Acta Psychopathologica Acesso livre

Abstrato

Clinical trials in psychiatry and clinical psychology: science or product testing?

Robert L. Woolfolk

During the recent era of evidence-based medicine, the randomized controlled trial (RCT) has been considered the most reliable method of evaluating interventions. The methodology is used not only in medicine but also in other fields, such as economics, education, and agriculture. In psychiatry and clinical psychology, RCTs have been widely used in conjunction with the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) [1]. This RCT/DSM combination has produced somewhat limited progress, both in identifying effective treatments and in facilitating progress in better understanding the scientific foundations of clinical intervention in these fields. This unfortunate circumstance results not from the limitations of the RCT as a tool of inductive logic, but rather from its use with data that are neither theoretically grounded nor psychometrically sound, under background conditions in which publication bias and economic interest converge to distort the rational and impartial use of the RCT. Until biases due to human interests are reduced and the fields of psychiatry and clinical psychology are more scientifically advanced, the RCT will be of limited use.