"What if We Held Psychotherapy to Same Standards as Medication?" (James C Coyne blogpost from 2012)

[Tom Kindlon]

James C Coyne is a bit of an interesting psychologist - a bit of a renegade as he asks searching questions of psychology.

AUTHOR OF

The Skeptical Sleuth

This blog is intended to encourage a healthy skeptical attitude toward the behavioral sciences literature and media coverage of it. It will provide critiques of specific studies and claims but also give readers a set of tools with which they can independently evaluate claims and be alert to hype and hokum. By confronting the journals and the media with better armed and more sophisticated readers, the blog is intended to improve the quality of the information available about research in the behavioral sciences.

Claims that are too good to be true probably are not true.

This is particular piece I'm referring to:

CBS 60 Minutes News on Treating Depression: Sorting Through the Confusion

What if We Held Psychotherapy to Same Standards as Medication?
Published on February 29, 2012 by James C. Coyne, Ph.D. in The Skeptical Sleuth

so not new.


This touches on some issues I explored in my paper

"Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome" (free at:
http://iacfsme.org/BULLETINFALL2011/Fall2011KindlonHarmsPaperABSTRACT/tabid/501/Default.aspx)

about trying to make sure similar standards are applied to nonpharmacological therapies as pharmacological therapies

e.g.

Turner went on:

It seems unfair that pharmacological, and not psychotherapeutic, treatment has become the usual first line approach to depression merely for economic reasons. But before we embrace any treatment as first line, it is prudent to ask whether its efficacy is beyond question. For psychotherapy trials, there is no equivalent of the FDA whose records we can examine, so how can we be sure that selective publication is not occurring here as well?​

and

What if we applied Kirsch's standards to psychotherapy? Unfortunately with no FDA-like registry of psychotherapy trials, so we cannot be sure we have accessed all unpublished, as well as published, psychotherapy studies. We do know there's ample evidence of publication bias, even if we can't quantify it with much precision. Rosenthal's calculation of the extent of "file drawer problems" is generally rejected outside of psychology, and so we should be skeptical of estimates of how many trials need to be left in file drawers in order for estimates of the efficacy of psychotherapy to be revised.

Just as published reports of the efficacy of antidepressants can be shown to be exaggerated, so too, reports of the efficacy of psychotherapy have been exaggerated, particularly when they are largely based on the many trials conducted by developers and promoters of particular therapies. There's ample evidence of publication bias, http://www.ncbi.nlm.nih.gov/pubmed/20194536 although the exact extent of it is not known. There is also evidence of confirmatory bias in published studies, selective reporting of outcomes, and that investigator allegiance I http://mentalhealthpros.com/mhp/pdf/Dodo-bird-meta-analys.pdf is more predictive of the outcome of a psychotherapy trial than to what a particular trial is being compared. For instance, a meta-analysis o http://www.ncbi.nlm.nih.gov/pubmed/20630260 of psychotherapy for depression had to exclude a particular problem-solving therapy conducted by its originator because it is such an extreme outlier. I am sure more such examples out there await discovery.

He makes some other interesting observations also on the comparison between antidepressants and psychotherapies for depression.*

*Note: my main interest in this is not to do with the specifics of the debate about how to treat depression, but just general issues for when pharmacological and non-pharmacological therapies (such as CBT and GET for ME/CFS) are compared.

 

[Sean]

and that investigator allegiance Ihttp://mentalhealthpros.com/mhp/pdf/Dodo-bird-meta-analys.pdf is more predictive of the outcome of a psychotherapy trial than to what a particular trial is being compared.

An inconvenient truth.

 

[biophile]

I get the feeling that James C Coyne would giggle at the SMC's press release that claimed the PACE Trial (a non-blinded trial which tested therapies that had different levels of encouragement and optimism and attempts to alter patients subjective perceptions about their symptoms) was extremely rigorous and the highest grade of clinical evidence conducted in the same manner of a drug intervention study.

 

[biophile]

It is also worth pointing out that reviews of treatments for CFS tend to exclude or frown upon non-blinded trials. If such reviews placed the same standard for CBT/GET, the "evidence base" would basically vanish.

 

[biophile]

Coyne posted the following comment:

"First, it is a pity that if you document Kirsch's shoddy science and wild inferences, you become a 'Kirsch basher' and that for some people, that label filters any evidence that you present and any holes in his arguments that you uncover."

http://www.psychologytoday.com/blog...g-through-the-confu-0/comments#comment-216743

Sound familiar?

 

[Sean]

Sound familiar?

Certainly does.

Biased framing and priming are powerful disinformation techniques, as the BSP crowd know full well.