Impact of psychosocial factors on the conduct of combined drug and psychotherapy research.
The effect of attitudes of therapists, patients and researchers on the conduct and outcome of combined drug and psychotherapy research was examined in a brief crisis-oriented psychotherapy clinic. Seventy-seven consecutive patients were given one of two anti-anxiety drugs or a placebo in conjunction with the typical psychoanalytically-oriented treatment used in the clinic. The therapists' attitudes favouring psychotherapy over drug therapy (and psychotherapy research) were clearly conveyed to the patients. Indicative of this are the following: (a) 82 per cent of the patients dropped out of drug taking, although a similar percentage remained in treatment; (b) only a third of the patients perceived it as being important to their therapists that they should take medication; (c) 87 per cent of the patients were rated as improved; and 75 per cent of patients completing forms considered that most or all of their improvement was attributable to talking. The research team, made up of members of the same department who therefore had similar values as the therapists, diligently collected outcome data, but ignored its responsibility to enforce drug-relation portions of the protocol. Overall, patients remained in therapy, improved and participated in completing forms, so that only the research goals of combined therapy were thwarted, while traditional clinic service and training goals proceeded as usual.