Cultural Sexism Moderates Efficacy of Psychotherapy: Results from a Spatial Meta-Analysis

We examined whether cultural sexism (county- and state-level gender attitudes) moderates the efficacy of psychotherapies by re-analyzing data from a previous meta-analysis of randomized controlled trials of youth psychotherapy for the most commonly targeted problems (depression, anxiety, conduct, attention-deficit hyperactivity disorder; 2,698 effect sizes (ESs);314 studies; N=19,739; ages 4-18). Higher cultural sexism was associated with lower ESs for studies with ³50% girls; this association became stronger as the proportion of girls in thesamples increased. Cultural sexism was unrelated to ESs for studies with >50% boys. An interaction between state- and county-level sexism revealed that psychotherapies were mostbeneficial when they were conducted in states and counties with the lowest cultural sexism. Thus, the context in which psychotherapies are delivered is associated with psychotherapy efficacy for girls.

Embracing Scientific Humility and Complexity: Learning “What Works for Whom” in Youth Psychotherapy Research

Clinical psychological scientists have spent decades attempting to understand “what works for whom” in the context of youth psychotherapy, toward the longstanding goal of personalizing psychosocial interventions to fit individual needs and characteristics. However, as the articles in this Special Issue jointly underscore, more than 50 years of psychotherapy research has yet to help us realize this goal. In this introduction to the special issue, we outline how and why “aspiration-method mismatches” have hampered progress toward identifying moderators of youth psychotherapy; emphasize the need to embrace etiological complexity and scientific humility in pursuing new methodological solutions; and propose individual and structural strategies for better-aligning clinical research methods with the goal of personalizing mental health care for youth with diverse identities and treatment needs.

Leveraging the developmental science of psychosocial risk to strengthen youth psychotherapy

More than 50 years of randomized clinical trials for youth psychotherapies have resulted in moderate effect sizes for treatments targeting the most common mental health problems in children and adolescents (i.e., anxiety, depression, conduct problems, and attention disorders). Despite having psychotherapies that are effective for many children, there has been a dearth of progress in identifying the contextual factors that likely influence who will respond to a given psychotherapy, and under what conditions. The developmental psychopathology evidence base consistently demonstrates that psychosocial risk exposures (e.g., childhood adversities, interpersonal stressors, family dysfunction) significantly influence the onset and course of youth psychopathology. However, the developmental psychopathology framework remains to be well integrated into treatment development and psychotherapy research. We argue that advances in basic developmental psychopathology research carry promising implications for the design and content of youth psychotherapies. Research probing the effects of psychosocial risks on youth development can enrich efforts to identify contextual factors in psychotherapy effectiveness and to personalize treatment. In this article we review empirically supported and hypothesized influences of individual- and family-level risk factors on youth psychotherapy outcomes, and we propose a framework for leveraging developmental psychopathology to strengthen psychotherapies.