A standard meta-analytic approach to aggregate the reported data on efficacy was not possible because of the small number of trials for a given intervention within broad treatment classes; substantial differences in the definition and types of reported outcomes; and considerable variation in the reporting of statistical details, such as exact p values and standard deviations Moreover, many studies neither stated what the primary outcome was no prespecified the sample size needed to adequately test for a primary outcome Therefore, similar to several previous literature syntheses of mental health interventions across multiple conditions (12,18), a vote-counting approach (19) was used to classify each trial as positive or negative. Any trial tha reported statistically significant improvement in at least one of the three patient-centered outcomes was operationally defined as a positive trial.