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August 2, 2000

Placebo Effect in Posttraumatic Stress Disorders—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(5):563. doi:10.1001/jama.284.5.561

In Reply: Dr Krakow and colleagues hypothesize that the act of completing weekly PTSD rating scales might have constituted "covert cognitive-behavioral therapy" due to "an element of exposure and desensitization." We agree that this is a credible hypothesis and have considered it as an explanation for the placebo effect observed in this chronically ill group of patients. However, we believe that completing weekly rating scales is not a potent form of cognitive-behavioral therapy. The placebo effect, thought to be due to the diagnosis, time, and attention paid by staff who are conducting clinical trials, has been well demonstrated in multiple trials of depression and other anxiety disorders. A placebo effect is not unexpected in this multicenter trial of patients with PTSD and has been demonstrated in a recent pharmacological trial of PTSD, which failed to show efficacy.1

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