On 2018 Jan 24, Doug Berger commented:

Excellent article from a brave young researcher willing to put her career in the line of fire of criticism of CBT and other psychotherapy adherents, not to mention employment opportunities where psychotherapy research has been a mainstay for years and is a cash-cow. The only caveat I would add is that the translation of basic science research into the ability og CBT to overcome the inability to single-(patient blind), or double-(patient and therapist blind), as well as the inability to have blind placebo, in a psychotherapy clinical trial is a serious doubt. Many psychiatric study drugs over the years have had considerable pre-clinical basic science data, even phase I or phase II clinical data, only to fail miserably in phase III trials when adequate numbers of subjects were studied in tightly blinded conditions with blind placebo control. Basic science research only lends itself to decide if it is worth while to test a drug in large populations clinically, it doesn’t say itself if a drug will work, especially in psychiatric conditions where endpoints are subjective and random error high.

The whole premise of CBT, that negative or distorted cognitions are the cause of a psychiatric condition is the only instance in all of medicine and psychiatry where a symptom of an illness is also construed to be the cause. Taking a symptom and making it into a cause is a way to spin the need of a therapy aimed at a cause that actually the result, and in psychiatric conditions with subjective endpoint hope and expectation effects are an easy way to garner some symptom reduction that can easily be called a "response" in a clinical trial. Reading the paper, I wonder if the journal asked the authors to propose ways to work around the blinding problem. The work-around is heuristic but not of practical value once a clinical trial gets going-and as the authors rightly note (and as I have noted in other papers below), there is really no way to do blind/blind placebo psychotherapy clinical trial.

Other papers on this topic: https://www.ncbi.nlm.nih.gov/pubmed/26870318 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863672/ https://www.japanpsychiatrist.com/Abstracts/CBT_Escape.html

D. Berger, U.S. Board Certified Psychiatrist

On 2018 Jan 24, Doug Berger commented:

Excellent article from a brave young researcher willing to put her career in the line of fire of criticism of CBT and other psychotherapy adherents, not to mention employment opportunities where psychotherapy research has been a mainstay for years and is a cash-cow. The only caveat I would add is that the translation of basic science research into the ability og CBT to overcome the inability to single-(patient blind), or double-(patient and therapist blind), as well as the inability to have blind placebo, in a psychotherapy clinical trial is a serious doubt. Many psychiatric study drugs over the years have had considerable pre-clinical basic science data, even phase I or phase II clinical data, only to fail miserably in phase III trials when adequate numbers of subjects were studied in tightly blinded conditions with blind placebo control. Basic science research only lends itself to decide if it is worth while to test a drug in large populations clinically, it doesn’t say itself if a drug will work, especially in psychiatric conditions where endpoints are subjective and random error high.

The whole premise of CBT, that negative or distorted cognitions are the cause of a psychiatric condition is the only instance in all of medicine and psychiatry where a symptom of an illness is also construed to be the cause. Taking a symptom and making it into a cause is a way to spin the need of a therapy aimed at a cause that actually the result, and in psychiatric conditions with subjective endpoint hope and expectation effects are an easy way to garner some symptom reduction that can easily be called a "response" in a clinical trial. Reading the paper, I wonder if the journal asked the authors to propose ways to work around the blinding problem. The work-around is heuristic but not of practical value once a clinical trial gets going-and as the authors rightly note (and as I have noted in other papers below), there is really no way to do blind/blind placebo psychotherapy clinical trial.

Other papers on this topic: https://www.ncbi.nlm.nih.gov/pubmed/26870318 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863672/ https://www.japanpsychiatrist.com/Abstracts/CBT_Escape.html

D. Berger, U.S. Board Certified Psychiatrist