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Ioana A. Cristea Profile picture
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Dec 31, 2022 • 9 tweets • 6 min read
In 2023, let's give #psychotherapy for #mental disorders the status it deserves when examining and regulating novel or "breakthrough" treatments. Our latest comment (@NaudetFlorian @joarhalvorsen Lisa Cosgrove) @TheLancetPsych lays out arguments for this
thelancet.com/journals/lanps…
Trials of new treatments for mental disorders should be comparative (indeed more regulatory trials should thelancet.com/journals/lance…
Patients in the comparison group should receive a 1st line/recommended by guidelines/effective treatment even if *NOT* biological or pharmacological.
The fact that new treatments are touted as breakthroughs after not being compared to the standard of care is a mockery of the patients' time and distress and a negation of ethics and equipoise.
E.g. benchmarking MDMA-assisted psychotherapy for #PTSD
nature.com/articles/s4159…
Stop labeling patients as treatment-resistant because they failed a variable number of courses of EXCLUSIVELY pharmacological or biological treatment alternatives when there is effective psychotherapy for their primary disorder #depression
thelancet.com/journals/lanps…
From our comment: "Trials that include psychotherapies as active comparators would enhance our knowledge of differential therapeutics. Excluding psychotherapies
when evaluating new treatments excludes testing relative to a key section of the mental health armamentarium."
"Reclaiming a more central role for psychotherapies in regulatory decisions re-opens the question of their own regulation, particularly for new interventions."
Is regulation possible? A 1st step (regulatory standards) already been proposed (@psych_verona: thelancet.com/journals/lanps…
Our illustrative appendix (which took a ton of work and does not use expressions like "evidence exists") looks at the evidence comparing for pharmacotherapy and psychotherapy for #depression & #PTSD
Finally, let's take a 1st step in this direction. @TheLancet @JAMA_current @bmj_latest any major medical journal commission a high-profile review of novel, effective, promising, scalable psychosocial #psychotherapy treatment alternative along the many of drugs/devices/biologics

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More from @IoanaA_Cristea

Ioana A. Cristea Profile picture
Nov 17, 2021
I used to be on the fence about this. Trials have protocols and these are customarily published or made public w/ publication. But I changed my mind (with some caveats)
Even when protocols r published, linking them to final publications & checking whether significant changes occurred & if they are justified is difficult. Trial registries often don't bring this information together. Key details are often missing. Often protocols r not published.
In 2 examples I examined of very high-profile trials in the highest impact journals in medicine, either there was no published protocol (thelancet.com/journals/lance…) or the protocol versions were published w/ final article, documenting major changes (osf.io/ne26f)
Read 10 tweets
Ioana A. Cristea Profile picture
Aug 5, 2021
Bashing #metaanalysis is as fashionable as ever, as always with hands up in the air. In response to a thread moaning the lack of added value of meta-analyses over individual studies, I realized I know of *many* meta-analyses that literally overturned whole fields.
So I want to start my alternative thread, in which instead the of the same old lamets, we list consequential meta-analyses in #Mentalhealth, which definitely provided more information than each and any single individual study.
These don't have to be methodologically flawless, because no study is. They do have to have a decent quality (which is much less of an elusive construct than oft presented). I will start with a few and update when I have time. Feel free to add to the collection. Order random.
Read 11 tweets
Ioana A. Cristea Profile picture
Oct 31, 2020
Our viewpoint "Preserving equipoise and performing randomized trials for COVID-19 social distancing interventions" with @NaudetFlorian and John Ioannidis @METRICStanford now in press @EpiPsychSci @CambridgeCore
cambridge.org/core/journals/…
In this viewpoint we make two main arguments. 1. There is equipoise for non-pharmacological interventions (NPI) for #SARSCoV2 #COVID19 containment because there is uncertainty re: the magnitude of both effectiveness & harms. Uncertainty is vast for some measures.
2. An agenda of randomized controlled trials of NPIs is both possible & feasible. We delineate measures that could be the focus on RCTs, along w/ issues related to designs, comparators (not advocating doing nothing!), outcomes (type, timing), obstacles & counterarguments to RCTs.
Read 8 tweets
Ioana A. Cristea Profile picture
May 31, 2020
My new & very likely most important paper of 2020 @TheLancetPsych #network #metaanalysis on the efficacy of cognitive bias modification for #anxiety or #depression in clinical or subclinical patients
(1st author @liviu_fodor, w/ @pimcuijpers @Toshi_FRKW )
thelancet.com/journals/lanps…
People who follow this field know I have been one of its first and unrelenting critics, starting with my meta-analysis in 2015 @TheBJPsych (again w/ @pimcuijpers) cambridge.org/core/journals/…, followed by others, including many viewpoints, comments & replies that I will spare you.
I was one of the first researchers to have explicitly state that maybe #CBM just does not work and there are no moderators or boundary conditions that can save it. But time passed, studies went on, the field continued to grow & adapt, and so maybe it was time for a reassessment.
Read 19 tweets

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