Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
Department of Social Psychology, Faculty of Behavioral and Social Sciences, University of Amsterdam, Amsterdam, The Netherlands.
J Clin Psychol. 2019 Mar;75(3):329-343. doi: 10.1002/jclp.22712. Epub 2018 Oct 28.
Institutional promotion of psychotherapy manuals as a requirement for evidence-based treatments (EBTs) yields the assumption that manualized treatment is more effective than nonmanualized treatment. This systematic review examines empirical evidence for this claim.
An electronic database search identified studies that directly or indirectly compared manual-based and non-manual-based treatment.
Six studies directly compared manualized and nonmanualized treatment (Hypothesis 1). None support manual superiority. Eight meta-analyses indirectly assessed effect sizes of manual-based treatment and control groups (Hypothesis 2). Three support manual superiority, five do not. One meta-analysis and 15 further studies addressed manual adherence as an indirect indicator of manual efficacy (Hypothesis 3). The meta-analysis concluded that manual adherence does not affect outcome, additional studies provided inconclusive results.
Manualized treatment is not empirically supported as more effective than nonmanualized treatment. While manual-based treatment may be attractive as a research tool, it should not be promoted as being superior to nonmanualized psychotherapy for clinical practice.
将心理治疗手册作为循证治疗（EBT）的要求在机构中推广，这使得人们假设规范化治疗比非规范化治疗更有效。本系统评价检验了这一说法的经验证据。
电子数据库检索确定了直接或间接比较基于手册和非基于手册治疗的研究。
六项研究直接比较了规范化和非规范化治疗（假设 1）。没有研究支持手册优越性。八项荟萃分析间接评估了基于手册的治疗和对照组的效应大小（假设 2）。有三项支持手册优越性，五项不支持。一项荟萃分析和 15 项进一步的研究将手册依从性作为手册疗效的间接指标（假设 3）。荟萃分析的结论是手册依从性不会影响结果，其他研究提供了不确定的结果。
规范化治疗没有得到经验支持，其效果优于非规范化治疗。虽然基于手册的治疗可能作为一种研究工具很有吸引力，但它不应被推广为优于非规范化心理治疗用于临床实践。
