October 1997

Manual-Guided Psychosocial TreatmentA New Virtual Requirement for Pharmacotherapy Trials?

Author Affiliations

From the Division of Substance Abuse, Yale University School of Medicine, New Haven, Conn.

Arch Gen Psychiatry. 1997;54(10):923-928. doi:10.1001/archpsyc.1997.01830220041007

The conduct of randomized clinical trials to evaluate the efficacy of pharmacotherapies for mental disorders is guided by research standards (at a high level of rigor) that govern most design elements, including randomization of subjects, use of placebo controls, formulation and dosage of the therapeutic agent, and monitoring of serum levels. In contrast, no such widely accepted guidelines are recognized for standardization of an essential, if unacknowledged, element of all such studies: the concomitant provision of at least a minimal form of psychosocial treatment. Standardized provision of psychosocial treatments in pharmacotherapy trials will foster replicability of findings and address several common problems (eg, attrition, medication noncompliance, reduction of error variance, and ethical issues associated with placebo controls). Careful selection and standardization of the psychosocial context in which medications are delivered will improve the validity, precision, and power of pharmacotherapy efficacy research, and should be considered a virtual requirement in research design.