To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

Femke Truijens; Levin Zühlke-van Hulzen; Stijn Vanheule

doi:10.1002/jclp.22712

To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

Femke Truijens^*, Levin Zühlke-van Hulzen, Stijn Vanheule

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

43 Citations (Scopus)

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Abstract

OBJECTIVE: 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.

METHODS: An electronic database search identified studies that directly or indirectly compared manual-based and non-manual-based treatment.

RESULTS: 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.

CONCLUSIONS: 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.

Original language	English
Pages (from-to)	329-343
Number of pages	15
Journal	Journal of Clinical Psychology
Volume	75
Issue number	3
DOIs	https://doi.org/10.1002/jclp.22712
Publication status	Published - Mar 2019
Externally published	Yes

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title = "To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment",

abstract = "OBJECTIVE: 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.METHODS: An electronic database search identified studies that directly or indirectly compared manual-based and non-manual-based treatment.RESULTS: 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.CONCLUSIONS: 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.",

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To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment. / Truijens, Femke; Zühlke-van Hulzen, Levin; Vanheule, Stijn.
In: Journal of Clinical Psychology, Vol. 75, No. 3, 03.2019, p. 329-343.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - To manualize, or not to manualize

T2 - Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

AU - Truijens, Femke

AU - Zühlke-van Hulzen, Levin

AU - Vanheule, Stijn

PY - 2019/3

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N2 - OBJECTIVE: 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.METHODS: An electronic database search identified studies that directly or indirectly compared manual-based and non-manual-based treatment.RESULTS: 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.CONCLUSIONS: 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.

AB - OBJECTIVE: 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.METHODS: An electronic database search identified studies that directly or indirectly compared manual-based and non-manual-based treatment.RESULTS: 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.CONCLUSIONS: 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.

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SN - 0021-9762

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JO - Journal of Clinical Psychology

JF - Journal of Clinical Psychology

IS - 3

ER -

To manualize, or not to manualize: Is that still the question? A systematic review of empirical evidence for manual superiority in psychological treatment

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