Mike says "It don't know of any study that used random assignment of treatment types, unless it was to different types of ECT." Well, here's at least one:
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.1997.tb09926.x/pdf And here's another one: http://psycnet.apa.org/psycinfo/1983-13121-001 Mike also says that "intractable patients are the ones offered ECT." Correct - in naturalistic settings. But in controlled research studies of ECT, patients are randomly assigned to conditions, so this statement is irrelevant. More importantly, Mike doesn't really address the core issue I raised in my reply. In all contemporary studies of ECT, at least those conducted in Western countries, patients are given full informed consent and are told that their participation is voluntary. They can also discontinue their participation at any time. Mike (and Paul B., if you'd like), can you please answer the following question: If so, why would patients be motivated to self-report that their depression is better if they know that the treatment team can't impose the intervention on them? I don't follow the reasoning here at all. Also, at the risk of being provocative, I like to ask Mike W. a question, as Mike has repeatedly insisted that studies of medication and ECT that aren't completely blinded are essentially meaningless (note, by the way, that I acknowledged the potential problem of blinding of ECT studies in my message). Mike, you conduct high quality work on neuropsychological measures, and have developed some of these measures yourself. Have you imposed the same remarkably strict standards on your own research and that of your colleagues in neuropsychology? Example: one gives a newly developed neuropsychological measure of response inhibition to psychiatric patients with frontal brain damage, psychiatric patients with brain damage to other regions, psychiatric patients without brain damage, and ostensible normal, and finds that the first group does the worst, with the second group doing significantly better but worse than the other groups. One therefore concludes that this newly developed measure is promising (but of course requires much more research) and possesses at least some degree of construct validity (and assuming the study was carried out properly, I would agree). So let's now take the same reasoning that Mike applies to all medication and ECT studies (again, Mike raises a few valid methodological concerns, to be sure, but he has repeatedly insisted that these studies are completely uninterpretable because of a lack of demonstration of 100% blinding). Well, many or most patients with brain damage "know" that they are brain damaged and even patients with frontal lobe damage, for example, may realize that they are having trouble inhibiting their impulses. Often or even usually, these patients are not "blind" to their brain damaged status. Moreover, when they receive a neuropsychological test of response inhibition, they are not truly "blinded" to the purpose of the test, as they have some idea of what the test is measuring. So in that case, Mike, would you say that these test results are entirely uninterpretable? Making matters more complicated, neuropsychological testers almost always have some idea of the neuropsychiatric status of the individuals they are testing; even if they don't, they can often quickly ascertain (after a few minutes of interaction) that these patients are cognitively impaired, so they aren't blind either. And of course they know what the tests they are administering are designed to measure. So, Mike, I am puzzled that you haven't similarly insisted that most or all studies in your own home field of neuropsychology should similarly be abandoned (if anything, the situation would seem to be worse in neuropsychology given the absence of random assignment). Can you explain why? ....Scott Scott O. Lilienfeld, Ph.D. Professor Department of Psychology, Room 473 Emory University 36 Eagle Row Atlanta, Georgia 30322 sli...@emory.edu; 404-727-1125 The Master in the Art of Living makes little distinction between his work and his play, his labor and his leisure, his mind and his body, his education and his recreation, his love and his intellectual passions. He hardly knows which is which. He simply pursues his vision of excellence in whatever he does, leaving others to decide whether he is working or playing. To him - he is always doing both. - Zen Buddhist text (slightly modified) -----Original Message----- From: Mike Wiliams [mailto:jmicha5...@aol.com] Sent: Wednesday, March 21, 2012 12:55 AM To: Teaching in the Psychological Sciences (TIPS) Subject: Re:[tips] ECT I guess I will go point by point. > (1) Even though most patients describe the procedure as no more > threatening than a trip to the dentist, their report is not especially > plausible or at least not plausible enough to be taken on its own > merits (see Paul's message below); No one stated that ECT is more painful or otherwise more aversive than the dentist. Just the possibility of experiencing the side effect of an induced seizure is sufficient. People avoid the dentist too. Clients endorse positive change on self-report measures just to get out of seeing a conventional therapist they don't like. > (2) Even though scores of published studies on ECT assure patients' > that their self-report reports of depression are confidential, they > somehow don't believe this assurance of confidentiality, and instead > think believe the treatment team will gain access to this information > and use it to decide on the course of future treatment; The published studies do not assure patients that their ratings are completely confidential. They are known by the treatment team. The information is not revealed to people outside of the treatment team. In addition, the team also usually completes the Hamilton Rating Scale. This includes an interview with the patient. > (3) Even though most (today, probably all) patients in published controlled > outcome studies of ECT give full informed consent regarding to whether to > receive the treatment (and therefore the treatment is voluntary), they > somehow don't believe that their participation is voluntary and instead > believe that the treatment will be forced upon them against their will. ECT is sold to the patients. I don't know of any study that used random assignment of treatment types, unless it was to different types of ECT. It is very common to have random assignment of drugs or psychotherapy. Intractable patients are the ones offered ECT. > (4) Even though patients in contemporary controlled studies of ECT are told > they will be randomly assigned to either a treatment arm or an alternative > treatment arm, they don't actually believe that the assignment is random, and > instead believe that the investigative team can decide at will whether to > alter the treatment plan on the basis of their self-reports. I know of no study of ECT that included other treatments in which the subjects were randomly assigned. The major point you are missing is that there can be no blinding of an ECT condition. The expectation biases associated with this are well known. They can account for the treatment effects associated with all the depression treatments. The investigators have the burden of proof in this and they neglect this problem in the same way that obesity researchers fail to notice that their entire science is based on the dieting behavior of young women. It has been a problem so long and impossible to fix that the entire field assumes that the problems don't actually exist. If an expectation bias exists then it could account for the treatment effect. The investigators have the burden to partial out this effect. I think it would be very illuminating if someone running a "blind" trial would just ask the patients to indicate which condition they thought they were in. The final point I need to make is that ECT may be effective. There is just no experiment that I can think of that will prove the effect. The main confound is expectation bias. Mike Williams --- You are currently subscribed to tips as: slil...@emory.edu. 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