1 - (OP23) A Systematically Developed, Comprehensive Map of Distinct Evidence-based Psychological Interventions for Severe Mental Disorders

Background: Though multiple psychological interventions were evaluated in randomized controlled trials (RCTs) and recommended by clinical practice guidelines, distinct evidence-based psychotherapies (EBPs) and variations tested have never been charted. We conducted a systematic mapping of these across six severe mental disorders (schizophrenia and psychotic, bipolar disorders, bulimia and anorexia nervosa, substance use disorders and borderline personality disorder).

Methods: We established a large cohort of EBPs by selecting all RCTs from six recent and large network meta-analyses for severe mental disorders in adults. Pairs of researchers independently selected all psychological intervention arms and assigned them to macro-families, based on labels and theoretical background. Subsequently, within each macro-family, groups of identical arms, i.e., referencing the same manual or protocol, were consolidated as discrete psychological interventions. Adaptations (i.e., modifications to a core manual) related to content, structure, delivery or cultural were also described.
Outcomes: From 260 RCTs, 422 psychological intervention arms were grouped in 45 macro-families and consolidated in 266 distinct interventions (63%, 95% CI [58% to 67%]) across disorders. CBT was the most common macro-family (89 singular interventions), followed by psychoeducation (26), supportive therapy (23), psychodynamic psychotherapy (22) and contingency management (22). Intervention redundancy was highest for substance use disorder (47 distinct of 104, 45%, 95% CI [35% to 54%]) and bulimia nervosa (25 of 45, 55%, 95% CI [41% to 69%]). For the other disorders, variability was high with distinct interventions representing 64% (borderline personality) to 81% (bipolar disorders) of all psychotherapy arms. Seventy-nine out of 266 distinct interventions (29%, 95% CI [24% to 35%]) contained adaptations, of which 32 interventions (12%, 95% CI [8% to 16%]) incorporated multiple modifications to the original manual or protocol. We identified a total of 137 adaptations, most of which involved content (n= 59, 43%, 95% CI [35% to 51%]) or structure (n= 42, 31%, 95% CI [23% to 38%]). Adaptations regarding delivery format (n=14, 10%, 95% CI [6% to 16%]) and cultural elements (n= 9, 7%, 95% CI [3% to 12%]) were rare. Seventy-five out of 266 distinct interventions (28%, 95% CI [23% to 34%]) had openly available manuals or protocols. Of the most common macro-families, manuals were publicly available for 20/89 CBT (22%), 5/23 supportive (22%) and 2/22 psychodynamic distinct interventions (9%).
Interpretation: Our findings showcase the variability of psychological interventions across six severe mental disorders in adults, but also provide a systematization of this variability in unique interventions and macro-families. Mapping EBPs across macro-families and discrete interventions could inform evidence-synthesis and identification of active ingredients, guide mechanisms of change exploration and support prioritizing interventions for research and dissemination. Interventions with open manuals could be prioritized in effectiveness research and subsequently in implementation, particularly in low and middle-income settings.