Nathan Huneke
@nathanhuneke.bsky.social
NIHR Academic Clinical Lecturer in General Adult Psychiatry at the University of Southampton
Placebo Effects | Affective and Anxiety Disorders
nathanhuneke.netlify.app
Placebo Effects | Affective and Anxiety Disorders
nathanhuneke.netlify.app
Excellent @liviaasan.bsky.social, well done!
October 25, 2025 at 3:04 PM
Excellent @liviaasan.bsky.social, well done!
Editorial accompanies jamanetwork.com/journals/jam...
Negative Effects During Placebo Treatment
This study compares premature study termination rates in placebo groups of high-quality randomized clinical trials across 9 major psychiatric disorders, focusing on total dropouts, dropouts due to adv...
jamanetwork.com
April 16, 2025 at 3:38 PM
Editorial accompanies jamanetwork.com/journals/jam...
3. We should develop readouts that are resistant to expectation effects (e.g. psychophysics, network connectivity). Experimental medicine models appear resistant to expectation effects, & could be used to develop such readouts academic.oup.com/ijnp/article... journals.sagepub.com/doi/abs/10.1...
Placebo Effects Are Small on Average in the 7.5% CO2 Inhalational Model of Generalized Anxiety
AbstractBackground. Anxiety disorders are highly prevalent and socio-economically costly. Novel pharmacological treatments for these disorders are needed b
academic.oup.com
March 12, 2025 at 5:00 PM
3. We should develop readouts that are resistant to expectation effects (e.g. psychophysics, network connectivity). Experimental medicine models appear resistant to expectation effects, & could be used to develop such readouts academic.oup.com/ijnp/article... journals.sagepub.com/doi/abs/10.1...
2. Statistical methods to 'account for' or 'correct for' expectation effects in RCTs exist but need testing and validating. Gathering data as in recommendation 1 would allow us to do this.
March 12, 2025 at 5:00 PM
2. Statistical methods to 'account for' or 'correct for' expectation effects in RCTs exist but need testing and validating. Gathering data as in recommendation 1 would allow us to do this.
We make the following recommendations:
1. We should systematically record blinding integrity for patients and for clinician raters, and if it fails, why. This would allow us to explore the above question.
1. We should systematically record blinding integrity for patients and for clinician raters, and if it fails, why. This would allow us to explore the above question.
March 12, 2025 at 5:00 PM
We make the following recommendations:
1. We should systematically record blinding integrity for patients and for clinician raters, and if it fails, why. This would allow us to explore the above question.
1. We should systematically record blinding integrity for patients and for clinician raters, and if it fails, why. This would allow us to explore the above question.
If blinding fails in active arms in RCTs w/ larger drug-placebo separation, that might be OK, as an effective treatment might unblinds patients/raters. BUT, if blinding failure in placebo arms drives the difference (maybe through 'disappointment'/'know'-cebo/'lessebo') then that would be a concern.
March 12, 2025 at 5:00 PM
If blinding fails in active arms in RCTs w/ larger drug-placebo separation, that might be OK, as an effective treatment might unblinds patients/raters. BUT, if blinding failure in placebo arms drives the difference (maybe through 'disappointment'/'know'-cebo/'lessebo') then that would be a concern.
Our recent work shows blinding integrity is rarely measured in psychiatric RCT's. Yet, signals suggest a potential relationship between functional unblinding and greater drug-placebo separation - perhaps due to lower placebo effect onlinelibrary.wiley.com/doi/full/10.... jaacap.org/article/S089...
The relationship between blinding integrity and medication efficacy in randomised‐controlled trials in patients with anxiety disorders: A systematic review and meta‐analysis
Background Blinding is thought to minimise expectancy effects and biases in double-blind randomised-controlled trials (RCTs). However, whether blinding integrity should be assessed and reported rema...
onlinelibrary.wiley.com
March 12, 2025 at 5:00 PM
Our recent work shows blinding integrity is rarely measured in psychiatric RCT's. Yet, signals suggest a potential relationship between functional unblinding and greater drug-placebo separation - perhaps due to lower placebo effect onlinelibrary.wiley.com/doi/full/10.... jaacap.org/article/S089...
i.e. higher expectations = higher treatment efficacy. Treatment effects are larger in open-label trials compared with the same treatment given double-blind. Despite this, effect of functional unblinding on estimates of efficacy has been little explored, partly due to lack of data
March 12, 2025 at 5:00 PM
i.e. higher expectations = higher treatment efficacy. Treatment effects are larger in open-label trials compared with the same treatment given double-blind. Despite this, effect of functional unblinding on estimates of efficacy has been little explored, partly due to lack of data
'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:
March 12, 2025 at 5:00 PM
'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:
In this narrative review we discuss how expectancy effects and functional unblinding can impact treatment and placebo responses in RCT's treatments in psychiatry.
We finish with recommendations for the field. Here is a summary:
We finish with recommendations for the field. Here is a summary:
March 12, 2025 at 5:00 PM
In this narrative review we discuss how expectancy effects and functional unblinding can impact treatment and placebo responses in RCT's treatments in psychiatry.
We finish with recommendations for the field. Here is a summary:
We finish with recommendations for the field. Here is a summary: