Psychotherapy and the placebo effect.

Rosenthal, David; Frank, Jerome D.

doi:10.1037/h0044068

Cited by 226 publications

(125 citation statements)

References 28 publications

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“…The lack of placebo controls in psychotherapy interventions is not new, and it has been discussed for decades (e.g., Rosenthal & Frank, 1956). But it persists.…”

Section: Causal Claim Meritedmentioning

confidence: 99%

The Pervasive Problem With Placebos in Psychology

Boot

Simons

Stothart

et al. 2013

Perspect Psychol Sci

541

317

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To draw causal conclusions about the efficacy of a psychological intervention, researchers must compare the treatment condition with a control group that accounts for improvements caused by factors other than the treatment. Using an active control helps to control for the possibility that improvement by the experimental group resulted from a placebo effect. Although active control groups are superior to “no-contact” controls, only when the active control group has the same expectation of improvement as the experimental group can we attribute differential improvements to the potency of the treatment. Despite the need to match expectations between treatment and control groups, almost no psychological interventions do so. This failure to control for expectations is not a minor omission—it is a fundamental design flaw that potentially undermines any causal inference. We illustrate these principles with a detailed example from the video-game-training literature showing how the use of an active control group does not eliminate expectation differences. The problem permeates other interventions as well, including those targeting mental health, cognition, and educational achievement. Fortunately, measuring expectations and adopting alternative experimental designs makes it possible to control for placebo effects, thereby increasing confidence in the causal efficacy of psychological interventions.

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“…The lack of placebo controls in psychotherapy interventions is not new, and it has been discussed for decades (e.g., Rosenthal & Frank, 1956). But it persists.…”

Section: Causal Claim Meritedmentioning

confidence: 99%

The Pervasive Problem With Placebos in Psychology

Boot

Simons

Stothart

et al. 2013

Perspect Psychol Sci

541

317

View full text Add to dashboard Cite

show abstract

“…Wilkins (1973) reviewed the literature which claimed the clients' prognostic expectancies determined the outcome of psychotherapy; he concluded that the results of empirical studies indicated no causal relationship between expectancy and therapeutic gain. Other researchers have argued that the expectations a client brought to therapy could have a significant effect on the person's progress, attendance, and outcome in therapy (Clemes and D'Andrea, 1965;Goldstein, 1960;Rosenthal and Frank, 1956 Herron, and Seidman, 1971;Martin, Moore, and Karwisch, 1977) and thus contribute to patients' and therapists• satisfaction with therapy and probably to the success of treatment (Martin, Sterne, and Hunter, 1976).…”

Section: Prognostic Expectationsmentioning

confidence: 99%

Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy.

Bonner

Everett²

1986

Professional Psychology: Research and Practice

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The purpose of this study was to assess the effects of client preparation and problem severity on children's and parents' understanding, attitudes, and expectations of child psychotherapy. Thirty-eight children with one of their parents served as subjects. Half of the children and parents received preparation information, and the other half were not prepared. Following preparation versus no-preparation procedures, children and parents completed questionnaires assessing problem severity, knowledge of and attraction to therapy, and prognostic expectations. Therapists rated problem severity and expectations for treatment outcome. Preparation increased children's and parents' knowledge of therapy, attraction-receptivity to therapists and treatment, and expectations for therapy outcome. Children and parents were found to be quite attracted and receptive to psychotherapy and to have very positive expectations for treatment outcome. The study's findings further indicated that therapists saw the children's problems as more severe and had lower prognostic expectations than did children and parents. No relation was found between problem severity and attraction-receptivity to treatment or expectations for treatment outcome.Current research in psychotherapy outcome is revealing psychotherapy to be a multidimensional process with a multidetermined outcome. The major determinants of successful psychotherapy are presently thought to lie in the characteristics of the client, the therapist, and the client-BARBARA L. BONNER received her doctorate in clinical psychology from Oklahoma State University in 1984. She is presently serving a 2-year postdoctoral fellowship in pediatric psychology and adolescent medicine at the University of Oklahoma Health Sciences Center. Dr. Bonner's current research interests are child psychotherapy outcome and the treatment and prevention of child sexual abuse.

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“…For example, Rosenthal and Frank [119] have expanded the inert nature of placebos to psychotherapy by defining placebo as ''an activity regarded as therapeutically inert from the standpoint of the theory of the therapy being studied'' (p. 299). Semantics apart, trialists should avoid the use of non-inert placebos in trials because they may cause the underestimation of treatment effects.…”

Section: Introductionmentioning

confidence: 99%

Imperfect placebos are common in low back pain trials: a systematic review of the literature

et al. 2008

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The placebo is an important tool to blind patients to treatment allocation and therefore minimise some sources of bias in clinical trials. However, placebos that are improperly designed or implemented may introduce bias into trials. The purpose of this systematic review was to evaluate the adequacy of placebo interventions used in low back pain trials. Electronic databases were searched systematically for randomised placebo-controlled trials of conservative interventions for low back pain. Trial selection and data extraction were performed by two reviewers independently. A total of 126 trials using over 25 different placebo interventions were included. The strategy most commonly used to enhance blinding was the provision of structurally equivalent placebos. Adequacy of blinding was assessed in only 13% of trials. In 20% of trials the placebo intervention was a potentially genuine treatment. Most trials that assessed patients' expectations showed that the placebo generated lower expectations than the experimental intervention. Taken together, these results demonstrate that imperfect placebos are common in low back pain trials; a result suggesting that many trials provide potentially biased estimates of treatment efficacy. This finding has implications for the interpretation of published trials and the design of future trials. Implementation of strategies to facilitate blinding and balance expectations in randomised groups need a higher priority in low back pain research.

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Psychotherapy and the placebo effect.

Cited by 226 publications

References 28 publications

The Pervasive Problem With Placebos in Psychology

The Pervasive Problem With Placebos in Psychology

Influence of client preparation and problem severity on attitudes and expectations in child psychotherapy.

Imperfect placebos are common in low back pain trials: a systematic review of the literature

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