Comparisons with medication

One type of design for the evaluation of psychotherapy that has increased in importance consists of comparisons to medication treatments. Because of the widespread use of medications and the large number of randomized clinical trials demonstrating the efficacy of psychotropic medication for the major psychiatric disorders, some(l8) have suggested that in fact the standard design for evaluation of the efficacy of psychotherapy should include medication and pill-placebo treatment groups in addition to the psychotherapy treatment group. This was the design of the influential National Institute of Mental Health Treatment of Depression Collaborative Research ProgramA9» In this study imipramine (plus clinical management) was compared with pill placebo (plus clinical management), cognitive psychotherapy, and interpersonal psychotherapy. The rationale for this design is that the medication group provides the standard reference condition with established efficacy. The pill-placebo group allows for establishing that the particular sample in the study showed the typical medication-placebo difference that would be expected (in other words, the sample was not unusual), and controls for some of the non-specific effects of the psychotherapy (for example, regular visits to a professional, positive expectancies for change). While the pill placebo is clearly not a perfect control condition for psychotherapy, it serves as a practical function—i.e. if a specific psychotherapy is not better than a pill placebo, should the psychotherapy be pursued as a treatment option?

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