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This is true regardless of how depressed the person is to begin with. Does that mean that psychotherapy is no better than sugar pills?How could the effects of antidepressants be "clinically insignificant," while the effects of psychotherapy are "substantial" when they are just as good as medication?What if we applied his criterion evenhandedly to both antidepressants and psychotherapy for depression?
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He noted that the NICE criterion of an effect size of 0.5 had been taken from Jacob Cohen's designation of it as "medium", but Cohen himself had distanced himself from his own designation of effect sizes as "small," "medium," or "large" with "The values chosen had no more reliable a basis than my own intuition." Turner suggested that Cohen would undoubtedly have rejected NICE's rigid distinction of 0.5 as a categorical cutoff between ineffective versus effective treatments.
Indeed, Cohen who is now deceased, offered no hint that he would have welcomed becoming the arbiter of categorical judgments of clinical significance and famously lampooned the categorical p It seems unfair that pharmacological, and not psychotherapeutic, treatment has become the usual first line approach to depression merely for economic reasons.
And from his recent book: Psychotherapy works for the treatment of depression, and the benefits are substantial.
In head-to-head comparisons, in which the short-term effects of psychotherapy and antidepressants are pitted against each other, psychotherapy works as well as medication.
They found essentially the same effect size of ES = 0.32 as Turner's group.
However, Kirsch and co-authors applied the criterion of ES= 0.50 for clinical significance and judged the effects of antidepressants as not being clinically significant.Once unpublished reports were taken into account, the overall effect size (ES) for antidepressants relative to placebo was reduced from 0.41 to 0.31, where ES is the standardized mean difference in improvement.However, in all cases, antidepressants were significantly superior to pill placebos.I see the application of evidence-based appraisal being done as a form of advocacy, selectively applying standards and selectively selecting data, as if lawyers were trying to prove their case, rather than judges carefully weighing the evidence.Sad, sad reflection on the field]Following her interview with psychologist Irving Kirsch, CBS News correspondent Leslie Stahl admitted: "I walked away really confused." Undoubtedly, lots of the viewing audience and even professionals were confused by what they had watched.Lesley Stahl: So you're saying if they took a sugar pill, they'd have the same effect?Tags: Adult Dating, affair dating, sex dating