2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43
And here is the previously promised post on serious medical research.
Recently, Pabmed published a meta-analysis of the comparative effectiveness of different treatments for anxiety disorders. Randomized controlled trial, all cases. In total, almost 40,000 patients participated in this. Three "diagnoses" were investigated: panic disorder, generalized anxiety disorder, and social phobia. Evaluated and compared the effectiveness of several options for drug treatment and different "psychological" techniques.
Among other things, when summing up the results in Pabmed's publication, there was the following phrase: "Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects" (c). Seeing her, some agitated individuals with attention deficit disorder began to joyfully exclaim in caps: I knew I believed, I hoped - psychotherapy is ineffective, this is all a hoax, the effect is like a placebo … Say "who would doubt" (c).
Since these enthusiastic cries began to disperse in reposts on the network, even through the pages of quite serious people related to both science and medicine, I consider it necessary to analyze in detail the essence of the research conducted. Since the topic is interesting, and a lot of work has been done by researchers in order to simply skim through the text without bothering to try to understand the essence of what has been written. But this essence can be quite unexpected for someone who reads inattentively>: 3
In the first lines, there is a bit of obligatory skepticism. Publishing in Pabmed is the so-called abstract, only brief results are indicated there and that's it. There is no description of research methods and other important details on which the interpretation of the results depends.
For example, there is no description of the exact clinical picture of anxiety disorders. Agree to evaluate the effectiveness of therapy:
- for a person experiencing psychological discomfort from large crowds of people in public transport or in a crowd …
-the agarophobe who is in a panic if it is necessary to cross the threshold of his house …
- for a terry persecuted schizophrenic who is in panic anxiety that huge orangutans from the future with lasers in their hands are chasing him right now across the roofs of houses …
These are three big differences, although anxiety disorder can be diagnosed in all three options. In all three options, the effectiveness of the same techniques will be completely different - and this does not cause any surprise, we drag. It should be so.
There is no description of a universal indicator of effectiveness and a method for calculating it for different methods of therapy.
There is also no detailed description of the research methodology, that is, for example, it is not known how the researchers formulated and defined the "psychological placebo" - yes, they have a similar indicator in the publication.
But - chu! I don't want the post to look like an attempt to justify by looking for a speck in someone else's eye. Yes, it is not clear from the abstract what conditions were examined (the form of the clinic, the intensity of the severity of anxiety, and so on), it is not clear how exactly the analysis was carried out and by what criteria. This is a moment of obligatory skepticism. Let's take it as an axiom that this study was organized correctly, the indicators were formulated accurately and reliably, and the methods were fully consistent with the clinic.
So, the researchers evaluated the effectiveness of the therapy. For this, the universal indicator "effect sizes" (hereinafter ES) was used.
The indicators of the effectiveness of therapy for anxiety disorders are as follows:
ES of non-selective serotonin reuptake inhibitors = 2, 25
ES of selective serotonin reuptake inhibitors = 2.09
ES of benzodiazepines = 2.15
ES of tricyclic antidepressants = 1.83
Cognitive Mindfulness Psychotherapy ES = 1.56
ES "relaxation" (no explanation, understand what you want) = 1, 36
ES of individual cognitive-behavioral psychotherapy = 1.30
ES of group cognitive-behavioral psychotherapy = 1, 22
Psychodynamic therapy ES = 1, 17
ES of remote impersonal psychotherapy (for example, psychotherapeutic correspondence over the Internet) = 1, 11
ES method of processing emotional trauma using eye movements Francine Shapiro = 1, 03
ES of interpersonal (interpersonal) therapy = 0.78
ES combination of cognitive psychotherapy and "drugs" (that is, medications without specifying which ones) = 2, 12
ES of "exercise" (whatever that means) = 1.23
ES of medicated placebo = 1.29
ES psychological placebo = 0.83
ES waitlists = 0.20
These are actually all the main numbers that can be compared and analyzed.
From these data, it can be seen that really individual cognitive psychotherapy is more effective than a drug placebo, and group therapy is slightly below the effectiveness of a drug placebo.
But let's remember for a second what a medicated placebo is. The "placebo effect" refers to the situation when, in the course of medical research, patients are quietly fed with pacifiers - and the patients still get better. That is, the patient from the control group is sure that he is being treated with real medicines, like everyone else, but they secretly give him a pacifier. Placebo. This is done with patients in control groups to compare the result of drug treatment and non-treatment.
The placebo effect is a pronounced psychological effect. A classic example, when patients of group 1 are given a pacifier by an ugly, angry, rude and always annoyed nurse, and patients of group 2 are given a kind and smiling head. branch. The nurse rudely makes you drink and show your tongue, and the head of the department talks about the achievements of medicine and describes the pacifier given as the newest, unique and very effective remedy. And in the second group, the placebo effect is significantly higher than in the first.
When a person receives a medication placebo, he is sure that he is participating in the study of the drug, and a new one (the person was notified, he signed a consent to participate). A person is convinced that he is fully treated with the latest medicines, all conditions, all the way around, all the activities, actions, the environment - indicate exactly this. And his conviction helps him to recover. This is nothing more than an element of "suggestion", that is, it is an element of psychotherapeutic influence.
So the rapturous cry "THE EFFICIENCY OF PSYCHOTHERAPY WAS THE SAME EFFICIENCY OF THE MEDICINAL PLACEBO" actually makes sense "THE EFFICIENCY OF THE PSYCHOTHERAPY WAS THE SAME EFFICIENCY OF THE PSYCHOTHERAPY." Let's clap those people who read diagonally and, taking a few words out of context, make fools of themselves ^ _ ^
The researchers deliberately separated the drug placebo from the psychological placebo (no matter how they define the latter, but skepticism was higher).
If you carefully read and work hard to comprehend what is written in the abstract of meta-analysis, we get the following conclusions:
-the effectiveness of drug therapy is higher than the effectiveness of psychotherapy, especially when it comes to generalized clinic of psychiatric conditions
- the effectiveness of cognitive psychotherapy is 1.5-2 times higher than the effectiveness of "psychological placebo". Drug therapy is also about one and a half times more effective than drug placebo.
- the total effectiveness of cognitive psychotherapy and drug therapy exceeds almost all isolated methods in terms of effectiveness.
- the effectiveness of cognitive psychotherapy is significantly higher compared to the Shapiro method and interpersonal (interpersonal) psychotherapy
If these conclusions are expressed in simple human language:
- In severe cases, medication works better than psychotherapy.
- Psychotherapy is proven to be effective.
- Psychotherapy and Medication Are Better Together than Separately.
- The less "dancing with a tambourine" is, the more effective psychotherapy is. The more dances there are, the less result.
And now, with your hand on the fifth intercostal space on the left, tell me: did these conclusions turn out to be breaking news for you, or did you guess something like that before?)))
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