Reading focus
Syllabus: How Do We Know When Psychotherapy Helps—or Harms?
Follow the changing denominators across acute treatment, maintenance and follow-up, using the corrections for affected details.
Why you’re reading it. Judge durability without equating responder-only comparisons with the original randomized comparison.
A question to consider. If relapse is less frequent among one group’s earlier responders, what information about selection, discontinuation and missing data is needed before claiming a lasting advantage?
Why this reading
A treatment’s apparent advantage can depend on when outcomes are measured and who remains under observation. This trial compares CBT, medication, their combination and placebo conditions across acute treatment, maintenance and follow-up after discontinuation.
Before you read
Response is a defined improvement criterion, not necessarily complete recovery. An intention-to-treat analysis aims to retain the original assignment groups; a responder-only analysis asks a different question. Missing outcomes and treatments received outside the trial affect both.
Read for
- Follow the participant flow, exclusions after randomization and the groups entering each later phase.
- Compare outcome measures and analysis populations before interpreting a difference in response or relapse.
Consider afterwards
- Why can a comparison among earlier responders differ from a comparison based on the original assignment groups?
- What additional design would help distinguish lasting treatment effects from the consequences of a particular discontinuation procedure?
Editorial context
The study analyzed 312 of 326 randomized adults in specialist clinics and restricted agoraphobic avoidance. Later phases selected responders; medication tapering and missing-data assumptions matter. This historical comparison is not a current prescribing recommendation. The publisher’s main text retains errors addressed by two November 2000 notices: laboratory units, allocation numbers and dose-escalation timing. Both correction records are linked below and describe the same changes.