Friday, January 15, 2021

Comments by jcoyne

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  • The DSM committee on anxiety disorders is populated not just by psychiatrists with conflict of interests, but by intellectually challenged psychologists like Lee Anna Clark. I think immense damage is being done to the evidence supported treatment movement by bracket creep of the anxiety disorders into lower and lower levels of severity. Among the problems is that clinical trials to establish evidence base status include disproportionately paid patients with little in common with seriously impaired persons seeking therapy. The risk is that treatment parameters validated with these mildly distressed persons will be insufficient for persons who suffer from serious disorder.

    In the old days I used to lament analog studies treating ersatz disorders like spider phobias being used to validate treatments. Now I see patients with ersatz disorders being included in clinical trials of “evidence-based treatments”. No wonder that the effect sizes for evidence-based treatment are so modest and that is so difficult to demonstrate that one credible structured psychological treatment has a clinically significant advantage over another.