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Ware JW, Venere K, Miller SA, Freeman H, Scalzitti DA, Hoogeboom T. A Systematic Appraisal of Conflicts of Interest and Researcher Allegiance in Clinical Studies of Dry Needling for Musculoskeletal Pain Disorders. Phys Ther 2023; 103:pzad023. [PMID: 37384639 DOI: 10.1093/ptj/pzad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and methods of conflicts of interest (COI) reporting in published dry needling (DN) studies and to determine the frequency of researcher allegiance (RA). METHODS A pragmatic systematic search was undertaken to identify DN studies that were included in systematic reviews. Information regarding COI and RA were extracted from the full text of the published DN reports, and study authors were sent a survey inquiring about the presence of RA. A secondary analysis also was undertaken based on study quality/risk of bias scores that were extracted from the corresponding systematic reviews and study funding extracted from each DN study. RESULTS Sixteen systematic reviews were identified, containing 60 studies of DN for musculoskeletal pain disorders, 58 of which were randomized controlled trials. Of the DN studies, 53% had a COI statement. None of these studies disclosed a COI. Nineteen (32%) authors of DN studies responded to the survey. According to the RA survey, 100% of DN studies included at least 1 RA criterion. According to the data extraction, 1 RA criterion was met in 45% of the DN studies. The magnitude of RA per study was 7 times higher according to the surveys than in the published reports. CONCLUSION These results suggest that COI and RA might be underreported in studies of DN. In addition, authors of DN studies might be unaware of the potential influence of RA on study results and conclusions. IMPACT Improved reporting of COI/RA might improve credibility of results and help identify the various factors involved in complex interventions provided by physical therapists. Doing so could help optimize treatments for musculoskeletal pain disorders provided by physical therapists.
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Affiliation(s)
- John W Ware
- Infirmary Therapy Services, Mobile, Alabama, USA
| | - Kenny Venere
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Stephanie A Miller
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Heather Freeman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - David A Scalzitti
- Department of Health, Human Function, & Rehabilitation Sciences, George Washington University, Washington, DC, USA
| | - Thomas Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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2
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Rabeyron T. L’évaluation et l’efficacité des psychothérapies psychanalytiques et de la psychanalyse. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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3
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Haun MW, Tönnies J, Krisam R, Kronsteiner D, Wensing M, Szecsenyi J, Vomhof M, Icks A, Wild B, Hartmann M, Friederich HC. Mental health specialist video consultations versus treatment as usual in patients with depression or anxiety disorders in primary care: study protocol for an individually randomised superiority trial (the PROVIDE-C trial). Trials 2021; 22:327. [PMID: 33952313 PMCID: PMC8097128 DOI: 10.1186/s13063-021-05289-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas, and (c) patients' reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. METHODS In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices in Germany. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: the primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation. DISCUSSION To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany. TRIAL REGISTRATION ClinicalTrials.gov, United States National Institutes of Health NCT04316572 . Prospectively registered on 20 March 2020.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany.
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
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Pile V, Smith P, Leamy M, Oliver A, Bennett E, Blackwell SE, Meiser-Stedman R, Stringer D, Dunn BD, Holmes EA, Lau JYF. A feasibility randomised controlled trial of a brief early intervention for adolescent depression that targets emotional mental images and memory specificity (IMAGINE). Behav Res Ther 2021; 143:103876. [PMID: 34098409 DOI: 10.1016/j.brat.2021.103876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/01/2020] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
Brief, evidence-based interventions for adolescent depression are urgently required, particularly for school-settings. Cognitive mechanisms research suggests dysfunctional mental imagery and overgeneral memory could be promising targets to improve mood. This feasibility randomised controlled trial with parallel symptomatic groups (n = 56) compared a novel imagery-based cognitive behavioural intervention (ICBI) to non-directive supportive therapy (NDST) in school settings. Blind assessments (of clinical symptoms and cognitive mechanisms) took place pre-intervention, post-intervention and follow-up three months later. The trial aimed to evaluate the feasibility and acceptability of the methodology and interventions, and estimate the likely range of effects of the intervention on self-reported depression. The pre-defined criteria for proceeding to a definitive RCT were met: full recruitment occurred within eleven months; retention was 89%; ICBI acceptability was above satisfactory; and no harm was indicated. Intention-to-treat analysis found large effects in favour of ICBI (relative to NDST) at post-intervention in reducing depressive symptoms (d = -1.34, 95% CI [-1.87, -0.80]) and improving memory specificity (d = 0.79 [0.35, 1.23]), a key cognitive target. The findings suggest that ICBI may not only improve mood but also strengthen abilities associated with imagining and planning the future, critical skills at this life stage. A fully powered evaluation of ICBI is warranted. Trial Registration: https://www.isrctn.com/; ISRCTN85369879.
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Affiliation(s)
- Victoria Pile
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Abigail Oliver
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Eleanor Bennett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden; Sweden and Division of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Y F Lau
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Price L, Briley J, Haltiwanger S, Hitching R. A meta-analysis of cranial electrotherapy stimulation in the treatment of depression. J Psychiatr Res 2021; 135:119-134. [PMID: 33477056 DOI: 10.1016/j.jpsychires.2020.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression rates have reached historic highs, with 49% of Americans reporting unabating symptoms and signs of depression, representing a 12% increase compared to the same time in 2019. With depression as a moderating factor for suicide, the need for efficacious treatments for depression has never been more pronounced. Although the armamentarium of the psychiatrist seems impressive having multiple medications and psychotherapy options, with guidelines for combination and augmentation treatments; many patients do not improve or are not suitable candidates for the usual, customary and reasonable (UCR) depression treatments. The use of various forms of brain stimulation technology as a complementary or alternative treatment for depression is growing and is expected to be part of the armamentarium of most psychiatrists by 2030. One form of brain stimulation, available in a phone sized prescription device, is cranial electrical stimulation (CES) which has been used as a treatment for depression since the 1970s. We have conducted two meta-analyses of CES research for depression separating randomized controlled trials (N = 5) from non-randomized studies on interventions (N = 12). For the double-blind RCTs 100 μA was used for 1 hour per day as 100 μA is a subsensory level of current so identical sham treatment devices could be used. METHODS Our literature review followed Cooper's Taxonomy of Literature Reviews that is appropriate for the behavioral and physical sciences and the PRISMA reporting guidelines. The evaluation of strengths and limitations of the research studies included in this report adheres to recommended published guidelines in the Cochrane Handbook for Systematic Reviews of Interventions, and in the Handbook of Research Synthesis and Meta-Analysis. We used the Cohen's d effect size summary metric in all analyses. Homogeneity of effect sizes within the fixed and random effects models are reported. Meta-analyses were performed using the Compressive Meta-Analysis, version 3 program. RESULTS The 5 RCTs represent a combined N of 242 and the 12 NRSIs represent 16 data sets with a combined N of 1173 for total of 1415 subjects across 17 studies. There were male and female subjects, from adolescents to 60 years old. The average effect for the 5 RCTs was calculated as d = -0.69 (i.e., the mean depression level at posttest for the active group was -0.69 standard deviations lower than the mean depression level for the sham group), a medium effect. The additional 12 NRSI studies analyzed show a small effect of d = -0.43 in favor of the active treatment group. CONCLUSION We conclude that CES has a small to medium significant effect in symptoms of depression across moderate to severe patients in civilian, military, veterans, advanced cancer and pediatric populations.
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Affiliation(s)
- Larry Price
- Methodology, Measurement & Statistical Analysis, Office of Research and Sponsored Programs, San Marcos, TX, USA; Psychometrics & Statistics, Texas State University, USA
| | - Josh Briley
- Electromedical Products International, Inc., Mineral Wells, TX, USA.
| | | | - Rita Hitching
- Electromedical Products International, Inc., Mineral Wells, TX, USA
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Rabeyron T. Why Most Research Findings About Psi Are False: The Replicability Crisis, the Psi Paradox and the Myth of Sisyphus. Front Psychol 2020; 11:562992. [PMID: 33041926 PMCID: PMC7530246 DOI: 10.3389/fpsyg.2020.562992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
The replicability crisis in psychology has been influenced by the results of nine experiments conducted by Bem (2011) and presented as supporting the existence of precognition. In this paper, we hope to show how the debate concerning these experiments could be an opportunity to develop original thinking about psychology and replicability. After a few preliminary remarks about psi and scientific epistemology, we examine how psi results lead to a paradox which questions how appropriate the scientific method is to psi research. This paradox highlights a problem in the way experiments are conducted in psi research and its potential consequence on mainstream research in psychology. Two classical experiments - the Ganzfeld protocol and the Bem studies - are then analyzed in order to illustrate this paradox and its consequences. Mainstream research is also addressed in the broader context of the replication crisis, decline effect and questionable research practices. Several perspectives for future research are proposed in conclusion and underline the heuristic value of psi studies for psychology.
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Affiliation(s)
- Thomas Rabeyron
- Université de Lorraine, Interpsy, Nancy, France.,University of Edinburgh, KPU, Edinburgh, United Kingdom
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7
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Increase value and reduce waste in research on psychological therapies. Behav Res Ther 2019; 123:103479. [PMID: 31639527 DOI: 10.1016/j.brat.2019.103479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
A seminal Lancet series focused on increasing value and reducing waste in biomedical research, providing a transferrable template to diagnose problems in research. Our goal was to document how some of these sources of waste apply to mental health and particularly psychological treatments research. We synthesize and critically evaluate empirical findings in relation to four major sources: i) defining research priorities; ii) research design, methods and analysis; iii) accessibility of research information; iv) accuracy and usability of research reports. We demonstrate that each source of waste considered is well-represented and amply documented within this field. We describe hype and insufficient consideration of what is known in defining research priorities, persistent risk of bias, particularly due to selective outcome reporting, for psychotherapy trials across mental disorders, intellectual and financial biases, direct and indirect evidence of publication bias, largely inexistent adoption of data sharing, issues of multiplicity and fragmentation of data and findings, and insufficient adoption of reporting guidelines. We expand on a few general solutions, including supporting meta-research, properly testing interventions to increase research quality, placing open science at the center of psychological treatment research and remaining vigilant particularly regarding the strains of research currently prioritized, such as experimental psychopathology.
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8
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The waiting list is an inadequate benchmark for estimating the effectiveness of psychotherapy for depression. Epidemiol Psychiatr Sci 2019; 28:278-279. [PMID: 30479243 PMCID: PMC6998910 DOI: 10.1017/s2045796018000665] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yoder WR, Karyotaki E, Cristea IA, van Duin D, Cuijpers P. Researcher allegiance in research on psychosocial interventions: meta-research study protocol and pilot study. BMJ Open 2019; 9:e024622. [PMID: 30782912 PMCID: PMC6377509 DOI: 10.1136/bmjopen-2018-024622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION One potential source of bias in randomised clinical trials of psychological interventions is researcher allegiance (RA). The operationalisation of RA differs strongly across studies, and there is not a generally accepted method of operationalising or measuring it. Furthermore, it remains unclear as to how RA affects the outcomes of trials and if it results in better outcomes for a preferred intervention. The aim of this project is to develop and validate a scale that accurately identifies RA, contribute to the understanding of the impact that RA has in a research setting and to make recommendations for addressing RA in practice. METHODS AND ANALYSIS A scale will first be developed and validated to measure RA in psychotherapy trials. The scale will be validated by surveying authors of psychotherapy trials to assess their opinions, beliefs and preferences of psychotherapy interventions. Furthermore, the scale will be validated for use outside the field of psychotherapy. The validated checklist will then be used to examine two potential mechanisms of how RA may affect outcomes of interventions: publication bias (by assessing grants) and risk of bias (RoB). Finally, recommendations will be developed, and a feasibility study will be conducted at a national mental health agency in The Netherlands. Main analyses comprise inter-rater reliability of checklist items, correlations to examine the relationship between checklist items and author survey (convergent validity) as well as checklist items and trial outcomes and multivariate meta-regression techniques to assess potential mechanisms of how allegiance affects trial outcomes (publication bias and RoB). ETHICS AND DISSEMINATION This study has been reviewed and approved by the Scientific and Ethical Review Board (VCWE) at the Vrije Universiteit Amsterdam. Study result and advancements will also be published on the Open Science Framework. Furthermore, main findings will be disseminated through articles in international peer-reviewed open access journals. Results and recommendations will be communicated to the Cochrane Collaboration, the Campbell Collaboration and other funding agencies.
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Affiliation(s)
- Whitney Rose Yoder
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ioana-Alina Cristea
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Wagner CJ, Dintsios CM, Metzger FG, L'Hoest H, Marschall U, Stollenwerk B, Stock S. Longterm persistence and nonrecurrence of depression treatment in Germany: a four-year retrospective follow-up using linked claims data. Int J Methods Psychiatr Res 2018; 27:e1607. [PMID: 29446186 PMCID: PMC6877203 DOI: 10.1002/mpr.1607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To measure persistence and nonrecurrence of depression treatment and investigate potential risk factors. METHODS We retrospectively observed a closed cohort of insurees with new-onset depression treatment in 2007 and without most psychiatric comorbidity for 16 quarters (plus one to ascertain discontinuation). We linked inpatient/outpatient/drug-data per person and quarter. Person-quarters containing specified depression services were classified as depression-treatment-person-quarters (DTPQ). We defined longterm-DTPQ-persistence as 16 + 1 continuous DTPQ and longterm-DTPQ-nonrecurrence as 12 continuous quarters without DTPQ and used multivariate logistic regression to explore associations with these outcomes. RESULTS Within first 16 quarters, 28,348 patients' first period (total time) persisted for a mean/median 5.4/3 (8.7/8) quarters. Fourteen percent had longterm-DTPQ-persistence, associated (p < .05) with baseline hospital (odds ratio, OR = 1.80), psychotherapy/specialist-interview and antidepressants (OR = 1.81), age (years, OR = 1.03), unemployment (OR = 1.21), retirement (OR = 1.31), and insured as a dependent (OR = 1.32). Thirty-four percent had longterm-DTPQ-nonrecurrence, associated with psychotherapy/specialist-interview (OR = 1.40), antidepressants (OR = 0.54), female sex (OR = 0.84), age (years, OR = 0.99), retirement (OR = 1.18), and insured as a dependent (OR = 0.88). Women differed for episodic and not chronic treatment. CONCLUSION Treatment measures compared to survey's symptoms measures. We suggest further research on "treatment-free-time." Antidepressants(-) and psychotherapy/specialist-interview(+) were significantly associated with longterm-DTPQ-nonrecurrence. This was presumably moderated by possible short-time/low-dosage antidepressants use(-) and selective therapy assignment(+). Sample selectivity limited data misclassification.
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Affiliation(s)
- Christoph J Wagner
- Institute for Health Economics and Clinical Epidemiology (IGKE), Cologne University Hospital, Cologne, Germany
| | - Charalabos Markos Dintsios
- Institute for Health Services Research and Health Economics, Heinrich Heine University, Duesseldorf, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy and Geriatric Centre, Tuebingen University Hospital, Tuebingen, Germany
| | - Helmut L'Hoest
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund (former BARMER GEK), Wuppertal, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund (former BARMER GEK), Wuppertal, Germany
| | - Bjoern Stollenwerk
- Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology (IGKE), Cologne University Hospital, Cologne, Germany
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11
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Control conditions for randomised trials of behavioural interventions in psychiatry: a decision framework. Lancet Psychiatry 2017; 4:725-732. [PMID: 28396067 DOI: 10.1016/s2215-0366(17)30153-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 11/21/2022]
Abstract
In psychiatry, comparative analyses of therapeutic options and the aggregation of data from clinical trials across different therapeutic approaches play an important role in clinical decision making, treatment guidelines, and health policy. This approach assumes that trials of pharmacological and behavioural therapies generally produce the same level of evidence when properly designed. However, trial design for behavioural interventions has some unique characteristics and control groups vary widely, which influence the effects observed in any given trial. In this Personal View, we review various control conditions typically used in psychiatry, outline their effect on the internal validity and expected effect size of a trial, and propose a decision framework for choosing a control condition depending on the risk to the patient population and the stage of development of the therapeutic intervention. We argue that the choice of control group and its justification need to be taken into consideration when comparing behavioural and pharmacological therapies.
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12
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Markozannes G, Aretouli E, Rintou E, Dragioti E, Damigos D, Ntzani E, Evangelou E, Tsilidis KK. An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction. BMC Psychol 2017; 5:31. [PMID: 28859685 PMCID: PMC5580223 DOI: 10.1186/s40359-017-0200-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/24/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias. METHODS We summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias. RESULTS Thirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence. CONCLUSIONS The present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.
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Affiliation(s)
- Georgios Markozannes
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Evangelia Rintou
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Elena Dragioti
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Dimitrios Damigos
- Department of Psychiatry, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, 02903, USA
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, 45110, Ioannina, Greece.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, SW7 2AZ, UK
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Meinlschmidt G, Lee JH, Stalujanis E, Belardi A, Oh M, Jung EK, Kim HC, Alfano J, Yoo SS, Tegethoff M. Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting. Front Psychol 2016; 7:1112. [PMID: 27516747 PMCID: PMC4963605 DOI: 10.3389/fpsyg.2016.01112] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes. METHOD As part of a larger neurofeedback study, all subjects-after being randomly assigned to an experimental or control neurofeedback condition-underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good-bad, GB; awake-tired, AT; and calm-nervous, CN). RESULTS Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t (613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t (612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t (612.3) = 4.137, p < 0.001] from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the 1st day until the last day with regard to GB mood (r = 0.614, 95%CI [0.297, 0.809], p < 0.001), but not AT mood (r = 0.279, 95%CI [-0.122, 0.602], p = 0.167) and CN mood (r = 0.277, 95%CI [0.124, 0.601], p = 0.170). DISCUSSION Our findings provide evidence for the applicability of smartphone-based micro-interventions eliciting short-term mood changes, based on techniques used in psychotherapeutic approaches, such as mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in line with the precision medicine approach. The here presented data were collected within a randomized trial, registered at ClinicalTrials.gov (Identifier: NCT01921088) https://clinicaltrials.gov/ct2/show/NCT01921088.
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Affiliation(s)
- Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of BaselBasel, Switzerland; Faculty of Medicine, Ruhr-University BochumBochum, Germany
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Esther Stalujanis
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel Basel, Switzerland
| | - Angelo Belardi
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel Basel, Switzerland
| | - Minkyung Oh
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Eun Kyung Jung
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Hyun-Chul Kim
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Janine Alfano
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel Basel, Switzerland
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical SchoolBoston, MA, USA; Incheon St. Mary's Hospital, The Catholic University of KoreaIncheon, South Korea
| | - Marion Tegethoff
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel Basel, Switzerland
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