Mental Health

THE QUIZ: Headaches

Scientific American, March 30, 2017

Dr. King, regarding acupuncture, perhaps you can comment on this article:

Research Casts Doubt on the Value of Acupuncture, Scientific studies show that the procedure is full of holes, Scientific American, August 2016

The article makes these statements below, and it seems to me that because of the subjective nature of endpoints used in any clinical trial of pain or migraine treatment, whether acute or prophylactic treatment, that it seems a bit too early to make definitive conclusions about acupuncture worthy of a “True” or “False” in a quiz because there is no way to filter out bias of hope or expectation and/or researcher/treater bias effects on the subject even with masked raters as they only record the report of the patient:

1. effects of acupuncture are the same whether needles are placed along the meridians or at random locations around the body.

2. acupuncture studies are extremely difficult to double-blind—a methodological approach in which neither the researchers nor patients know who is receiving the treatment under investigation and who is receiving the placebo or sham.

3. researchers know which patients receive or do not receive real acupuncture, likely biasing the results.

For more information about Douglas Berger Psychiatrist Tokyo visit the following websites:

Mental Health

“Tell it about You Mother ” by Casey Schwartz, June 24, 2015

The article “Tell it about You Mother ” by Casey Schwartz, June 24, 2015, ( is a review of a study that suggests there is a link of psychoanalysis with specific brain changes. The article reports the fMRI images of one-patient which is neither a report of results nor analysis, and the one-patient data is a personal contact from the study authors to the NY Times article author, not a publication of the results (“Images from Andrew J. Gerber and Katherine R. Surrence/Columbia University”).

I could not find any results from this fMRI study on a literature search. I asked the authors of the original paper Gerber and Peterson for some data or analysis, and received no reply. One article I did find was a description of the of the study plan but no results are reported: Measuring Transference Phenomena with fMRI, Andrew J. Gerber and Bradley S. Peterson, Am Psychoanal Assoc. 2006; 54(4): 1319–1325 ( This article noted that the study planned only 10 subjects and was not blinded to the therapist nor the subject as to the content of the procedures (so there was no blinded control group). The NY Times article had the term “Preliminary research” under the image, however, In spite of only presenting the data of one unblinded subject, and the data having no publication or analysis, the NYT article says “ goes on to state, “… indicates that brain regions involved in transference include the left and right insula”. The research article itself stated, “It is crucial that the paradigm be designed for optimal reliability and clinical relevance at this stage, before it is applied broadly to questions of development, psychopathology, and psychotherapeutic change.”

Changes in the brain are also seen in other activities. For example, this study,, Nature Neuroscience 12, 1370 – 1371 (2009); 11 October 2009 | doi:10.1038/nn.2412, found an increase in white matter underlying the intraparietal sulcus following training of a complex visuo-motor skill. This study was not blinded and there was no placebo control group. Mindfulness meditation has also been found to alter regions of the brain associated with memory, awareness of self, and compassion, according to a brain imaging study: Psychiatry Research: Neuroimaging (Jan. 30, 2011). The subjects in this study were not blinded and there was no placebo control group.

The brain is clearly an organ that can modify itself to various stimuli, changes are not necessarily indicative of effects of a specific psychotherapy. There is data on only one subject presented, the study is not blinded, there is no comparison group, no blind placebo group, and no analysis of any cohort of data that can be found in the literature at this time. The NYT should look into whether there is any published data

and analysis of this data, and make an addendum to the Schwartz article of what is or isn’t published, the robustness of any study presented (i.e., number of subjects, blinding, placebo, comparison group, etc.), and revise any suggestions of effects of psychoanalysis on the brain in a new article written by a panel of clinical trial experts or as least by the Editors.

For more information about Douglas Berger Psychiatrist Tokyo visit the following websites:

Mental Health

“Top Papers That Can Change Your Practice”

by Sy Atezaz Saeed, MD, MS and Richard M. Bloch, PhD, Article Originally Published in the ‘Psychiatric Times’ on February 23, 2017

Drs. Saeed and Bloch,

You quoted a paper on IPT as showing IPT to be more effective than placebo or waiting list and comparable to pharmacotherapies.

Did this paper, or any paper, ever study IPT with single-blinding (=subject blind) or double-blinding (and thus with blind placebo)? I think not as it is impossible to blind a psychotherapy study, using the term “placebo” in a psychotherapy study is misleading as it is not a blind placebo.

In addition, comparing IPT to medications that show efficacy vs blind placebo (thus the rigor in showing efficacy is higher than in unblinded studies) invalidates clinical trial logic because the methods to prove efficacy are very different in blinded medication studies vs psychotherapy studies. MDD is studied with subjective endpoints and an unblinded study can not filter bias from the expectation and hope of knowing the therapy one is given. Blind raters only record the unblinded report of the subjects.

Because MDD psychotherapy trials cannot be single- or double-blinded, nor can they have blind placebo, the rigor of these trials for psychotherapy in MDD is low so that it is premature to make claims of efficacy for IPT in MDD. These kinds of papers do not belong in a “Top Ten” list unless you want to include “papers with problems to be aware of” in the list.

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