SynthesisThe Journal of clinical psychiatry2013
Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials.
Synthesis in The Journal of clinical psychiatry, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults.The Cochrane database of systematic reviews · 2016Pooled it
- The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder.BMC psychology · 2016Pooled it
- Inference-Based Cognitive Behavioral Therapy versus Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Multisite Randomized Controlled Non-Inferiority Trial.Psychotherapy and psychosomatics · 2024Trial
- Full-scale Randomized Trial Comparing Acceptance and Commitment Therapy Telephone-Delivered Coaching With Standard Telephone-Delivered Coaching Among Medicare/Uninsured Quitline Callers.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2022Trial
- Iwankapiya American Indian pilot clinical trial: Historical trauma and group interpersonal psychotherapy.Psychotherapy (Chicago, Ill.) · 2020Trial
- Mindfulness and progressive muscle relaxation as standardized session-introduction in individual therapy: A randomized controlled trial.Journal of clinical psychology · 2019Trial
- Psychotherapy integration under scrutiny: investigating the impact of integrating emotion-focused components into a CBT-based approach: a study protocol of a randomized controlled trial.BMC psychiatry · 2016Trial
- Brief Psychotherapy for Maternal Depression: Impact on Mothers and Children.Journal of the American Academy of Child and Adolescent Psychiatry · 2016Trial
- A Comprehensive Self-Management Irritable Bowel Syndrome Program Produces Sustainable Changes in Behavior After 1 Year.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2016Trial
- Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD.The American journal of psychiatry · 2015Trial
- Randomized trial of telephone-delivered acceptance and commitment therapy versus cognitive behavioral therapy for smoking cessation: a pilot study.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2014Trial
- Evaluating an e-mental health program ("deprexis") as adjunctive treatment tool in psychotherapy for depression: design of a pragmatic randomized controlled trial.BMC psychiatry · 2014Trial
- Six-month effects of integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients--follow up from an open, pragmatic randomized controlled trial.BMC complementary and alternative medicine · 2014Trial
- Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients--a pragmatic randomized controlled trial.BMC complementary and alternative medicine · 2013Trial
- Clinical Effectiveness and Cost-Effectiveness of Blended Treatment for Major Depression Compared With Treatment as Usual Within Routine Care in Europe: A Noninferiority Randomized Controlled Trial.Interactive journal of medical research · 2026Article
- Improving Outpatient Psychotherapy for Adults With Major Depressive and Anxiety Disorders Using Web-Based High-Frequency Monitoring and Feedback in Autosystemic Hypnotherapy: Protocol for a Two-Arm ABAB Crossed-Therapist Randomized Clinical Implementation Trial.JMIR research protocols · 2026Article
- Identifying who benefits most from supportive versus expressive techniques in psychotherapy for depression: Moderators of within- versus between-individual effects.Journal of consulting and clinical psychology · 2024Article
- Pedagogical stance in mentalization-based treatment.Journal of clinical psychology · 2022Article
- In support of supportive psychotherapy.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2022Article
- Analyzing Psychotherapy on Twitter: An 11-Year Analysis of Tweets From Major U.S. Media Outlets.Frontiers in psychiatry · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectiveClinical trials sometimes have the same therapists deliver more than 1 psychotherapy, ostensibly to control for therapist effects. This "crossed therapist" design makes controlling for therapist allegiance imperative, as therapists may prefer one treatment they deliver to the other(s). Research has established a strong relationship between principal investigators' allegiances and treatment outcome. Study therapists' allegiances probably also influence outcome, yet this moderating factor on outcome has never been studied. DATA SOURCES: English language abstracts in PsycINFO and MEDLINE from January 1985 to December 2011 were searched for keywords psychotherapy and randomized trial. STUDY SELECTION: The search yielded 990 abstracts that were searched manually. Trials using the same therapists in more than 1 condition were included. DATA EXTRACTION: Thirty-nine studies fulfilled inclusion criteria. Meta-regression analyses assessed the influence of researchers' allegiance on treatment outcome, testing the hypothesis that studies poorly controlling for therapist allegiance would show stronger influence of researcher allegiance on outcome. A single-item measure assessed researchers' reported attempts to control for therapist allegiance.
resultsOnly 1 of 39 studies (3%) measured therapist treatment allegiance. Another 5 (13%) mentioned controlling for, without formally assessing, therapist allegiance. Most publications (67%) did not even mention therapist allegiance. In studies not controlling for therapist allegiance, researcher allegiance strongly influenced outcome, whereas studies reporting control for therapist allegiance showed no differential researcher allegiance. Researchers with cognitive-behavioral therapy allegiance described controlling for therapist allegiance less frequently than other researchers.
conclusionsThe crossed therapist design is subject to bias due to differential psychotherapist allegiance. Worrisome results suggest that researchers strongly allied to a treatment may ignore therapist allegiance, potentially skewing outcomes. All clinical trials, and especially crossed therapist designs, should measure psychotherapist allegiance to evaluate this possible bias.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.