Employing open/hidden administration in psychotherapy research: A randomized-controlled trial of expressive writing

Abstract

Psychotherapy has been shown to be effective, but efforts to prove specific effects by placebo-controlled trials have been practically and conceptually hampered. We propose that adopting open/hidden designs from placebo research would offer a possible way to establish specificity in psychotherapy. Therefore, we tested the effects of providing opposing treatment rationales in an online expressive writing intervention on affect in healthy subjects. Results indicate that it was possible to conduct the expressive writing intervention both covertly and openly, but that participants in the hidden administration condition did not fully benefit from the otherwise effective expressive writing intervention in the long-run. Effect sizes between open and hidden administration groups were comparable to pre-post effect sizes of the intervention. While this finding is important for the understanding of psychotherapy's effects per se, it also proves that alternative research approaches to establish specificity are feasible and informative in psychotherapy research.Trial registration: German Clinical Trials Register DRKS00009428

Psychotherapy: A World of Meanings

“…For example, a number of meta-analyses showed that various bona fide psychotherapies, i.e., therapies with a clear treatment rationale but with very different underlying theories, aims, and methods appear to be equally effective (Spielmans et al., 2007; Cuijpers et al., 2008; Barth et al., 2013; Frost et al., 2014). In addition, opposing treatment approaches with the same treatment rationale have shown to be equally effective in a trial on clients with panic disorder (Kim et al., 2012) as much as similar treatments provided with opposing treatment rationales have shown to differ in their effects (Tondorf et al., 2017).…”

Sharing clinical notes, and placebo and nocebo effects: Can documentation affect patient health?

“…The majority of studies investigating placebo effects have concentrated on patients' consciously-held beliefs that a treatment will be effective (Berna et al, 2017;Vase et al, 2005). Patients' expectations in augmenting placebo effects are perhaps most clearly observed in so-called "open-hidden" experimental investigations (Amanzio et al, 2001;Tondorf et al, 2017). For example, in an experiment in a hospital setting, intravenous analgesics were administered to patients covertly (from another room) or openly (in full view of the patient).…”

“…However, it is also commonly theorized that expectancies can be shaped by other pathways, such as learning processes, particularly conditioning (Amanzio and Benedetti, 1999;Benedetti et al, 2003b); verbal instructions including the provision of a treatment rationale (Locher et al, 2017;Tondorf et al, 2017); and perceptions about others. Classical-or "Pavlovian"-conditioning refers to the learned associations between a neutral stimulus (e.g.…”

“…Studies show that many patients misunderstand or misremember what is communicated to them about their medications and treatment plans (McCarthy et al, 2012). Survey evidence suggests that many patients report better understanding of treatment rationales a result of open notes, and this may provide a novel pathway toward eliciting placebo effects (Locher et al, 2017;Tondorf et al, 2017). For example, evidence from primary care indicates that patient understanding is enhanced by reading clinical notes (Esch et al, 2016).…”

When a Placebo Is Not a Placebo: Problems and Solutions to the Gold Standard in Psychotherapy Research

“…Two groups received the same online expressive writing intervention but different treatment rationales: participants in the open-arm were told that the intervention had beneficial effects on mood in the long-run whereas participants in the hidden-arm were informed that mood only influenced how they perform in the intervention. Significant differences were observed as shown by a long-term decrease of negative affect in the open-arm only (Tondorf et al, 2017 ). However, this study included healthy subjects and the design should still be tested in a clinical setting.…”