The dilemma of the control condition in experience-based cognitive and behavioural treatment research
Authors:
Tessa Harta; Jesse R. Fannb; Thomas A. Novackc
| Affiliations: | a Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA |
| b Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA | |
| c Department of Rehabilitation Medicine, University of Alabama at Birmingham, AL, USA |
DOI:
10.1080/09602010601082359
Publication Frequency:
6 issues per year
First Published:
January
2008
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Abstract
Rehabilitation using cognitive and behavioural treatment methods (i.e., experience-based interventions) faces particular challenges in improving its evidence base through rigorous studies such as randomised controlled trials (RCTs). Experience-based treatments are often complex, with multiple “active ingredients” that may be difficult to characterise. In addition to the difficulty in specifying treatment ingredients, experience-based rehabilitation researchers face challenges in designing or selecting appropriate control or comparison conditions to test the efficacy of complex treatments. Based on lessons learned in designing a cognitive-behavioural intervention for anger self-management for people with traumatic brain injury (TBI) for the National Institutes of Health (NIH)-funded TBI Clinical Trials Network, we review the advantages, disadvantages and applications of a variety of control conditions for experience-based interventions. We discuss controls in which active treatments are withheld (no-treatment controls, waitlist controls, and placebo-analogue designs); controls that involve comparison to naturally occurring or devised usual care treatments; and conditions that compare active treatments (dismantling designs, dose controls, and equivalence trials). Recommendations for selecting and developing control groups that maximise both equipoise and participant enrolment/retention are discussed.
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