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.

Abstract

<h4>Background</h4>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.<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Discussion</h4>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.<h4>Systematic review registration</h4>PROSPERO (CRD420250619644).