Why randomised controlled trials of psychological treatments are still essential

Abstract

The movement towards evidence-based practice in psychotherapy has recently provoked a backlash. In the past few years, some authors have raised questions concerning the validity of randomised controlled trials (RCTs), which have long been regarded as a crucial linchpin for evidence-based practice. These critics have argued that data from RCTs should not be prioritised above data derived from alternative evidentiary sources, such as observational studies, uncontrolled case studies, and clinical experience. 1 Clay R More than one way to measure. Am Psychol. 2010; 41: 52 Google Scholar , 2 Guy A Thomas R Stephenson SL Loewenthal D NICE under scrutiny: the impact of the National Institute for Health and Clinical Excellence guidelines on the provision of psychotherapy in UK. J Psychol Therap Primary Care. 2012; 1: 77-102 Google Scholar Although many of the criticisms have been aimed at RCT methodology in general, some sceptics have extended them to raise questions concerning the role of RCTs in the evaluation of psychological treatments. Changing the topic does not change the facts – Authors' replyIn keeping with Rapoport's Rules of Argumentation,1 we acknowledge several points of agreement with Jonathan Shedler regarding our Comment.2 We concur that the treatments recommended in the post-traumatic stress disorder (PTSD) practice guidelines are not panaceas: even the best PTSD treatments leave many patients with clinically significant symptoms. Development of better interventions or improvement of existing ones to reach these remaining individuals is needed. Full-Text PDF Changing the topic does not change the factsIn a Comment published in The Lancet Psychiatry, Scott Lilienfeld and colleagues1 wrote that I encouraged psychotherapists to ignore new practice guidelines for post-traumatic stress disorder (PTSD) because they relied inordinately on randomised controlled trials (RCTs). I did not urge therapists to ignore the guidelines because they relied on RCTs; I urged them to ignore the guidelines because research studies—the same RCTs they laud—show that the recommended therapies do not work for most patients. Full-Text PDF