Irving Kirsch | |
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Born | March 7, 1943 |
Known for | Placebo research |
Scientific career | |
Fields | Psychiatry |
Hypnosis |
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Irving Kirsch (born March 7, 1943) is an American psychologist and academic. He is the Associate Director of the Program in Placebo Studies and a lecturer in medicine at the Harvard Medical School and Beth Israel Deaconess Medical Center. [1] He is also professor emeritus of psychology at the Universities of Hull and Plymouth in the United Kingdom, and the University of Connecticut in the United States. [2] [3] Kirsch is a leading researcher within the field of placebo studies who is noted for his work on placebo effects, antidepressants, expectancy, and hypnosis. He is the originator of response expectancy theory, and his analyses of clinical trials of antidepressants have influenced official treatment guidelines in the United Kingdom. He is the author of the 2009 book The Emperor's New Drugs , which argued most antidepressant medication is effective primarily due to placebo effects.
The son of Jewish immigrants from Poland and Russia, Kirsch was born in New York City on March 7, 1943. Kirsch received his PhD in psychology from the University of Southern California in 1975. While a graduate student, he produced, in conjunction with the National Lampoon, a hit single and subsequent record album entitled The Missing White House Tapes , which were crafted by doctoring tape recordings of Richard Nixon’s speeches and press conferences during the Watergate hearings. The album was nominated for a Grammy award as Best Comedy Recording in 1974.
In 1975, Kirsch joined the psychology department at the University of Connecticut, where he worked until 2004, when he became a professor of psychology at the University of Plymouth. He moved to the University of Hull in 2007 and joined the faculty of the Harvard Medical School in 2011. Kirsch has authored or edited 10 books and more than 200 scientific journal articles and book chapters. [4]
Kirsch’s response expectancy theory is based on the idea that what people experience depends partly on what they expect to experience. [5] According to Kirsch, this is the process that lies behind the placebo effect and hypnosis. The theory is supported by research showing that both subjective and physiological responses can be altered by changing people’s expectancies. [6] The theory has been applied to understanding pain, depression, anxiety disorders, asthma, addictions, and psychogenic illnesses.
Kirsch’s analysis of the effectiveness of antidepressants was an outgrowth of his interest in the placebo effect. His first meta-analysis was aimed at assessing the size of the placebo effect in the treatment of depression. [7] The results not only showed a sizeable placebo effect, but also indicated that the drug effect was surprisingly small. This led Kirsch to shift his interest to evaluating the antidepressant drug effect.
The controversy surrounding this analysis led Kirsch to obtain files from the U.S. Food and Drug Administration (FDA) containing data from trials that had not been published, as well as those data from published trials. Analyses of the FDA data showed the average size effect of antidepressant drugs to be equal to 0.32, clinically insignificant according to the National Institute for Health and Clinical Excellence (NICE) 2004 guidelines, requiring Cohen's d to be no less than 0.50. [8] No evidence was cited to support this cut-off and it was criticised for being arbitrary; [9] NICE removed the specification of criteria for clinical relevance in its 2009 guidelines. [10] [11]
Kirsch challenges the chemical-imbalance theory of depression, writing "It now seems beyond question that the traditional account of depression as a chemical imbalance in the brain is simply wrong." [12] In 2014, in the British Psychological Society's Research Digest, Christian Jarrett included Kirsch's 2008 antidepressant placebo effect study in a list of the 10 most controversial psychology studies ever published. [13]
In September 2019 Irving Kirsch published a review in BMJ Evidence-Based Medicine, which concluded that antidepressants are of little benefit in most people with depression and thus they should not be used until evidence shows their benefit is greater than their risks. [14]
Kirsch has focused some of his research on the topic of hypnosis. The basis of his hypnosis theory is that placebo effects and hypnosis share a common mechanism: response expectancy. Kirsch's idea on this topic is that the effects of both hypnosis and placebos are based upon the beliefs of the participant. [15] He has characterized clinical hypnosis as a "nondeceptive placebo." [16]
Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since. The disorder causes the second-most years lived with disability, after lower back pain.
Hypnosis is a human condition involving focused attention, reduced peripheral awareness, and an enhanced capacity to respond to suggestion.
Hypnotherapy, also known as hypnotic medicine, is the use of hypnosis in psychotherapy. The efficacy of hypnotherapy is not well supported by scientific evidence, and, due to the lack of evidence indicating any level of efficacy, it is regarded as a type of alternative medicine by reputable medical organisations such as the National Health Service.
A placebo is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets, inert injections, sham surgery, and other procedures.
Sertraline, sold under the brand name Zoloft among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. The effectiveness of sertraline for depression is similar to that of other antidepressants, and the differences are mostly confined to side effects. Sertraline is better tolerated than the older tricyclic antidepressants. Sertraline is effective for panic disorder, social anxiety disorder, generalized anxiety disorder (GAD), and obsessive–compulsive disorder (OCD). Although approved for post-traumatic stress disorder (PTSD), sertraline leads to only modest improvement in this condition. Sertraline also alleviates the symptoms of premenstrual dysphoric disorder (PMDD) and can be used in sub-therapeutic doses or intermittently for its treatment.
In a blind or blinded experiment, information which may influence the participants of the experiment is withheld until after the experiment is complete. Good blinding can reduce or eliminate experimental biases that arise from a participants' expectations, observer's effect on the participants, observer bias, confirmation bias, and other sources. A blind can be imposed on any participant of an experiment, including subjects, researchers, technicians, data analysts, and evaluators. In some cases, while blinding would be useful, it is impossible or unethical. For example, it is not possible to blind a patient to their treatment in a physical therapy intervention. A good clinical protocol ensures that blinding is as effective as possible within ethical and practical constraints.
A nocebo effect is said to occur when a patient's negative expectations for a treatment cause the treatment to have a worse effect than it otherwise would have. For example, when a patient anticipates a side effect of a medication, they can experience that effect even if the "medication" is actually an inert substance. The complementary concept, the placebo effect, is said to occur when positive expectations improve an outcome. The nocebo effect is also said to occur in someone who falls ill owing to the erroneous belief that they were exposed to a physical phenomenon they believe is harmful, such as EM radiation.
Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.
Agomelatine, sold under the brand names Valdoxan and Thymanax, among others, is an atypical antidepressant most commonly used to treat major depressive disorder and generalized anxiety disorder. One review found that it is as effective as other antidepressants with similar discontinuation rates overall but fewer discontinuations due to side effects. Another review also found it was similarly effective to many other antidepressants.
Gepirone, sold under the brand name Exxua, is a medication used for the treatment of major depressive disorder. It is taken orally.
Esketamine, sold under the brand names Spravato and Ketanest among others, is the S(+) enantiomer of ketamine. It is a dissociative hallucinogen drug used as a general anesthetic and as an antidepressant for treatment of depression. Esketamine is the active enantiomer of ketamine in terms of NMDA receptor antagonism and is more potent than racemic ketamine.
Vilazodone, sold under the brand name Viibryd among others, is a medication used to treat major depressive disorder. It is classified as a serotonin modulator and is taken by mouth.
Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.
Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.
The ideomotor phenomenon is a psychological phenomenon wherein a subject makes motions unconsciously. Also called ideomotor response and abbreviated to IMR, it is a concept in hypnosis and psychological research. It is derived from the terms "ideo" and "motor". The phrase is most commonly used in reference to the process whereby a thought or mental image brings about a seemingly "reflexive" or automatic muscular reaction, often of minuscule degree, and potentially outside of the awareness of the subject. As in responses to pain, the body sometimes reacts reflexively with an ideomotor effect to ideas alone without the person consciously deciding to take action. The effects of automatic writing, dowsing, facilitated communication, applied kinesiology, and ouija boards have been attributed to the phenomenon.
The Emperor's New Drugs: Exploding the Antidepressant Myth is a 2009 book by Irving Kirsch, arguing that the chemical imbalance theory of depression is wrong and that antidepressants have little or no direct effect on depression but, because of their common or serious side-effects, they are powerful active placebos.
Steven D. Hollon is an American psychologist, academic and researcher. He is the Gertrude Conaway Vanderbilt Professor of Psychology at Vanderbilt University.
Michael Pascal Hengartner is an academic psychologist at the Zurich University of Applied Sciences who has published on the subject of antidepressants and in other areas. In 2022, he published a book called Evidence-Biased Antidepressant Prescription: Overmedicalisation, Flawed Research, and Conflicts of Interest. He has also published with other notable researchers such as Joanna Moncrieff and Irving Kirsch.