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Does the placebo effect inflate the effectiveness of psychotherapy?

Discussion in 'Other Health News and Research' started by Bob, Mar 23, 2016.

  1. Bob

    Bob

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    Does the placebo effect inflate the effectiveness of psychotherapy?
    Sarah Knowles.
    The Mental Elf.
    23rd March 2016
    http://www.nationalelfservice.net/t...t-inflate-the-effectiveness-of-psychotherapy/

    A review of this 2015 paper...

    Cuijpers P, Karyotaki E, Andersson G, Li J, Mergl R, Hegerl U.
    The effects of blinding on the outcomes of psychotherapy and pharmacotherapy for adult depression: A meta-analysis.
    Eur Psychiatry. 2015; 30:685-93.
    http://www.europsy-journal.com/article/S0924-9338(15)00131-5/abstract
    http://www.sciencedirect.com/science/article/pii/S0924933815001315

     
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  2. A.B.

    A.B. Senior Member

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    Is the sky blue? Is water wet?

    The article is still unwilling to face the truth however, as it subscribes to the view that improvement in a placebo group is due to some mental healing effect. Perhaps the author doesn't know any better.

    PS: I mean the mental elf article.
     
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  3. Bob

    Bob

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    The Mental Elf review is a handy intro to the study, but I didn't find their analysis very helpful. I think the conclusion in the study's abstract is probably more helpful.
     
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  4. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    My impression is that Sarah Knowles is honest enough to admit she does not really understand this study. The problem is that the authors of the study do not seem to understand their study. As Knowles says to begin with, it is upside down - or maybe worse than that. It is a bit like picking up a sock and a glove and asking which is right and which is left. I cannot see why the inclusion of a placebo has anything to do with the apparent difference between two treatments you can obviously tell apart in all cases. This seems to be the sort of dross we have met before - but in this case the bid is in No Trumps.
     
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  5. jimells

    jimells Senior Member

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    Doesn't this mean that they had to treat 25 patients to find one that responded to treatment? Or is there some other meaning for "NNT" besides "Number Needed to Treat"?

    Instead of worrying about placebo effect, perhaps they should investigate why doctors are using treatments that work so poorly.
     
  6. Esther12

    Esther12 Senior Member

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    I don't understand what they were trying to do from the abstract. Seems pretty unlikely that the placebo effect would not inflate claims about the effectiveness of psychotherapy.
     
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  7. A.B.

    A.B. Senior Member

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    Indeed. We know that the placebo effect is the sum of various factors that can give the false appearance of treatment related improvement. The largest of these factors is regression to the mean. Patients and doctors having their own biases when interpreting the situation is also a big one. Arguing that the effectiveness of psychotherapy is not inflated by this is akin to arguing that the respective conditionsdon't get better without treatment, and that in a psychotherapy setting both patients and therapists are mostly free of bias.
     
    Last edited: Mar 24, 2016
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  8. alex3619

    alex3619 Senior Member

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    I am at the point where you can throw as much data at me as you like involving significance and effect size that without also seeing a scatter plot I think its potentially nonsense. A few outliers can massively distort the results. In all potentially heterogeneous conditions I think scatter plots are mandatory or the study is very hard to interpret.

    I also want to see far more use of objective measures.

    NNT of 25 tells me: don't bother using this treatment.
     
  9. Sean

    Sean Senior Member

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    Yep. A big fat meh. :meh:
     
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  10. Bob

    Bob

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    It definitely means the "number needed to treat". "NNT=25" or "NNT=1 in 25" means that for 25 treated there is 1 positive outcome (i.e. a 4% positive outcome rate). But in this case I think it might be referring to the number of occasions in which there was a difference in treatment effect when comparing psychotherapy and pharmacotherapy studies. (i.e. a difference between psychotherapy and pharmacotherapy studies was detected for 1 in 25 comparisons.) It seems too low to indicate how many patients respond to treatment. But i haven't read the full paper so I may be way off the mark.
     
    Last edited: Mar 24, 2016
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  11. A.B.

    A.B. Senior Member

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    http://www.thennt.com/thennt-explained/
     
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  12. Snow Leopard

    Snow Leopard Hibernating

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    Given that there is no placebo control for a psychotherapy study, I don't really understand any conclusion that claims there is a higher or lower effect of placebo on studies of psychotherapy interventions.
     
    Last edited: Mar 24, 2016
  13. jimells

    jimells Senior Member

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    Over the years I have found this website to be very interesting and helpful, especially when doctors are trying to sell me statins, baby aspirin, etc.
     
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