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Advances in Psychiatric Treatment (2006) 12: 268-279
© 2006 The Royal College of Psychiatrists

The evolving randomised controlled trial in mental health: studying complexity and treatment process

Jonathan Green

Jonathan Green is a reader in child and adolescent psychiatry at the University of Manchester and an honorary consultant child psychiatrist for Manchester Children’s Hospitals Trust. His clinical and research interests have focused on disorders of social development and the study of complex treatment interventions in child and adolescent mental health services (CAMHS). He has led cohort studies and four large randomised trials in CAMHS, including most recently the Medical Research Council’s Preschool Autism Communication Trial (PACT) of a new psychosocial intervention for autism. He has a particular interest in the measurement of process in clinical trials and has written on the therapeutic alliance.

As a gold-standard methodology for the testing of the effectiveness of health treatments, the randomised controlled trial (RCT) continues to evolve to meet the challenges of new contexts and areas of medicine. This article reviews two particular evolving features of RCTs that make them increasingly well adapted to testing psychological interventions in mental health. The first is a new confidence that RCTs can be successfully adapted to test the more complex (often psychosocial) health interventions and technologies. The second is an increasing emphasis on using the RCT method to explore many facets of the process of treatment as well as its outcome. These two developments should help the RCT method to come of age in mental health, increase the face validity of the RCT method for practitioners and aid the effective translation of research work into improvements in practice.




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J. Green and G. Dunn
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The British Journal of Psychiatry, May 1, 2008; 192(5): 323 - 325.
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