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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
Author(s) -
Truijens Femke,
Zühlkevan Hulzen Levin,
Vanheule Stijn
Publication year - 2019
Publication title -
journal of clinical psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.124
H-Index - 119
eISSN - 1097-4679
pISSN - 0021-9762
DOI - 10.1002/jclp.22712
Subject(s) - psychology , psychotherapist , clinical psychology , cognitive psychology
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.