It was a real privilege to be invited to present on treatment-resistance in anxiety disorders at the Psychiatry Masterclass 2025 at the Conrad Dubai. Many thanks to the organising and scientific committees for inviting me!

It was great to be there with such excellent speakers!

Our new Insights article out now in European Neuropsychopharmacology

We argue that poor control conditions in digital therapeutics trials risk misleading efficacy claims.

Let’s raise the bar for DTx trial design.

🔗 authors.elsevier.com/a/1l-8p,L21E...

@ecnp.eu
#DTx #MentalHealth #ClinicalTrials

'Response to treatment' results from 3 broad effects: non-specific effects, placebo-specific effects (expectations, associative learning, maybe unblinding effects...), and the improvement specifically attributable to the treatment itself. These effects appear to be additive:

Active treatment and placebo response were correlated for most outcomes; but not for quality of life. I find this very interesting - would we see greater drug/placebo separation if quality of life was our main outcome for RCTs in psychiatry?? 🤔

As with many psychiatric conditions, we found placebo effect size has increased over time in gambling disorder. Absence of company sponsorship and if the active medication was a nutritional supplement (such as NAC) were also associated with increased placebo response.

Pleased to be able to share our meta-analysis exploring placebo and nocebo response in gambling disorder, out now in Acta Neuropsychiatrica. This is the first meta-analysis of placebo response in RCTs for gambling disorder.

https://buff.ly/3V8dnk3

Analyses within-subject suggested some had unexpected increases in anxiety from baseline, despite positive expectations. The CO2 is a strong stimulus causing high autonomic activity. Perhaps this interfered with expression of placebo response? Perhaps CO2 interfered with frontal cortical function?

Surprisingly, we found that anxiety was identical with the 'Lorazepam' or with the control! BUT, participants reported high expectations after conditioning. What happened?

We attempted to develop a placebo conditioning procedure using the 7.5% CO2 model of generalised anxiety. We hoped participants would believe that a 'Lorazepam nasal spray' would reduce anxiety during a CO2 challenge.

Excited to announce I am joining the #ECNP Early Career Academy! Looking forward to working with everyone else in the academy on applied #neuroskyence

We provide operationalised criteria for treatment failure and for treatment resistance using a staging model. The paper also includes a discussion as to whether a less well-defined, more comprehensive concept of 'difficult to treat' anxiety disorders is useful clinically

Humbled to receive this commendation for academic research by the Royal College of Psychiatrists today. Thanks to friends and collaborators who have supported me on this journey so far!