Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
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
Fontanarosa PB, Brady KT, Pearlstein T, Asnis GM, Baker D, Rothbaum B, Sikes CR, Farfel GM. Placebo Effect in Posttraumatic Stress Disorders—Reply. JAMA. 2000;284(5):563. doi:10.1001/jama.284.5.561