STUDY PROTOCOL article
Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1664393
This article is part of the Research TopicExpanding the Reach of Evidence-Based Psychological Interventions for Mental Health: Innovation, Access, and EquityView all 5 articles
Meta-Epidemiological Assessment and Evaluation of Certainty of Evidence in Systematic Reviews with Meta-Analyses of Cognitive Behavioral Therapy and Psychodynamic/Psychoanalytic Psychotherapy: An Umbrella Review Protocol
Provisionally accepted
Rogério Lerner1*
Bárbara Gonçalves2
Caroline Martins Dias1
Júlia Benvenutti Gerotto1
Tayane Aparecida Teizen Ruffino1
Yasmin Meireles Aragão1
Izabella Lopes de Arantes1Marina Klein1- 1Universidade de Sao Paulo, São Paulo, Brazil
- 2Universidade Presbiteriana Mackenzie, São Paulo, Brazil
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Psychodynamic/psychoanalytic psychotherapy (PPT) and cognitive behavioral therapy (CBT) are two major therapeutic modalities widely used in clinical practice and supported by distinct theoretical and empirical bases. Persistent debate–particularly around PPT’s evidentiary strength–underscore the need to critically appraise the methodological quality and certainty of evidence of systematic reviews with meta-analyses (SRMAs) that underpin claims regarding its effectiveness, particularly in comparison with CBT. Objective: This umbrella review will assess and compare the methodological rigor (AMSTAR-2) and certainty of evidence (GRADE) of systematic reviews with meta-analyses (SRMAs) of randomized controlled trials (RCTs) of CBT and PPT, published between 2015 and 2024. Methods: We will search Embase, The Cochrane Library, PsycINFO, PubMed, and Web of Science for peer-reviewed SRMAs of RCTs of CBT and PPT across various mental disorders. Methodological quality will be assessed using AMSTAR-2, and their certainty of evidence will be evaluated using the GRADE system. Descriptive, correlational, and comparative analyses will examine associations between methodological quality, certainty of evidence, and reported SRMA-level effect patterns, and be used to synthesize the findings. Sensitivity analyses will address quality threshold, comparator class, psychiatric diagnosis, and quality thresholds; multiple testing will be corrected by Holm-Bonferroni. Discussion: By evaluating and comparing the volume, methodological rigor, and certainty of evidence of SRMAs CBT and PPT, this umbrella review aims to contribute to the ongoing debate on evidence-based psychotherapy, inform clinical decision-making, guide future research, and support evidence-informed public health policy. PROSPERO registration number CRD420250619644.
Keywords: AMSTAR-2, quality, Systematic reviews, Grade, Meta-epidemiology, Umbrella review
Received: 11 Jul 2025; Accepted: 17 Sep 2025.
Copyright: © 2025 Lerner, Gonçalves, Dias, Gerotto, Ruffino, Aragão, de Arantes and Klein. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rogério Lerner, rogerlerner@usp.br
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