNone.ReferencesAndersson G, Cuijpers P (2009). Internet-based and othercomputerized psychological treatments for adult depression:a meta-analysis. Cognitive Behaviour Therapy 38, 196–205.Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E(2014). Guided Internet-based vs. face-to-face cognitivebehavior therapy for psychiatric and somatic disorders: asystematic review and meta-analysis. World Psychiatry:Official Journal of the World Psychiatric Association (WPA) 13,288–295.Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H(2004). Utilising survey data to inform public policy:comparison of the cost-effectiveness of treatment of tenmental disorders. The British Journal of Psychiatry: TheJournal of Mental Science 184, 526–533.Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H,Jüni P, Cuijpers P (2013). Comparative efficacy of sevenpsychotherapeutic interventions for patients withdepression: a network meta-analysis. PLoS Medicine 10,e1001454.Bédard M, Felteau M, Marshall S, Cullen N, Gibbons C,Dubois S, Maxwell H, Mazmanian D, Weaver B, Rees L,Gainer R, Klein R, Moustgaard A (2014).Mindfulness-based cognitive therapy reduces symptoms ofdepression in people with a traumatic brain injury: resultsfrom a randomized controlled trial. The Journal of HeadTrauma Rehabilitation 29, E13–E22.Chalmers I, Glasziou P (2009). Avoidable waste in theproduction and reporting of research evidence. Lancet(London, England) 374, 86–89.Coventry PA, Hudson JL, Kontopantelis E, Archer J,Richards DA, Gilbody S, Lovell K, Dickens C, Gask L,Waheed W, Bower P (2014). Characteristics of effectivecollaborative care for treatment of depression: a systematicreview and meta-regression of 74 randomised controlledtrials. PLoS ONE 9, e108114.Cuijpers P (2014). Combined pharmacotherapy andpsychotherapy in the treatment of mild to moderate majordepression? JAMA Psychiatry 71, 747–748.Cuijpers P (2015). Psychotherapies for adult depression:recent developments. Current Opinion in Psychiatry 28,24–29.Cuijpers P, van Straten A (2011). New psychotherapies formood and anxiety disorders: necessary innovation or wasteof resources? Canadian Journal of Psychiatry. RevueCanadienne De Psychiatrie 56, 251; author reply 251–252.Cuijpers P, Van Straten A, Warmerdam L, Smits N (2008).Characteristics of effective psychological treatments ofdepression: a metaregression analysis. PsychotherapyResearch: Journal of the Society for Psychotherapy Research 18,225–236.Cuijpers P, Donker T, van Straten A, Li J, Andersson G(2010a). Is guided self-help as effective as face-to-facepsychotherapy for depression and anxiety disorders? Asystematic review and meta-analysis of comparativeoutcome studies. Psychological Medicine 40, 1943–1957.Cuijpers P, Smit F, Bohlmeijer E, Hollon SD, Andersson G(2010b). Efficacy of cognitive-behavioural therapy and otherpsychological treatments for adult depression:meta-analytic study of publication bias. The British Journal ofPsychiatry: The Journal of Mental Science 196, 173–178.Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD,Andersson G (2010c). The effects of psychotherapy for adultdepressionareoverestimated: ameta-analysis of studyqualityand effect size. Psychological Medicine 40, 211–223.Cuijpers P, van Straten A, Schuurmans J, van Oppen P,Hollon SD, Andersson G (2010d ). Psychotherapy forchronic major depression and dysthymia: a meta-analysis.Clinical Psychology Review 30, 51–62.Cuijpers P, Koole SL, van Dijke A, Roca M, Li J, ReynoldsCF (2014). Psychotherapy for subclinical depression:meta-analysis. The British Journal of Psychiatry: The Journal ofMental Science 205, 268–274.Flint J, Cuijpers P, Horder J, Koole SL, Munafò MR (2014).Is there an excess of significant findings in publishedstudies of psychotherapy for depression? PsychologicalMedicine, 1–8.Giosan C, Cobeanu O, Mogoase C, Muresan V, Malta LS,Wyka K, Szentagotai A (2014). Evolutionary cognitivetherapy versus standard cognitive therapy for depression: aprotocol for a blinded, randomized, superiority clinicaltrial. Trials 15, 83.Hollon SD (2015). The efficacy and acceptability ofpsychological interventions for depression: where we arenow and where we are going. Epidemiology and PsychiatricSciences. doi:10.1017/S2045796015000748.Hollon SD, Muñoz RF, Barlow DH, Beardslee WR, Bell CC,Bernal G, Clarke GN, Franciosi LP, Kazdin AE, Kohn L,Linehan MM, Markowitz JC, Miklowitz DJ, Persons JB,Niederehe G, Sommers D (2002). Psychosocialintervention development for the prevention and treatmentof depression: promoting innovation and increasing access.Biological Psychiatry 52, 610–630.Karyotaki E, Smit Y, Cuijpers P, Debauche M, De Keyser T,Habraken H, Pitchot W, Raes F, Salomez D, Gillain B,The future of psychotherapy research 3Fairon N, Paulus D, Robays J, Holdt Henningsen K (2014).The Long-Term Efficacy of Psychotherapy, Alone or inCombination with Antidepressants, in the Treatment of AdultMajor Depression. KCE, Federaal Kenniscentrum voor deGezondheidszorg: Brussels.Kazdin AE (2007). Mediators and mechanisms of change inpsychotherapy research. Annual Review of ClinicalPsychology 3, 1–27.Leucht S, Hierl S, Kissling W, Dold M, Davis JM (2012).Putting the efficacy of psychiatric and general medicinemedication into perspective: review of meta-analyses. TheBritish Journal of Psychiatry: The Journal of Mental Science 200,97–106.Munder T, Brütsch O, Leonhart R, Gerger H, Barth J (2013).Researcher allegiance in psychotherapy outcome research:an overview of reviews. Clinical Psychology Review 33,501–511.Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S,Chatterjee S, De Silva MJ, Bhat B, Araya R, King M,Simon G, Verdeli H, Kirkwood BR (2010). Effectiveness ofan intervention led by lay health counsellors for depressiveand anxiety disorders in primary care in Goa, India(MANAS): a cluster randomised controlled trial. Lancet(London, England) 376, 2086–2095.Solomonov N, Barber JP (2015). What we know, what wedo not know, and where are we heading? Efficacy andacceptability of psychological interventions for depression.Epidemiology and Psychiatric Sciences. doi:10.1017/S2045796015000815.van Straten A, Hill J, Richards DA, Cuijpers P (2015).Stepped care treatment delivery for depression: asystematic review and meta-analysis. Psychological Medicine45, 231–246.Vittengl JR, Clark LA, Dunn TW, Jarrett RB (2007).Reducing relapse and recurrence in unipolar depression: acomparative meta-analysis of cognitive-behavioraltherapy’s effects. Journal of Consulting and ClinicalPsychology 75, 475–488.4 P. Cuijpers

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The future of psychotherapy research: stop the waste and focus on
issues that matter
P. Cuijpers
Epidemiology and Psychiatric Sciences / FirstView Article / September 2015, pp 1 - 4
DOI: 10.1017/S2045796015000785, Published online: 09 September 2015
Link to this article: http://journals.cambridge.org/abstract_S2045796015000785
How to cite this article:
P. Cuijpers The future of psychotherapy research: stop the waste and focus on issues that matter. Epidemiology and
Psychiatric Sciences, Available on CJO 2015 doi:10.1017/S2045796015000785
Request Permissions : Click here
Downloaded from http://journals.cambridge.org/EPS, IP address: 31.138.156.224 on 10 Sep 2015
The future of psychotherapy research: stop the waste
and focus on issues that matter
P. Cuijpers1,2
1 Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands
2 EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
Key words: Antidepressants, behaviour therapy, cognitive therapy, depression, psychotherapy.
It is well-established that psychotherapies can effect-
ively treat depression. In the past four decades, more
than 400 randomized controlled trials have been con-
ducted (Cuijpers, 2015), showing that different types
of psychotherapy are effective (Barth et al. 2013), that
the effects do not or only marginally differ from each
other, that they are comparable with those of antide-
pressants, and that combined treatment is more effect-
ive than psychotherapy or medication alone (Cuijpers,
2014). However, psychotherapies are probably less
effective in chronic depression and dysthymia, when
patients have comorbid alcohol problems, and in sub-
threshold depression, although in these patients ther-
apies can prevent the onset of full-blown major
depressive disorders (Cuijpers et al. 2014).
The two Editorials in this issue give interesting per-
spectives onwherewearewith researchon these therap-
ies andwhat should happen in the future (Hollon, 2015;
Solomonov & Barber, 2015). The first thing that stands
out is that both agree that although psychotherapies
are effective, there is still considerable room for
improvement. The Editorials point at the problem that
the effects of psychotherapy have been overestimated
because of publication bias, but also that the longer
term effects of psychotherapies are not well known,
except maybe for cognitive-behavioural therapy where
longer-term effects have been shown (Karyotaki et al.
2014) in several trials. The small effects of psychothera-
pies and treatments in general in chronic and
treatment-resistant depression (Cuijpers et al. 2010d)
and the high relapse rates after successful recovery
(Vittengl et al. 2007) are also important problems.
I want to underscore that although therapies are
effective, there is still much room for improvement.
The effect sizes found for treatments for mental disor-
ders do not differ very much from those in general
medical disorders (Leucht et al. 2012), but still it is esti-
mated that current treatments cannot take away more
than one-third of the disease burden of depression,
and then only in optimal conditions (Andrews et al.
2004). And then there is the problem that more than
40% of the patients do not or only partially respond
to treatment and less than one-third of the patients
are completely recovered after treatment (Hollon
et al. 2002). And after successful response the relapse
rates are estimated to be 50% after 2 years and up
to 80% after 5 years (Vittengl et al. 2007). These pro-
blems are in addition to the problem that much of
the earlier research has considerably overestimated
the effects of acute treatments of depression, not only
because of publication bias, but also because of the
low quality of many trials in the field (Cuijpers et al.
2010c) and probably researcher allegiance (Munder
et al. 2013).
Both articles give indications for how future
research can contribute to a further reduction of the
disease burden. In addition to that, however, I would
like to stress that there is also much research that is
not needed anymore in the future. In the broader bio-
medical field it is estimated that about 85% of research
is wasted, because of irrelevant questions, inappropri-
ate designs and methods, and biased reporting
(Chalmers & Glasziou, 2009). There is no reason to
assume that this is very different in randomised trials
of psychotherapies for depression. We found earlier
that of 115 trials in this field only 11 met all nine gen-
erally accepted quality criteria, and that the effects of
these 11 studies were considerably smaller than those
of lower-quality studies (Cuijpers et al. 2010c). We
also found that adjusting for unpublished trials
reduces the effect size of psychotherapies with more
than one-third (Cuijpers et al. 2010b), and reporting
in these trials also is often biased (Flint et al. 2014).
Address for correspondence: Professor P. Cuijpers, Department of
Clinical Psychology, VU University Amsterdam, Van der
Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
(Email: p.cuijpers@vu.nl)
Epidemiology and Psychiatric Sciences, page 1 of 4. © Cambridge University Press 2015
doi:10.1017/S2045796015000785
EDITORIALS IN THIS ISSUE
In addition to that, a considerable number of studies
report on the effects of newly developed psychothera-
pies for depression (e.g., Bédard et al. 2014; Giosan
et al. 2014) and on comparative trials comparing two
types of psychotherapies. It is well-established, how-
ever, that all therapies for depression are about equally
effective (Barth et al. 2013) and that if a new therapy
would indeed be more effective than an existing ther-
apy, it would take a new trial with about 800 patients
to show its superiority (Cuijpers & van Straten, 2011).
If a therapy is found to be superior to an existing ther-
apy in an underpowered trial that would rather raise
doubts about the validity of the trial than trust that
this new therapy is indeed more effective.
Other trials have focused on examining psy-
chotherapies for depression in specific target popula-
tions, like older adults, women with postpartum
depression and patients with comorbid general medic-
al disorders. However, meta-analyses consistently
show that psychotherapies are effective in all such tar-
get groups (Cuijpers et al. 2008). By far the majority of
trials examining psychotherapies for depression find
positive effects, whether these are in specific target
groups or in unselected populations of adults. It
seems therefore not necessary to spend resources on
examining these therapies in all such specific target
groups.
In the same way it can be argued that it is no longer
needed to examine different treatment formats in ran-
domised controlled, because all research consistently
suggests that individual, group, guided self-help and
guided Internet-based therapies formats result in com-
parable outcomes (Cuijpers et al. 2010a; Andersson
et al. 2014).
In order to reduce the disease burden of depression
much research is needed in many areas. The two arti-
cles give several directions for future directions in
research on psychological treatments, including
research how to reduce drop-out rates for psychothera-
pies, because they use considerable resources with
apparently little benefits (Solomonov & Barber, 2015).
But also more research on the long-term effects of
therapies, treatment-resistant and chronic depression,
the high relapse rates and more knowledge on who
benefits from which treatment are important goals
for future research, as justly indicated in these two
articles in this issue.
In this context it could be added that it is also
important to examine how treatments work, because
if we understand the processes of how therapies
work we may finally start improving the effects of
therapies. However, examining working mechanisms
of treatments is notoriously complicated (Kazdin,
2007), and requires different types of research, includ-
ing not only research on mediators in randomised
trials, but also experimental studies, theoretical work
and animal studies. Although this will require quite
some resources, it will be one of the few ways how
we can improve the effects of treatments. It has been
shown that all pharmacological therapies are about
equally effective, that all psychological treatments are
equally effective, and that pharmacological and psy-
chological treatments are also equally effective. That
means that all treatments we have are about equally
effective, while we hardly know anything about who
benefits from which treatment. This basically implies
that the effects of treatments have not been improved
since the 1950s when the tricyclic antidepressants
(TCAs) were first tested.
The other approach to a further reduction of the dis-
ease burden of depression is to focus on improvement
of how to apply treatments better in routine care and
how to scale treatment up. Although the effects of
treatments may not have improved since their first
development, mental health care has made consider-
able progress in terms of reaching depressed patients
and applying therapies to people who can benefit
from therapies. That is important because large
group of patients who may benefit from treatment
still do not use these services enough, like adolescents,
older adults, minority and lower socioeconomic
groups. And in low- and middle income countries
treatments are hardly available at all. It is important
therefore to simplify therapies and make them more
accessible.
The suggestion by Solomonov and Barber to
develop stepwise treatment models offers therefore
an interesting perspective, with the simplest and
cheapest treatments first, followed by more compli-
cated and intensive therapies. That is in line with
more generic models that are aimed at improving
existing treatments and making them more efficient,
like stepped care (van Straten et al. 2015) and collabora-
tive care models (Coventry et al. 2014). But there are
also other ways to improve access and simplify treat-
ments without reducing their effects, like using trained
lay health counsellors for the delivery of treatments in
low-resourced countries, as has been done in India
(Patel et al. 2010), or using Internet-based guided self-
help therapies which cost much less time than trad-
itional, individual therapies (Andersson & Cuijpers,
2009).
Psychotherapies and other treatments for adult
depression are effective, but there is also much room
for improvement. The two Editorials in this issue
give a nice overview of where we are and where we
should be heading. We need much research, on the
long-term effects, on treatments of chronic and
treatment-resistant depression, on relapse, and on
working mechanisms. But there is also much research
2 P. Cuijpers
which we no longer need because it has been examined
sufficiently, like new therapies that promise superior
effects over existing therapies while they always show
equal effects. Resources are scarce and using them for
unnecessary research will slow down progress and let
patients with depression suffer more than needed.
Acknowledgement
None.
Financial Support
This research received no specific grant from any fund-
ing agency, commercial or not-for-profit sectors.
Conflict of Interest
None.
References
Andersson G, Cuijpers P (2009). Internet-based and other
computerized psychological treatments for adult depression:
a meta-analysis. Cognitive Behaviour Therapy 38, 196–205.
Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E
(2014). Guided Internet-based vs. face-to-face cognitive
behavior therapy for psychiatric and somatic disorders: a
systematic review and meta-analysis. World Psychiatry:
Official Journal of the World Psychiatric Association (WPA) 13,
288–295.
Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H
(2004). Utilising survey data to inform public policy:
comparison of the cost-effectiveness of treatment of ten
mental disorders. The British Journal of Psychiatry: The
Journal of Mental Science 184, 526–533.
Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H,
Jüni P, Cuijpers P (2013). Comparative efficacy of seven
psychotherapeutic interventions for patients with
depression: a network meta-analysis. PLoS Medicine 10,
e1001454.
Bédard M, Felteau M, Marshall S, Cullen N, Gibbons C,
Dubois S, Maxwell H, Mazmanian D, Weaver B, Rees L,
Gainer R, Klein R, Moustgaard A (2014).
Mindfulness-based cognitive therapy reduces symptoms of
depression in people with a traumatic brain injury: results
from a randomized controlled trial. The Journal of Head
Trauma Rehabilitation 29, E13–E22.
Chalmers I, Glasziou P (2009). Avoidable waste in the
production and reporting of research evidence. Lancet
(London, England) 374, 86–89.
Coventry PA, Hudson JL, Kontopantelis E, Archer J,
Richards DA, Gilbody S, Lovell K, Dickens C, Gask L,
Waheed W, Bower P (2014). Characteristics of effective
collaborative care for treatment of depression: a systematic
review and meta-regression of 74 randomised controlled
trials. PLoS ONE 9, e108114.
Cuijpers P (2014). Combined pharmacotherapy and
psychotherapy in the treatment of mild to moderate major
depression? JAMA Psychiatry 71, 747–748.
Cuijpers P (2015). Psychotherapies for adult depression:
recent developments. Current Opinion in Psychiatry 28,
24–29.
Cuijpers P, van Straten A (2011). New psychotherapies for
mood and anxiety disorders: necessary innovation or waste
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The future of psychotherapy research: stop the waste and focus on issues that matter

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