criteria, we were able to conduct an adequately powered test of between study heterogeneity and examine if the type of depression influenced relative efficacy. Results: Psychotherapy and medication were not significantly different at post-treatment, however effect sizes were not consistent. Although there was no association between severity and relative efficacy, a small but significant advantage for medications in the treatment of dysthymia did emerge. However, psychotherapy showed a significant advantage over medication at follow-up and this advantage was positively associated with length of follow-up. Moreover, discontinued acute phase psychotherapy did not differ from continued medication at follow-up. Limitations: Limitations included relatively fewer studies of severe and chronic depression, as well as dysthymia. In addition, only a minority of studies reported follow-up data. Conclusions: Our results indicated that both psychotherapy and medication are viable treatments for unipolar depression and that psychotherapy may offer a prophylactic effect not provided by medication. However, our analyses diverged from previous findings in that effects were not consistent and medication was significantly more efficacious than psychotherapy in the treatment of dysthymia.
Baldwin, S. A., Wampold, B. E. & Imel, Z. E. (2007). Journal of Consulting and Clinical Psychology, 75(6), 842-852.
Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients seen by 80 therapists (therapist average caseload was 4.1). Patients rated both the alliance and outcome and all models adjusted for baseline psychological functioning. The results indicated that therapist variability in the alliance predicted outcome, whereas patient variability in the alliance was unrelated to outcome. Reasons why therapist variability as opposed to patient variability predicted outcome are discussed. Clinical implications include therapists monitoring their contribution to the alliance, clinics providing feedback to therapists about their alliances, and therapists receiving training to develop and maintain strong alliances.
Cognitive behavioral therapy
Group cognitive behavioural treatment for low-back pain in primary care: a randomized controlled trial and cost-effectiveness analysis.
Lamb, S. E., Hansen, Z., Lall, R., Castelnuovo, E., Withers, E. J., Nichols, V. Potter, R. & Underwood, M. R. (2010). The Lancet.
Today's new issue of *The Lancet* includes an article: "Group cognitive behavioural treatment for low-back pain in primary care: a randomized controlled trial and cost-effectiveness analysis." The authors are Sarah E Lamb, Zara Hansen, Ranjit Lall, Emanuela Castelnuovo, Emma J Withers, Vivien Nichols, Rachel Potter, & Martin R Underwood, on behalf of the Back Skills Training Trial investigators.
Effective treatments that result in sustained improvements in low-back pain are elusive.
This trial shows that a bespoke cognitive behavioural intervention package, BeST, is effective in managing subacute and chronic low-back pain in primary care.
The short-term effects (<=4 months) are similar to those seen in high quality studies and systematic reviews of manipulation, exercise,acupuncture, and postural approaches in primary