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The Selection and Design of Control Conditions for Randomized Controlled Trials of Psychological Interventions

Mohr D.C.a, b · Spring B.a, b · Freedland K.E.c · Beckner V.d · Arean P.d · Hollon S.D.e · Ockene J.f · Kaplan R.g
aDepartment of Preventive Medicine, Northwestern University, Chicago, Ill., bHines VA Medical Center, Hines, Ill., cDepartment of Psychiatry, Washington University School of Medicine, St. Louis, Mo., dDepartment of Psychiatry, University of California, San Francisco, Calif., eDepartment of Psychology, Vanderbilt University, Nashville, Tenn., fUniversity of Massachusetts Medical School, Worchester, Mass., and gSchool of Public Health, University of California, Los Angeles, Calif., USA Psychother Psychosom 2009;78:275–284 (DOI:10.1159/000228248)


The randomized controlled trial (RCT) provides critical support for evidence-based practice using psychological interventions. The control condition is the principal method of removing the influence of unwanted variables in RCTs. There is little agreement or consistency in the design and construction of control conditions. Because control conditions have variable effects, the results of RCTs can depend as much on control condition selection as on the experimental intervention. The aim of this paper is to present a framework for the selection and design of control conditions for these trials. Threats to internal validity arising from modern RCT methodology are reviewed and reconsidered. The strengths and weaknesses of several categories of control conditions are examined, including the ones that are under experimental control, the ones that are under the control of clinical service providers, and no-treatment controls. Considerations in the selection of control conditions are discussed and several recommendations are proposed. The aim of this paper is to begin to define principles by which control conditions can be selected or developed in a manner that can assist both investigators and grant reviewers.


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