Research across four decades has produced numerous empirically-tested evidence-based psychotherapies (EBPs) for youth psychopathology, developed to improve upon usual clinical interventions. Advocates argue that these should replace usual care; but do the EBPs produce better outcomes than usual care?

This question was addressed in a meta-analysis of 52 randomized trials directly comparing EBPs to usual care. Analyses assessed the overall effect of EBPs vs. usual care, and candidate moderators; multilevel analysis was used to address the dependency among effect sizes that is common but typically unaddressed in psychotherapy syntheses.

The PubMed, PsychINFO, and Dissertation Abstracts International databases were searched for studies from January 1, 1960 – December 31, 2010.

507 randomized youth psychotherapy trials were identified. Of these, the 52 studies that compared EBPs to usual care were included in the meta-analysis.

Sixteen variables (participant, treatment, and study characteristics) were extracted from each study, and effect sizes were calculated for all EBP versus usual care comparisons.

EBPs outperformed usual care. Mean effect size was 0.29; the probability was 58% that a randomly selected youth receiving an EBP would be better off after treatment than a randomly selected youth receiving usual care. Three variables moderated treatment benefit: Effect sizes decreased for studies conducted outside North America, for studies in which all participants were impaired enough to qualify for diagnoses, and for outcomes reported by people other than the youths and parents in therapy. For certain key groups (e.g., studies using clinically referred samples and diagnosed samples), significant EBP effects were not demonstrated.

EBPs outperformed usual care, but the EBP advantage was modest and moderated by youth, location, and assessment characteristics. There is room for improvement in EBPs, both in the magnitude and range of their benefit, relative to usual care.