Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 double-blind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect. Examination of pre-post effect sizes among depressed individuals assigned to no-treatment or wait-list control groups suggest that approximately one quarter of the drug response is due to the administration of an active medication, one half is a placebo effect, and the remaining quarter is due to other nonspecific factors. EDITORS' NOTEThe article that follows is a controversial one. It reaches a controversial conclusion-that much of the therapeutic benefit of antidepressant medications actually derives from placebo responding. The article reaches this conclusion by utilizing a controversial statistical approach-meta-analysis. And it employs meta-analysis controversially-by meta-analyzing studies that are very heterogeneous in subject selection criteria, treatments employed, and statistical methods used. Nonetheless, we have chosen to publish the article. We have done so because a number of the colleagues who originally reviewed the manuscript believed it had considerable merit, even while they recognized the clearly contentious conclusions it reached and the clearly arguable statistical methods it employed.We are convinced that one of the principal aims of an electronic journal ought to be to bring our readers information on a variety of current topics in prevention and treatment, even though much of it will be subject to heated differences of opinion about worth and ultimate significance. This is to be expected, of course, when one is publishing material at the cutting-edge, in a cutting-edge medium.We also believe, however, that soliciting expert commentary to accompany particularly controversial articles facilitates the fullest possible airing of the issues most germane to appreciating both the strengths and the weaknesses of target articles. In the same vein, we welcome comments on the article from readers as well, though for obvious reasons, we cannot promise to publish all of them.Feel free to submit a comment by emailing admin@apa.org.

A meta-analysis was performed on 18 studies in which a cognitive-behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive-behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments.

How EXPECTANCIES SHAPE EXPERIENCEEdited by Irving Kirsch H, low does one explain the power of placebo effects in medication and psychotherapy research? Why do people with medical illnesses who strongly anticipate getting better really do? Response expectancies actually effect autonomic functioning and may be the key to how we ultimately understand the biochemistry of hope.In this groundbreaking volume, the pioneer of research in response expectancies, Irving Kirsch, brings together prominent scientists who have studied this effect in human function and dysfunction over the past decade and practitioners who have applied these findings to enhance the effectiveness of both pharmacological and psychological treatment They have extended our understanding of how response expectancies account for symptom maintenance, motivation, and change in such diverse areas as asthma, substance abuse, sexual dysfunction, and smoking. There are often surprising findings pointed to expectancy modification as a key to enhancing effectiveness of treatment and prevention across settings and theoretical orientations.

The current thinking in the Disaster Risk Reduction field emphasizes assessment and reduction of vulnerability and especially social vulnerability as an important factor in mitigating the effects of disasters. In the process of emphasizing vulnerability, the role and complexity of social resilience was somewhat lost and at times minimized. For example, Terry Cannon and his colleagues include resilience as a factor of social vulnerability in a report to United Kingdom Department for International Development (DFID) (Cannon, Twigg and Rowell, 2002). The United Nations University, Institute for Environment and Human Security (UNU-EHS) delineates “Social Vulnerability” and “Individual Vulnerability” as working areas, but does not mention Social or Individual Resilience (Bogardi, 2006)

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