The effects of group improvisational music therapy on depression in adolescents and adults with substance abuse: a randomized controlled trial**

Validity and reliability of electroencephalographic frontal alpha asymmetry and frontal midline theta as biomarkers for depression

Electroencephalographic (EEG) frontal alpha asymmetry (FAA) and frontal midline (FM) theta have been suggested as biomarkers for depression and anxiety, but have mostly been assessed in small and non-clinical studies. In a clinical sample of 79 adults with depression (ICD-10: F32), resting EEG and scales of depression (MADRS) and anxiety (HADS-A) were measured at intake and after 3 months. FAA and FM theta values were referenced to a normative population database. Internal consistency, test-retest reliability, and correlations with psychiatric tests were examined. Reliability was sufficient. However, FAA and FM theta values were close to the general population, and correlations with psychiatric tests were mostly small and non-significant, with the exception of FAA on F7-F8 z-scores and HADS-A. We conclude that the validity of FAA and FM theta and therefore their potential as biomarkers for depression and anxiety remain unclear.

Shifting effects in randomised controlled trials of complex interventions: a new kind of performance bias?

OBJECTIVE

Randomised controlled trials (RCTs) aim to provide unbiased estimates of treatment effects. However, the process of implementing trial procedures may have an impact on the performance of complex interventions that rely strongly on the intuition and confidence of therapists. We aimed to examine whether shifting effects over the recruitment period can be observed that might indicate such impact.

METHOD

Three RCTs investigating music therapy vs. standard care were included. The intervention was performed by experienced therapists and based on established methods. We examined outcomes of participants graphically, analysed cumulative effects and tested for differences between first vs. later participants. We tested for potential confounding population shifts through multiple regression models.

RESULTS

Cumulative differences suggested trends over the recruitment period. Effect sizes tended to be less favourable among the first participants than later participants. In one study, effects even changed direction. Age, gender and baseline severity did not account for these shifting effects.

CONCLUSION

Some trials of complex interventions have shifting effects over the recruitment period that cannot be explained by therapist experience or shifting demographics. Replication and further research should aim to find out which interventions and trial designs are most vulnerable to this new kind of performance bias.

Joseph Hersey Pratt's cost-effective class method and its contemporary application: some problems in biopsychosocial innovation

Problems reflecting the stress of illness and the illness of stress account for 20-50% of medical visits and an unquantified but substantial portion of the billions of dollars spent annually on tests and procedures (Stoeckle et al. 1964). The "high-tech" form of practice, favored so powerfully by American medicine and supported so lavishly by financial incentives, produces limited benefits in this domain of suffering and medical care. In an era of increasing panic about the runaway cost of health care, medicine desperately needs cost-effective forms of "low-tech" treatment for patients with psychosomatic conditions and the emotional dimensions of chronic and recurrent illness. Between 1905 and 1955 Joseph Hersey Pratt (1872-1956), an eminent Boston internist and professor of medicine, developed what appears to have been a highly efficient, class-based method for treating such patients in an empathic and biotechnically sound manner. Pratt pioneered his technique in the Emmanuel Church Tuberculosis Class between 1905 and 1923, the work for which he is best known. Seven years later he adapted the method for treatment of patients with chronic psychosomatic conditions, and from 1930 to 1955 he again appears to have achieved considerable success in a highly efficient manner in what was called the Thought Control Class at the Boston Dispensary. Although the treatment of tuberculosis has of course been totally transformed by antibiotics, psychosomatic conditions and the emotional dimensions of chronic illnesses like tuberculosis form an ever larger component of the suffering seen in general medical practices. For this reason, a historical study of Pratt's techniques, theories, and the fate of his innovations may provide practical guidance for contemporary health care practice.