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March 15, 2024 | VOL. 77, NO. 1 CURRENT ISSUE pp.1-42

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Recent Developments in Group Psychotherapy Research

Jenny Rosendahl , Ph.D. ,
Cameron T. Alldredge , M.S. ,
Gary M. Burlingame , Ph.D. ,
Bernhard Strauss , Ph.D.

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This article reviews group psychotherapy research published within the past 30 years, predominantly focusing on outcomes of group treatments for patients with various mental disorders. Additionally, meta-analyses on the efficacy of group treatments for patients with cancer or chronic pain are summarized. Results strongly support the use of group therapy and demonstrate outcomes equivalent to those of individual psychotherapy. The research also appears to emphasize the effect of feedback on outcomes in group treatments and an association between treatment outcomes and group cohesion and alliance. Other promising developments in the field of group therapy are discussed.

Research on group therapy over the past 30 years has been summarized in 11 meta-analyses, including 329 randomized controlled trials and 370 comparisons between group therapy and various control groups, together involving over 27,000 patients.

Meta-analytic results demonstrate that group therapy is effective compared with nonactive treatment and is equivalent to other active treatments for various mental disorders.

Group therapy treatments have recently been applied to patients with a variety of medical conditions, such as neurological diseases, cancer, and chronic pain.

Increasing emphasis is being placed on conducting studies that use feedback measures to help therapists identify patients likely to experience failure in treatment and/or in the therapeutic relationship.

Editor’s Note: This article is part of a special issue on group psychotherapy with Guest Editor Fran Weiss, L.C.S.W.-R., B.C.D. Although authors were invited to submit manuscripts for the themed issue, all articles underwent peer review as per journal policies.

In 2018, after a lengthy effort, the American Psychological Association decided to recognize group psychotherapy as a specialty, thus making it a defined area of practice requiring specific knowledge and skills gained through organized education and training. This decision was based on evaluation of the empirical, theoretical, and clinical literature on group treatments. The findings were so convincing that group psychotherapy was posited as an area for further education equivalent to those of clinical or counseling psychology. Indeed, the American Psychological Association group specialty petition referenced specific training programs in North America that emphasized group psychotherapy and the longstanding efforts of the American Group Psychotherapy Association to train clinicians at pre- and postdegree levels.

Since 1971, research in all areas of psychotherapy has been regularly summarized in the Handbook of Psychotherapy and Behavior Change , originally written by Allen Bergin and Sol Garfield ( 1 ). In 2021, the 50th anniversary year, the seventh edition ( 2 ) of this book will be published, and most of the chapters for this new edition are already available. We discuss some elements of the chapter on group psychotherapy ( 3 ) in this review.

Two authors of this review (G.M.B., B.S.) summarized the research on group therapy for the Handbook ’s fifth and sixth editions ( 4 , 5 ). The forthcoming edition continues a long history of research cooperation and has refined the methods used to produce the summaries of evidence. In the early years of research on group psychotherapy, studies tended to focus on smaller samples, usually without much control of potential influencing factors. The past 20 years have seen a shift in the general standard of group psychotherapy research, as evidenced by many controlled, carefully planned studies with larger samples and rigorous methodology. These developments in the research have contributed to advancement beyond narrative summaries (as was the case in previous editions of the Handbook ’s chapters on group psychotherapy) ( 4 , 5 ) and have led to the more reliable meta-analytical summaries about various disorders.

Research on Group Psychotherapy Outcomes

The Handbook ’s previous chapters on group psychotherapy ( 4 , 5 ) were based on a simple model that identified potential variables influencing group treatment outcomes. The “five influencing factors model” served as the ordering principle for the literature reviews and is still considered useful in reflecting on group therapy in practice and supervision. The five factors include formal change theory, group dynamics, structural aspects of groups, characteristics of group participants, and characteristics of the group leader. Together, these variables work to define the group process and provide information regarding the form and function of groups.

Following a model by Barlow ( 6 ), the latest group therapy chapter is built on a conceptual model in which different types of therapeutic groups are distinguished from each other ( Figure 1 ). This model outlines three main types of therapeutic groups: leaderless groups (which mainly play a role in self-help and addiction treatment), psychoeducational groups (which are important in psychiatric settings and increasingly within day hospitals), and therapeutic groups that are either manual or model based. Manual-based groups are typically short term and are primarily designed according to specific therapy orientations or formal change theories (e.g., group analysis or cognitive-behavioral therapy [CBT]). For example, in short-term group analysis, techniques focus on a specific conflictual theme, and CBT techniques, such as exposure or cognitive restructuring, are applied. Model-based groups are less structured and focus on principle-based interventions tailored to the developmental stage of the group as a whole in addition to those of individual members.

FIGURE 1. Conceptual framework for organizing group therapy treatments a

a Adapted from Burlingame and Strauss ( 3 ).

Meta-Analyses on the Efficacy of Group Therapy in Treating Mental Disorders

Because of the long tradition of research on group psychotherapy and the growing importance of evidence-based standards, a large number of randomized controlled studies (RCTs) on the efficacy of group psychotherapy are available. Since 2013, numerous meta-analyses have been published through international cooperation among colleagues from the United States (Gary Burlingame, Brigham Young University), Germany (Bernhard Strauss and Jenny Rosendahl, University of Jena), Canada (Giorgio Tasca, University of Ottawa), and Italy (Gianluca Lo Coco, University of Palermo). In a joint effort, 11 meta-analyses have been conducted, including 329 RCTs (370 comparisons between group therapy and various control groups) and more than 27,000 patients. In the new edition of the Handbook ( 2 ), the evidence on group therapy is summarized according to the highest level of evidence-based research, allowing for specification of direction and strength of differences between treatment conditions ( 7 ), calculation of overall effect, and estimation of heterogeneity on individual study effects ( 8 ). Figure 2 provides an overview of the disorder-specific findings of the individual meta-analyses.

FIGURE 2. Meta-analyses results, by disorder and control condition a

a Effect sizes of 0.2 were interpreted as small, 0.5 as medium, and 0.8 as large ( 7 ). Heterogeneity was considered nonexistent if I 2 =0% and was quantified as low, moderate, and high with upper limits of 25%, 50%, and 75% for I 2 , respectively ( 8 ).

*p<0.05, **p<0.01, ***p<0.001.

To date, 11 different meta-analytic summaries ( 9 – 19 ) have been based on RCTs examining the efficacy of group psychotherapy for patients with mental disorders. In comparison to untreated control groups (e.g., waitlist control groups, minimal contact conditions), group psychotherapy has demonstrated large effects on the reduction of disorder-specific symptoms associated with anxiety, obsessive-compulsive disorders, and depression. For eating disorders (e.g., bulimia, binge eating disorder) and posttraumatic stress disorder (PTSD), medium effects have been found ( 12 , 14 ). Additionally, small effects have been shown for substance use disorders and schizophrenia ( 16 , 17 ).

Comparisons to active treatment conditions (e.g., individual psychotherapy, pharmacotherapy, inpatient or outpatient treatment as usual) have yielded a more complex picture. Compared with inpatient or outpatient treatment as usual, group psychotherapy has demonstrated significant advantages with medium to large effect sizes on disorder-specific symptoms for patients with depression, bipolar disorder, and borderline personality disorder ( 15 , 19 ). Specific comparison with pharmacotherapy ( 11 , 19 ) has been available only in the context of obsessive-compulsive disorders and depression, with no significant differences found.

In comparisons between group psychotherapy and individual psychotherapy, disorder-specific findings have been identified for obsessive-compulsive disorders (no differences) and substance-induced disorders (small effect in favor of group therapy). In a meta-analytic summary comparing group and individual therapy across various disorders ( 10 ), 46 studies with equivalent treatments (treatment protocol, patients, dosage) across formats demonstrated similar effectiveness (effect size g=–0.01), in addition to 21 studies with nonequivalent treatment approaches (g=–0.06). Furthermore, in all comparisons of individual and group therapy, there were no differences in the rates of acceptance (i.e., patients in groups expressed the same level of satisfaction as those in individual therapy), remission, improvement, or premature termination. In sum, meta-analytic results demonstrate that treatment in small groups is effective compared with nonactive treatment and is equivalent to other active treatments.

A majority of studies in these meta-analyses examined group CBT approaches in the broadest sense, which included third-wave methods such as mindfulness-based therapies. Exceptions were mostly found in the efficacy research on treatments for borderline personality disorder ( 15 ), eating disorders ( 12 ), and PTSD ( 14 ), which included the use of interaction-focused and psychodynamic approaches. In addition, systemic approaches were found in studies involving multifamily groups for schizophrenia. Psychoeducational groups were also widespread and were found effective in treating schizophrenia and affective disorders (particularly bipolar disorders). A majority of studies on the efficacy of group treatments have been conducted in outpatient settings and have mainly focused on short-term groups.

Aside from the group CBT approaches, psychodynamic and group analytic approaches have the longest tradition. Nevertheless, the most recent systematic review of psychodynamic group studies ( 20 ) showed that, despite important theoretical contributions in the field, only a small number of studies reached the standards of outcome research. On the other hand, promising trends have emerged during the past decade, such as conceptual clarifications of group analytic work ( 21 ). In addition, efforts to improve research have been made. For example, Lorentzen ( 22 ) developed a transdiagnostic manual for short- and long-term group analysis that has provided the basis for studies comparing the two approaches and for detecting several moderators ( 23 , 24 ). In addition, new approaches have been developed on the basis of interpersonal and psychodynamic assumptions, such as Whittingham’s ( 25 ) eight-session, manualized focused brief group therapy, which combines elements derived from process groups and attachment theory. Furthermore, Tasca et al.’s ( 26 ) integrative approach combining psychodynamic, interpersonal, and attachment theory (group psychodynamic-interpersonal psychotherapy) has led to empirical studies. Both of these approaches demonstrate that brief focused groups can be useful in the psychodynamic field and may be interpreted as a response to the overwhelming evidence for short-term group CBT. Promising psychodynamic group research can be found for mentalization-based approaches in different treatment settings and for various patient groups ( 27 ).

All studies included in the meta-analyses were RCTs implementing rigorous research designs. Although such trials generally provide less biased estimates of psychotherapy outcomes and generate substantially more replicable results than do other designs, they have been criticized for their limited external validity and absence of information on treatment mechanisms ( 28 , 29 ).

Moderators of Group Treatment Outcomes

An increasing number of studies have implemented rigorous study designs to test moderators of treatment efficacy in the various meta-analyses. However, no clear trends have emerged, and single moderators have proven relevant for different disorders. For example, “allegiance,” defined as the researcher’s belief in the superiority of a treatment (risk of allegiance bias lowers the effects of head-to-head comparisons in anxiety disorders) ( 18 ), group size (larger groups lead to lower effects when working with patients with borderline personality disorder) ( 15 ), and specific diagnosis (larger effects on binge eating frequency seen in binge eating disorders compared with bulimia) ( 12 ) are significant moderators. In group therapy for schizophrenia, two moderators explained variance in effect size: a higher treatment dose (i.e., increased frequency × length of sessions) produced larger effects, and advanced (i.e., doctoral-level) training of group leaders led to larger effect sizes ( 17 ). In patients with PTSD ( 14 ), gender (larger effects in women) and trauma type (smaller effects for military-sector trauma) were found to be moderators. For the other disorders, either no significant moderators were found or they were not systematically investigated (affective disorders, social anxiety, panic disorder, obsessive-compulsive disorder, substance abuse disorder) ( 9 , 11 , 13 , 16 , 19 ).

Group Therapy for Medical Conditions

The scope of application of small group treatments has been expanded to patients with a variety of medical conditions (e.g., neurological diseases such as epilepsy and dementia). Research on group treatments for oncological patients (with a focus on breast cancer) has continued. In the 2013 chapter ( 5 ), 23 studies examining group therapy for cancer patients were summarized. These studies primarily included supportive-expressive therapy ( 30 ), CBT, and psychoeducation groups. Since then, this area of research has expanded considerably, with the largest number of group therapy studies still focusing on patients with breast cancer. Several of these studies now have long-term (up to 11 years) follow-up data available ( 31 ). Results from these studies suggest that the effects of group therapy, as demonstrated by reduced cortisol and depression, are maintained over the long term compared with outcomes among patients assigned to control conditions ( 31 ).

The predominant therapeutic approach among groups for those with general medical conditions has been CBT with a focus on stress and stress management ( 32 ), although some studies have examined psychoeducational approaches, and even fewer have focused on supportive group therapies ( 33 ). Similar to research on group therapy for mental disorders, the oncology literature shows a trend toward testing group treatments that can be classified as third-wave CBT (i.e., mindfulness-based stress reduction) ( 34 ). It has been observed that the primary outcome criteria have expanded considerably, with resilience, optimism, and posttraumatic growth investigated more often. Overall, the effects of group therapies have been relatively positive, although some studies have yielded contradictory results. The supportive-expressive groups in the tradition of Spiegel or Yalom ( 30 , 35 ) have almost completely disappeared from the literature and have been replaced by third-wave approaches (e.g., mindfulness-based or acceptance and commitment treatments), which diverge from traditional CBT in that they focus more on one’s relationship with thoughts and emotions rather than on their content.

A second general medical issue that has been examined in the context of group therapies is pain. A majority of these studies have focused on chronic pain and fibromyalgia, although a minority have dealt with specific pain conditions. Nine studies on fibromyalgia published since 2013 were included in the Handbook’s most recent review ( 3 ), which tested a variety of group approaches and found relatively good effects in terms of physical function, pain-related disability, pain severity, anxiety, depression, and self-efficiency ( 36 ). Studies on chronic pain have primarily focused on coping with and reducing pain-related disability.

Overall, group studies on pain only partially confirmed the effectiveness of CBT approaches (the gold standard treatment) for pain. In any case, there are enough studies on group treatment in oncology and pain therapy to warrant a more differentiated meta-analytical consideration of the results.

General Conclusions Regarding Group Psychotherapy Outcomes

The 2013 chapter on group therapy ( 5 ) summarized 250 studies concerning 12 different disorders in a systematic narrative review, despite the studies’ increasing methodological quality. In contrast, the updated review ( 3 ) refers to a total of 11 new meta-analyses, with group therapy compared with active or nonactive control conditions. All considered meta-analyses used a rigorous methodology, included RCTs only, and considered the risk of bias in the studies. In addition to the 329 studies in the meta-analyses, 40 studies on group treatments for patients with cancer or pain were included. Results from this most current review demonstrate that group treatments achieve large effects compared with nonactive treatment conditions and that the differences from other treatments, such as individual therapy, are negligible in terms of effect size. In a majority of comparisons (75%), the heterogeneity of single study effects was small, suggesting that these can be considered reliable estimates of treatment effect.

Despite these findings, existing treatment guidelines of international organizations (e.g., American Psychological Association, National Institute for Health and Care Excellence), and guidelines in German-speaking countries (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften), recommend group therapies only in exceptional cases ( 37 ), which is both surprising and demands an explanation. One possible explanation is that group therapies have been excluded from the work of researchers who systematically summarize the evidence regarding the effects of psychotherapy.

Taken together, our current review covering about 30 years suggests that group therapy can be recommended for treating a wide range of issues. This finding is based on past comparisons of group therapy with nonactive control groups and with active treatments ( Figure 2 ). These results need to be acknowledged and conveyed in current treatment guidelines. As Yalom and Leszcz ( 30 ) have argued, group therapy is a “triple E treatment,” meaning that it is effective compared with nonactive treatments; equivalent to other active treatments, including individual therapy; and efficient in terms of time and cost. Thus, it is worthy of being promoted by health policies.

Limitations of Studies on Group Psychotherapy Outcomes

A limitation regarding interpretation of the research findings refers to their validity for a wider range of treatments. Specifically, there is a gap between clinical-theoretical considerations of psychodynamic or group analytical approaches and specific studies in the group therapy literature. One notable exception is a Norwegian study on the empirical comparison of short- (20 sessions) and long-term (80 sessions) groups in an RCT ( 23 ). This study, based on an exemplary group analysis manual ( 22 ), suggested that the mere presence of personality pathology justifies longer-term groups ( 24 ). Presumably, the development of manuals in psychodynamic group therapy is important to stimulate further empirical research in the group-analytic context.

In addition to the development of mindfulness-based group therapies, two promising approaches have recently emerged in the interpersonal and psychodynamic context, respectively. These approaches, however, require more empirical support. Specifically, Whittingham ( 25 ) developed a manualized “ultra-short group therapy” (eight sessions of focused brief group therapy), which combines elements of process-oriented groups as defined by Yalom and Leszcz ( 30 ) and concepts of attachment theory. Tasca and colleagues ( 26 , 38 ) have described group psychodynamic-interpersonal psychotherapy as an integrative group concept drawing from psychodynamic, interpersonal, and attachment-oriented approaches. The effectiveness of this therapy has been demonstrated in several studies of patients diagnosed as having disorders such as binge eating.

Another limitation relates to treatment setting, because a majority of studies on evidence-based groups have been conducted in outpatient settings with short-term groups. Controlled studies of true long-term groups are not available, except for those of the previously mentioned studies ( 23 , 24 ). The last systematic summary on inpatient therapy groups was a meta-analysis published several years ago ( 39 ), which included 24 controlled studies and 46 pre-post comparisons. Results yielded a small effect for controlled studies (d=0.31) and a large effect (d=0.59) for pre-post comparisons. The largest effects were found for patients with affective disorders.

Cohesion and Alliance

Two recent meta-analyses studied the two relationship variables most frequently investigated within the group context: alliance and cohesion. Cohesion, which refers to the sense of connection or closeness among group members, is related to therapeutic outcome to the same extent reported for the therapeutic alliance in individual therapy (r=0.28) ( 49 ). In a meta-analysis ( 50 ) of 55 studies and more than 6,000 group members, a mean correlation (r=0.26) between cohesion and outcome measures was found, which can be interpreted as the mean effect. Single study results on the cohesion-outcome correlation in group therapy, however, were heterogeneous. A moderating effect was found for theoretical orientation, with the highest correlation observed for interpersonal groups, followed by psychodynamic, cognitive, supportive, and eclectic therapy groups. The cohesion-outcome association was stronger when group leaders emphasized member interaction and when groups were long lasting.

The relationship between member-leader alliance and outcomes of group therapy has been summarized in a recent meta-analysis ( 51 ). The 29 studies in this meta-analysis included 3,628 patients and yielded a significant weighted average correlation between alliance and outcome (r=0.17), which was lower compared with the correlation observed for individual treatment (r=0.28) ( 49 ). A possible explanation for this is the fact that the relationship between a patient and therapist is only one part of group therapy, but it makes up the entirety of the therapeutic relationship in individual therapy. Some moderators were observed; heterogeneity of study results could have been explained by treatment orientation (lower correlation for CBT than for other group treatments) and the reporting perspective (higher correlation for patient-reported than for mixed or observer-reported alliance).

Promising Developments

In addition to cohesion and alliance, patient characteristics may influence group therapy outcomes. Specifically, the influence of attachment characteristics on treatment effects has been examined ( 52 ). Over the past decade, numerous studies have shown that positive changes in attachment characteristics do indeed contribute to improvements in interpersonal problems and in other psychological symptoms ( 53 ). Analogous findings have been reported from social and organizational psychology. Based on these results, it has been postulated that “repeated interactions with responsive and supportive leaders and cohesive groups beneficially alter a person’s attachment patterns and psychological functioning” ( 54 ). In the context of attachment research, other methodological approaches have been tested, such as the actor-partner independence model ( 55 ) and attachment heterogeneity in groups ( 56 ). Overall, the research shows high relevance for attachment characteristics in group treatment, a finding that should encourage group leaders to attend to the influence of attachment goals on group members’ behavior and the impact of attachment characteristics on members’ willingness to engage with and stay in the group. Attachment characteristics may also moderate the relationship between group cohesion and member outcomes and should therefore be considered during group composition and selection of members. Another area for future development, consistent with those occurring in individual psychotherapy, includes development of Internet-based group treatments relying on both asynchronous (i.e., Internet forum providing contact to a therapist) and synchronous (i.e., real time) online contact. In this regard, the field has made considerable progress in the last years, reflecting new technologies that allow such interventions to reach a wider range of patients than face-to-face settings.

Is psychotherapy effective? A re-analysis of treatments for depression

1 Psychologische Hochschule Berlin, Berlin, Germany

C. Flückiger

2 Department of Psychology, University of Zürich, Zürich, Switzerland

F. Leichsenring

3 Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany

A. A. Abbass

4 Department of Psychiatry, Centre for Emotions and Health, Dalhousie University, Halifax, NS, Canada

M. J. Hilsenroth

5 The Derner Institute of Advanced Psychological Studies, Adelphi University, Hy Weinberg Center, Garden City, NY, USA

6 Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium

7 Research Department of Clinical, Educational and Health Psychology, University College London, London, UK

8 Department of Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria

C. Steinert

9 Department of Psychology, Medical School Berlin, Berlin, Germany

B. E. Wampold

10 Modum Bad Psychiatric Center, Modum Bad, Vikersund, Norway

11 University of Wisconsin–Madison, Madison, Wisconsin, USA

The aim of this study was to reanalyse the data from Cuijpers et al. 's (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al ., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted.

The data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention.

The SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43).

Conclusions

The re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.

Those who cannot remember the past are condemned to repeat it. – George Santayana

Literature and philosophy both allow past idols to be resurrected with a frequency which would be truly distressing to a sober scientist. – Morris Raphael Cohen

In the 1950s and 1960s, Eysenck made some claims about the effectiveness of psychotherapy (Eysenck, 1952 , 1961 , 1966 ). Our collective memories of the specific claims made by Eysenck have diminished over time and we seem to be left with the simple conclusion that Eysenck claimed that psychotherapy was ineffective (Wampold, 2013 ; Wampold and Imel, 2015 ). Recently, Cuijpers et al. ( 2018 ) summarised Eysenck's claims by noting, ‘He [Eysenck] suggested that psychotherapies are not effective in the treatment of mental disorders (Eysenck, 1952 )’ (p. 1). It is important to know whether psychotherapy is effective or not. However, to make any statement about Eysenck and his claims, one has to understand exactly what he claimed and the bases on which he made his claims. We begin by reviewing what Eysenck had to say about the effects of psychotherapy.

Based on a review of research available at that time, Eysenck indeed did conclude that psychotherapy was not effective:

A survey was made of reports on the improvement of neurotic patients after psychotherapy, and the results compared with the best available estimates of recovery without benefit of such therapy . The figures fail to support the hypothesis that psychotherapy facilitates recovery from neurotic disorder (emphasis added; Eysenck, 1952 , p. 323) When untreated neurotic control groups are compared with the experimental groups of neurotic patients treated by means of psychotherapy, both groups recover to approximately the same extent (emphasis added, Eysenck, 1961 , p. 719).

To be clear about Eysenck's claims about the ineffectiveness of psychotherapy, he compared the effects of psychotherapy with those patients who did not receive any treatment.

It is important to note that Eysenck was not simply impugning the absolute effectiveness of psychotherapy, he was at the same time concluding that one form of psychotherapy was effective and that other therapies were unscientific and ineffective ( viz. , behaviour therapy; Eysenck, 1961 ; see Wampold, 2013 ; Wampold and Imel, 2015 ).

Given the distinction among various psychotherapies, any examination of Eysenck's claims must consider what is and what is not psychotherapy. Eysenck was very careful to define psychotherapy:

(1) There is an interpersonal relationship of a prolonged kind between two or more people.
(2) One of the participants has had special experience and/or has received special training in the handling of human relationships.
(3) One or more of the participants have entered the relationship because of a felt dissatisfaction with their emotional and/or interpersonal adjustment.
(4) The methods used are of a psychological nature, i.e. involve such mechanisms as explanation, suggestion, persuasion and so forth.
(5) The procedure of the therapist is based upon some formal theory regarding mental disorder in general, and the specific disorder of the patient in particular.
(6) The aim of the process is the amelioration of the difficulties which cause the patient to seek the help of the therapist (Eysenck, 1961 , p. 698).

Eysenck’s definition of psychotherapy is in accord with most definitions of psychotherapy, which emphasize that an interpersonal relationship is at the heart of the endeavor (e.g. Wampold and Imel, 2015 ).

Eysenck's claims created controversy as well as angst, among mental health professionals as well as the public. There were articles rebutting Eysenck's conclusions and rejoinders, creating a contentious interchange (for a summary see Glass and Kliegl, 1983 ; Wampold, 2013 ; Glass, 2015 ; Wampold and Imel, 2015 ). The debate about Eysenck's claims led to a proliferation of randomised clinical trials examining both the absolute efficacy of psychotherapy (i.e. the effects of psychotherapy v . natural history) and the relative efficacy of various treatments (i.e. the relative effects of different therapies; Wampold, 2013 ; Wampold and Imel, 2015 ). In the late 1970s, Mary Lee Smith and Gene Glass (Smith and Glass, 1977 ; Smith et al. , 1980 ) conducted a comprehensive meta-analysis of controlled studies of psychotherapy and found that psychotherapy was indeed effective, with a standardised mean difference (SMD) between treated and untreated patients of approximately 0.70, a relatively large effect. Of course, Eysenck disputed these results by suggesting that meta-analyses ignored problems with the primary studies, such as the heterogeneity of included studies (‘apples and oranges’ problem) (Eysenck, 1978 , 1984 , 1995 ). However, several re-analyses of Smith and Glass and additional meta-analyses have established an SMD of approximately 0.70, although this varies somewhat depending on the problem being treated (see Wampold and Imel, 2015 ).

Recently, Cuijpers et al. ( 2018 ) have addressed several of the problems mentioned by Eysenck (and others) by examining the effects of interventions for a particular disorder, namely depression, considering various factors that might bias the estimates. In their article, a reassessment of the effects of psychotherapy for adult depression, they claimed, much in the way that Eysenck did, that there is insufficient evidence to declare that psychotherapy is effective:

These results suggest that the effects of psychotherapy for depression are small, above the threshold that has been suggested as the minimal important difference in the treatment of depression, and Eysenck was probably wrong. However, this is still not certain because we could not adjust for all types of bias (p. 1)… [and] the possibility that psychotherapies do not have effects that are larger than spontaneous recovery cannot be excluded (p. 7).

In this article, we address Cuijpers et al .'s ( 2018 ) claims and show that a different understanding of Eysenck's conjectures produces an estimate of effectiveness for psychotherapy for depression that closely approximates what has been found previously.

A re-analysis of Cuijpers et al. (2018)

The goal of Cuijpers et al . ( 2018 ) was to revisit Eysenck's conclusion that psychotherapy was not effective by meta-analytically examining the corpus of studies comparing an intervention for adults with depression to a control group and correcting obtained effects for bias of various types. Of course, as meta-analytic methods improve, it is commendable to scrutinise prior conclusions in light of the best available methods.

Cuijpers et al . ( 2018 ) examined 369 effects produced by studies that compared interventions for depression with a control group. The overall effect for these interventions was an SMD of 0.70 suggesting that Eysenck's conclusions were in fact incorrect Q.E.D. But Cuijpers et al . claimed that this estimate was biased and when the effects were corrected for these biases the ‘true’ effect is between 0.2 and 0.3, casting some doubts on whether Eysenck's conclusions were truly incorrect. However, Cuijpers et al .'s conclusions depend on several methodological decisions that need to be re-examined. In this article, we examine several of their decisions and then reanalyse their data with decisions that we contend are more in line with Eysenck's conjectures.

Choice of control group

The corpus of studies in Cuijpers et al . ( 2018 ) included three types of control groups: waiting list (WL, k = 159), care-as-usual (CAU, k = 144), and ‘other control’ ( k = 66). 1 Unfortunately no definition of these types of control groups was presented and no methods for making this determination were provided (e.g. coding procedures, interrater agreement, etc.). What is most important is that Cuijpers et al. considered WL controls as biased and excluded studies using WL when estimating the true effect of psychotherapy. This is a decision that results in a significant decrease in the estimates of psychotherapy effectiveness, and one which is questionable. We examine each of these types of control groups, noting the questions that each is able to address.

Waiting-list controls

WL controls contain patients who are told that during the treatment phase they will receive no treatment (NT) as part of the study but that after the treatment period, if they choose to, they will receive one of the experimental treatments. To be clear, no treatment is provided to the patients and this type of control group is thought to be a means to estimate the natural history of the disorder (Wampold et al. , 2005 ; Stegenga et al. , 2012 ). If we consider that Eysenck was focusing on the effects of psychotherapy compared with recovery without psychotherapy, it would seem that WL is an appropriate control group as it compares the outcome of psychotherapy with an estimate of natural course of the disorder.

There may well be methodological problems with WL controls. WL patients may actually improve during the study period because they became remoralised by anticipation of being included in a state-of-the-art treatment, which might not be obtainable elsewhere, in 15 or so weeks (Frank and Frank, 1991 ). There is evidence that patients improve from when they make an appointment to receive services and when they present for such services (Frank and Frank, 1991 ). Indeed, WL patients in clinical trials for depression improve quite dramatically during the waiting period; the effect for patients on WL in randomised controlled trials for depression from beginning of the waiting period to the end of the waiting period is approximately 0.40 (Minami et al. , 2007 ; see also Posternack and Miller, 2001 ). WL patients may improve as a function of being included in the trial and therefore the use of WL controls may underestimate the effects of psychotherapy.

On the other hand, patients might feel demoralised by not being selected to receive treatment immediately: ‘Nothing good ever happens to me. I can't even get selected to receive treatment now.’ This is the resentful demoralisation threat to validity (Shadish et al. , 2002 ). However, there is little evidence that patients on the WL in clinical trials suffer from resentful demoralisation. Of course, many patients in routine clinical care are placed on waiting lists until services are available. Ahola et al . ( 2017 ) studied patients on waitlists and concluded, ‘scheduled waiting should be regarded as a preparatory treatment and not as an inert non-treatment control’ (p. 611).

Cuijpers et al . ( 2018 ) chose to question WL as a control group and exclude studies that used WL controls to estimate the ‘true’ effects of psychotherapy:

Waiting list control groups may stimulate patients to do nothing about their problems because they will get a treatment after the waiting period. Recent meta-analyses suggest that waiting lists may be a nocebo, and artificially inflate the effect sizes of therapies (Furukawa et al ., 2014 ) (emphasis added, p. 2). 2

To be clear, Cuijpers et al . ( 2018 ) claim is that WL is inappropriate because it might induce patients not to seek help. That is, patients on WL are purported to avoid seeking therapy or any other type of external help. Consequently, according to this view, WL patients represent the population of depressed patients not receiving treatment, which is exactly the control that should be used to determine whether a treatment is superior to spontaneous recovery without treatment. The Eysenckian conjecture that psychotherapy is not more effective than NT would suggest that WL control is a suitable, if not the suitable, hypothesis-driven control group.

What is the best way to empirically determine whether WL is biased? Logically one could compare WL control patients with NT controls. But how would that work? First, NT controls are unethical as one cannot deny patients with mental disorder treatment and that is the reason WL controls are used in lieu of NT controls. Second, NT patients would most likely experience effects of being included in a trial but be denied any treatment at all. They might be discouraged and deteriorate as a result or they might seek alternate treatment and improve – who knows?

Cuijpers et al .'s ( 2018 ) attribution of bias for WL controls rests on purported evidence that WL cause patients to deteriorate relative to NT patients. But how is that known given that it is unethical to deny treatment to patients with mental health disorders who are seeking treatment? The meta-analysis cited by Cuijpers et al . that claimed WL artefactually causes deterioration ( viz. , Furukawa et al ., 2014 ) is a network meta-analysis that involved clinical trials of cognitive behaviour therapy (CBT) against various controls in the treatment of depression. A closer look showed that this meta-analysis contained 13 comparisons (from only six separate trials) with NT controls. However, none of the studies using an NT control involved patients seeking treatment for depression. The patients in studies with NT controls were college students selected for study (not seeking help for depression) or community members identified through screening. Most, although not all, were mildly to moderately depressed and all were not seeking treatment for depression. It is well established that seeking relief for distress is a vital factor for response to placebo (Price et al. , 2008 ). Interventions in NT trials were more similar to prevention programs than treatment programs and many NT studies did not involve psychotherapy according to Eysenck's definition. Prevention programs and programs for those not seeking treatment typically are ineffective (Lilienfeld, 2007 ; Wampold and Imel, 2015 ). Consequently, it is understandable that the effects of CBT v. NT would be rather small. In the NT study that contributed more than half of all participants in NT comparisons in the Furukawa et al . meta-analysis ( viz. , Dowrick et al ., 2000 ), the difference of intervention v. NT was only SMD = 0.169, suggesting that the treatments employed were only marginally helpful for participants. Of course, in the framework of Furukawa et al .'s network meta-analysis, these small treatment effects contribute to the impression of more change for participants in NT than in WL.

On the other hand, the CBT v. WL in the Furukawa et al . ( 2014 ) meta-analysis included studies of patients seeking treatment for depression and it is not surprising that there were larger effects in these studies. The conclusion that WL is a ‘nocebo’ is due to the fact that the CBT v. NT prevention studies showed smaller effects than the CBT v. WL treatment studies, despite that the studies in these two comparisons were markedly different. Making inferences about the relative effectiveness of treatments or control groups (here WL v . NT) from network meta-analyses in lieu of examining direct comparisons often leads to erroneous conclusions (see e.g. Del Re et al. , 2013 ; Jansen and Naci, 2013 ; Wampold and Serlin, 2014 ; Wartolowska et al ., 2014 ; Wampold et al ., 2017 ), especially when, as in Furukawa et al ., the consistency of indirect estimates with direct estimates cannot be assured (none of the trials directly compared NT and WL controls). Thus, the results of this meta-analysis do not provide persuasive evidence that WL is an inappropriate control. Moreover, Furukawa et al . reported that the difference between NT and WL was not significantly different when publication bias was considered.

Given the problematic nature of the Furukawa et al . ( 2014 ) meta-analysis and other evidence, we contend that WL is indeed an appropriate control group to address Eysenck's conjecture that psychotherapy is not more effective than NT.

Care as usual

To estimate the ‘true’ effects of psychotherapy, Cuijpers et al . ( 2018 ) included CAU as appropriate controls. CAU is an appropriate control group if one is estimating whether psychotherapy is more effective than the various mental health treatments being given in routine care. However, CAU typically contains a wide array of treatments (Spielmans et al. , 2010 ; Wampold et al ., 2011 ), which was noted by Cuijpers et al .: ‘[CAU] is problematic since (sic) this varies considerably across settings and health care systems, making comparisons very heterogeneous’ (p. 3). Eysenck was making a claim that psychotherapy was not more effective than NT, not that it was not more effective than the usual care patients were receiving, which might well be psychotherapy or other mental health services. Indeed in Cuijpers et al . CAU included credible treatments such as supportive psychotherapy or pharmacotherapy delivered by experienced therapists (Saloheimo et al ., 2016 ); combination of psychotherapy and pharmacotherapy according to Dutch Depression Guidelines (Wiersma et al. , 2015 ), or antidepressant medication (Power and Freeman, 2012 ). CAU is often nearly as effective as first-line psychotherapeutic treatments for several disorders, including borderline personality disorder, anxiety and depression (Wampold et al ., 2011 ; Cristea et al ., 2017 ). Comparisons of these relatively active treatments produce effects irrelevant to Eysenck's claims about the effectiveness of psychotherapy vis-à-vis NT.

Other control groups

Cuijpers et al . ( 2018 ) included ‘other control groups’ when estimating the ‘true’ effect of psychotherapy. They did not define what ‘other controls’ were but we examined these studies and found that ‘other controls’ included pill placebos (e.g. Elkin et al ., 1989 ; Dimidjian et al ., 2006 ; Hegerl et al ., 2010 ), or ‘so called’ psychological placebos (e.g. Watt and Cappeliez, 2000 ; Spinelli and Endicott, 2003 ; Armento, 2012 ; Losada et al ., 2015 ). We know that pill placebo with clinical management is often quite effective, often as effective or nearly as effective as antidepressant medication, particularly for depression (Kirsch, 2002 , 2009 , 2010 ; Kirsch et al ., 2008 ). Furthermore, psychological placebos are often quite effective (Baskin et al. , 2003 ; Smits and Hofmann, 2009 ; Honyashiki et al ., 2014 ). In any event, the use of pill placebo and psychological placebos addresses questions about the relative efficacy of psychotherapy compared to some relatively active controls, but does not address Eysenck's claims about the effectiveness of psychotherapy in comparison with NT.

Definition of psychotherapy

Cuijpers et al . ( 2018 ) made conclusions about psychotherapy, as evidenced by the subtitle of their article: ‘A reassessment of the effects of psychotherapy for adult depression.’ If one is to assess the effects of psychotherapy vis-à-vis the claims of Eysenck, then it is incumbent to include only studies of psychotherapy. However, Cuijpers et al . did not provide any description of inclusion and exclusion criteria for psychotherapy and many of the studies in Cuijpers et al . were clearly not psychotherapy. For example, in one study depressed patients were given a copy of a self-help book based on cognitive therapy and were ‘asked to read the book and to complete all the homework exercises in the book within 1 month’ (Floyd et al. , 2004 , p. 305). In a similar study (van Bastelaar et al. , 2011 ), patients with diabetes and elevated depression symptoms were given access to a website with ‘eight lessons’ (p. 51) on depression and diabetes. Lamers et al . ( 2010 ) investigated a ‘minimal psychological intervention’ for elderly depressed patients delivered by ‘four nurses with no specific mental health expertise’ (p. 219). In Cuijpers et al . ( 2018 ) we counted at least 61 effects derived from interventions that did not meet common definitions of psychotherapy, including Eysenck’s ( 1961 ) definition, recreating the ‘apples and oranges’ problem about which Eysenck was concerned. At the very least, conclusions about psychotherapy are unjustified when interventions that are not psychotherapy are lumped with psychotherapeutic treatments.

Western v. non-Western studies

Cuijpers et al . ( 2018 ) excluded non-Western studies ( viz. , those from Africa, Asia and Latin America) based on the finding that the effects of psychotherapy were greater in non-Western countries. Cuijpers et al . ( 2018 ) did not define ‘Western’ in a transparent manner (Latin America is in the Western hemisphere and Chile and Argentina are typically classified as ‘Western’) and provided no hypothesis-driven or theoretical reason to exclude evidence from some countries. Excluding non-Western evidence created smaller effects. Our re-analyses suggested the Western/non-Western effect is at least partially due to outliers, which we omitted in our re-analysis (see below).

Risk of bias

Cuijpers et al . ( 2018 ) further reduced the number of studies by excluding studies with ‘possible systematic errors … or deviations from the true or actual outcomes’ (p. 3). It seems to us, however, that this reduction was conducted in a manner that discards relevant research studies. Specifically, ‘four items of the Cochrane risk of bias assessment tool’ (p. 3) were used to define risk of bias and studies were excluded if any one of these four criteria were coded as negative or unclear.

Using only four of the six domains of the Cochrane risk of bias (RoB) tool, Cuijpers et al .'s ( 2018 ) definition did not cover a number of methodological aspects that are especially relevant for psychotherapy, possibly leading to the inclusion of studies with important deficits and to the exclusion of studies with appropriate methodology. In short, Cuijpers et al . excluded the RoB domains ‘blinding of participants and personnel’ and ‘selective outcome reporting.’ Coding the first domain was considered ‘not possible’ (p. 4) in the included studies and coding the latter was feared to result in ‘very few trials … with low risk of bias’ (p. 4) – that is to say, all psychotherapy studies have significant risk of bias. Clearly, patients and therapists are always cognisant of the psychotherapy they are receiving (or not receiving) and therefore blinding is not possible. However, there is broad consensus in the Cochrane and the psychotherapy research communities that exactly because of this deviation from the ideal experiment it is important to pay attention to methodological dimensions capturing quality of care and expectations (e.g. treatment credibility, therapist allegiance and treatment integrity), which were ignored in Cuijpers et al .'s ( 2018 ) study (see Baskin et al ., 2003 ; Higgins and Green, 2011 ; Laird et al. , 2017 ; Munder and Barth, 2018 ).

One of the studies excluded by Cuijpers et al .'s ( 2018 ) definition of risk of bias is the NIMH Treatment of Depression Collaborative Research Program (Elkin et al ., 1989 ), even though this was considered the most sophisticated and methodologically rigorous clinical trial of psychotherapy ever conducted. In contrast, Cuijpers et al . included other studies that have important methodological shortcomings, including those with few therapists (Milgrom et al. , 2005 , with two therapists, and Burns et al ., 2007 with one therapist) and several that did not monitor or assess adherence (e.g. Burns et al ., 2007 ). Allegiance, an important aspect in psychotherapy studies (Munder et al. , 2011 ; Munder et al. , 2012 ; Munder et al. , 2013 ) was ignored even though many of the studies in this data set were conducted by advocates of one of the treatments.

There are other problems with the Cuijpers et al . RoB determination. There are major discrepancies between the number of studies assigned to each risk category reported in Table 1 and Appendix C of Cuijpers et al . ( 2018 ). Also, no coding procedure or interrater agreement was reported. Given these problems in Cuijpers et al .'s RoB determination, we did not use their ratings in our analysis.

Our estimate of the effects of psychotherapy

Professor Cuijpers, upon our request, provided the effect size estimators as well as their standard errors for all 369 comparisons. First, we examined the three types of control groups separately using standard random-effects meta-analysis using the ‘metafor’ package of ‘R’ statistical software (Viechtbauer, 2010 ). In each case, we omitted the outliers (13 WL, 2 CAU and 1 ‘other control’) based on thresholds determined by visual inspection of the effect size distribution for each type of control and omitted comparisons for which g > 2.00. Removing such outliers reduces the estimate of the effectiveness of psychotherapy, compared with other procedures, such as Winsorization (Tukey, 1962 ), in which data are adjusted for outliers rather than eliminated entirely. Then, we also adjusted the effects for publication bias using trim and fill R0-estimates within the ‘metafor’ package.

The results are shown in Fig. 1 , for all comparisons and those that involved psychotherapy. As we have discussed here, the WL is the most appropriate control group for estimating the effects of psychotherapy compared with NT. As can be seen in Fig. 1 , the effect of treatment v. WL is 0.71 ( s.e. = 0.03), a statistically conservative estimate, given elimination of outliers and correcting for publication bias, and one which is similar to that determined by Smith and Glass ( 1977 ) and many others (see Wampold and Imel, 2015 ).

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Effect sizes for psychological interventions for depression. Error bars represent standard errors. PT = psychotherapy. Overall is based on all effect sizes without outliers and corrected for publication bias ( k = 146 contrasts with WL, k = 142 contrasts with CAU, k = 65 contrasts with ‘other’ controls). PT for adult depression only includes (individual or group) psychotherapy for adults with a diagnosis of depression ( k = 30 contrasts with WL, k = 29 contrasts with CAU, k = 12 contrasts with ‘other control’).

Because we wanted to restrict conclusions to psychotherapy, as defined by Eysenck, for the treatment of adult patients diagnosed with depression, we trimmed the data set accordingly. There were 270 comparisons that met definition of psychotherapy (either individual or group), of these 112 contained adults (excluding elderly, students, patients with general medical conditions or women with post-partum depression) and finally 71 comparisons that involved a diagnosis of depression. The effects for these 71 comparisons (30 WL, 29 CAU and 12 ‘other control’), after correcting for publication bias, are also presented in Fig. 1 (the standard errors are larger for the psychotherapy studies due to smaller sample sizes). The effect for psychotherapy v. WL in this set of comparisons was 0.75 ( s.e. = 0.09), again confirming that psychotherapy is effective compared with NT, with a magnitude in the neighbourhood of what Smith and Glass ( 1977 ) found. Note, as well, that in this set of comparisons of treatments that were actually psychotherapy for adult patients diagnosed with depression, psychotherapy was significantly superior to CAU (Hedges' g = 0.31, s.e. = 0.11) and ‘other control’ (Hedges' g = 0.43, s.e. = 0.09).

We also tested the set of psychotherapy comparisons to see if there were differences among treatments. We used Cuijpers et al .'s ( 2018 ) coding and found that there were no statistically significant differences among different types of psychotherapy for adult patients diagnosed with depression (adding type of treatment to a meta-regression model with the type of control did not significantly increase model fit, likelihood ratio test = 9.888, p = 0.195). This result is consistent with Cuijpers et al . and contradicts Eysenck's claims about the superiority of behavioural treatments.

There are some methodological limitations that may or may not impact the results of the present meta-analysis. First, face-to-face interventional studies are conducted in super-nested designs, randomisation procedures (as one of the key methods to handle risk of biases for internal validity) usually randomise patients to treatment conditions but therapists are neither randomly selected nor randomised to conditions, which may impact the generalisability of the study results to therapists that are not investigated under the study conditions (e.g. Wampold and Imel, 2015 ). Second, there were unsolved discrepancies between the main text and the Appendix of Cuijpers et al . ( 2018 ) with regard to RoB criteria, which call into question the reliabilities of the RoB evaluations, further compounding the fact that rater procedures and rater agreement were not reported (see Hartling et al ., 2012 ; Armijo-Olivo et al ., 2014 ). Thus, quality of studies was not considered in our re-analysis. Third, although more statistical driven outlier definitions could have been applied (e.g. Viechtbauer and Cheung, 2010 ), we opted to exclude outliers based on visual inspection of effect size distribution. This had the advantage of being consistent with Cuijpers et al . who used the same definition of outliers. Fourth, we did not independently calculate effect sizes but used instead the effects provided by Cuijpers et al .

After removing outliers, correcting for publication bias, using WL control groups, and restricting analysis to psychotherapy studies, the results of our analyses reveal that psychotherapy for depression is demonstrably effective compared with NT. Indeed, the effect size for psychotherapy compared with natural history, as estimated using WL controls, is about the same size as is generally accepted (i.e. in the neighbourhood of 0.70).

The discrepancy between our results and Cuijpers et al . ( 2018 ) is due in large part to what is considered an appropriate control group for determining the effectiveness of psychotherapy. Eysenck's claims were about the effectiveness of psychotherapy related to the natural history of the disorder. Determining natural history within the context of randomised clinical trials of psychotherapy is impossible but we have made a case that WL controls are the best possible solution for testing the particular conjecture put forth by Eysenck. Furthermore, dismissing WL conditions as biased is not supported by evidence. In any case, psychotherapy, as defined by Eysenck, is more effective than CAU, even when such care is quite credible, and is more effective than ‘other control’ as defined by Cuijpers et al .

Given these results, as well as a considerable corpus of evidence consistent with these results (Wampold and Imel, 2015 ), we argue that the field should accept the general conclusion that psychotherapy is an effective practice and give our attention to ways that psychotherapy could be improved.

Acknowledgement

1 There was a discrepancy between Table 1 of Cuijpers et al. 's ( 2018 ) manuscript and Appendix C in Supplemental materials for WL ( k = 159 v . 150, respectively) and CAU ( k = 144 v . 153, respectively), which has been resolved by P. Cuijpers (personal communication, April, 20th, 2018).

2 A nocebo is treatment without active ingredients (e.g. inert pill, sham procedures) that results in increased symptoms due to expectations created that the nocebo will be harmful, usually through instructions (Miller et al. , 2009 ; Benedetti, 2014 ). Clearly, patients on WL are not induced to expect deterioration under this condition, so even if patients deteriorate as a result of being on the WL, WL is not a nocebo. There is a difference between something that is harmful and a nocebo.

Financial support

Conflict of Interest

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Some results uranium dioxide powder structure investigation

Processes of Obtaining and Properties of Powders
Published: 28 June 2009
Volume 50 , pages 281–285, ( 2009 )

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E. I. Andreev 1 ,
K. V. Glavin 2 ,
A. V. Ivanov 3 ,
V. V. Malovik 3 ,
V. V. Martynov 3 &
V. S. Panov 2

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Features of the macrostructure and microstructure of uranium dioxide powders are considered. Assumptions are made on the mechanisms of the behavior of powders of various natures during pelletizing. Experimental data that reflect the effect of these powders on the quality of fuel pellets, which is evaluated by modern procedures, are presented. To investigate the structure of the powders, modern methods of electron microscopy, helium pycnometry, etc., are used. The presented results indicate the disadvantages of wet methods for obtaining the starting UO 2 powders by the ammonium diuranate (ADU) flow sheet because strong agglomerates and conglomerates, which complicate the process of pelletizing, are formed. The main directions of investigation that can lead to understanding the regularities of formation of the structure of starting UO 2 powders, which will allow one to control the process of their fabrication and stabilize the properties of powders and pellets, are emphasized.

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Investigation of the Properties of Uranium-Molybdenum Pellet Fuel for VVER

L. A. Karpyuk, V. V. Novikov, … O. A. Bakhteev

Investigation of the Influence of the Energy of Thermal Plasma on the Morphology and Phase Composition of Aluminosilicate Microspheres

V. V. Shekhovtsov

Evaluation of the Possibility of Fabricating Uranium-Molybdenum Fuel for VVER by Powder Metallurgy Methods

A. V. Lysikov, E. N. Mikheev, … D. S. Missorin

Patlazhan, S.A., Poristost’ i mikrostruktura sluchainykh upakovok tverdykh sharov raznykh razmerov (Porosity and Microstructure of Chaotic Packings of Solid Spheres of Different Sizes), Chernogolovka: IKhF RAN, 1993.

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Andreev, E.I., Bocharov, A.S., Ivanov, A.V., et al., Izv. Vyssh. Uchebn. Zaved., Tsvetn. Metall. , 2003, no. 1, p. 48.

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Elektrostal’ Polytechnical Institute (Branch), Moscow Institute of Steel and Alloys, ul. Pervomaiskaya 7, Elektrostal’, Moscow oblast, 144000, Russia

E. I. Andreev

Moscow Institute of Steel and Alloys (State Technical University), Leninskii pr. 4, Moscow, 119049, Russia

K. V. Glavin & V. S. Panov

JSC “Mashinostroitelny Zavod”, ul. K. Marksa 12, Elektrostal’, Moscow oblast, 144001, Russia

A. V. Ivanov, V. V. Malovik & V. V. Martynov

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Original Russian Text © E.I. Andreev, K.V. Glavin, A.V. Ivanov, V.V. Malovik, V.V. Martynov, V.S. Panov, 2009, published in Izvestiya VUZ. Poroshkovaya Metallurgiya i Funktsional’nye Pokrytiya, 2008, No. 4, pp. 19–24.

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Andreev, E.I., Glavin, K.V., Ivanov, A.V. et al. Some results uranium dioxide powder structure investigation. Russ. J. Non-ferrous Metals 50 , 281–285 (2009). https://doi.org/10.3103/S1067821209030183

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Published : 28 June 2009

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DOI : https://doi.org/10.3103/S1067821209030183

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