Innovations to improve outcomes and uptake of psychotherapies for mental disorders: a state-of-the-art review.

Psychotherapies have been found effective in the treatment of most mental disorders. However, substantial improvements are still much needed, and many innovations of therapies are currently being developed. We review the current status of promising innovations to improve the outcomes and uptake of psychotherapies for mental disorders, discussing the largest and most recent meta-analyses. Innovations are categorized into four domains: a) the digital field (including Internet-based interventions in general; mobile interventions; serious games; virtual and augmented reality; prescription digital therapeutics; blended therapy; avatar therapy; and chatbots/artificial intelligence-generated conversational agents); b) personalized treatments (research on predictors and moderators in large randomized controlled trials; use of individual patient data meta-analyses in personalization; machine learning approaches; personalized and modular therapies; and matching therapists to patients); c) new and improved therapies (cognitive bias modification; cognitive remediation; psychedelic-assisted psychotherapies; transdiagnostic therapies; research on effective components through factorial trials and component network meta-analyses; innovations in the understanding of the processes involved in psychotherapies, including research on common factors and the therapeutic alliance, and on the fidelity vs. flexibility question; research on prevention of adverse effects of therapies, the impact of increased session frequency or progress feedback on outcomes, and methodological innovations in trial designs); and d) dissemination and simplification of therapies (task sharing, digital interventions in low- and middle-income countries; and single-session interventions). These innovations vary in their maturity, from dozens of supporting trials to few or none. Methods to assess the strength of innovations suggest that no innovation will be a paradigm-shifting "silver bullet" that dramatically increases treatment outcomes, but that progress will only be possible through multiple, incremental improvements.