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Lecture 6

Lecture 6: Randomized controlled trials

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Michael Bagby

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Randomised controlled trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. They have several important features:  Random allocation to intervention groups  Patients and trialists should remain unaware of which treatment was given until the study is completed-although such double blind studies are not always feasible or appropriate  All intervention groups are treated identically except for the experimental treatment  Patients are normally analysed within the group to which they were allocated, irrespective of whether they experienced the intended intervention (intention to treat analysis)  The analysis is focused on estimating the size of the difference in predefined outcomes between intervention groups. Non-randomised controlled trials, can detect associations between an intervention and an outcome. But they cannot rule out the possibility that the association was caused by a third factor linked to both intervention and outcome Pg.623-643 Laying out the fundamental controversies or issues and retell story – solution RCT is a type of ECT Doctors: diagnostic tests are done to identify an underlying problem and questions done in systematic way . to confirm diagnosis Rule in and Rule out – Treatment going to be selected is for chrones disease not for colitis – ECT went to scientific literature and figure out what is most effective 1. Diagnose and ruled out other conditions 2. Rely in sci. literature - info. Comes from ects, rcts Some get drug/placebo target bacteria, EBM Relies in scientific evidence – accumulation of Sci. evidence Abnormal behavior –depression EST – diagnosed and randomized in treatment or placebo or comparative therapy which is not CBT the fact that a lot of psychopathologies use ESApproach to methodology Are the RCTs or ECTs correct up to be. Systematically identifies problems of ESTs Assumptions: Malleability –change of treatments. 8-26weeks bec. Phase depressive symptoms of remission and comes back but if it comes back then different depressive symptoms Temporally stable in cross situations – personality How many think it can be change in 26weeks malleability of personality Treating only the symptoms Major depression – 40-50% rate – Weston argues ECTs in psychotherapy – psychological processes are malleable Psychodynamics psychotherapy –Freud Psychofynamic = talk but freud listen to childhood so that they can understand what leads to their adults = vulnerable type of personality styles = those developmental styles e.g. excessively dependent - reoccurrence of breakups again – carry it from relationship to relationship repetition compulsion – not fix underlying cause – repeat itself not fix personality OHIP – cover psychoanalytic treatment CBT – changing behavior but treatment manualized – RCTs patients treatment exact same way CBT – do what manual says – give them homework at each day in treatment follow prescribed mechanisms bec. If we are testing treatment make sure many gets same treatment Moods – psychotherapy – try change how she think about situation not situation but how th
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