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Institutional promotion of psychotherapy manuals as a requirement for evidence‐based treatments (EBTs) yields the assumption that manualized treatment is more effective than nonmanualized treatment. This systematic review examines empirical evidence for this claim.

An electronic database search identified studies that directly or indirectly compared manual‐based and non‐manual‐based treatment.

Six studies directly compared manualized and nonmanualized treatment (Hypothesis 1). None support manual superiority. Eight meta‐analyses indirectly assessed effect sizes of manual‐based treatment and control groups (Hypothesis 2). Three support manual superiority, five do not. One meta‐analysis and 15 further studies addressed manual adherence as an indirect indicator of manual efficacy (Hypothesis 3). The meta‐analysis concluded that manual adherence does not affect …