Allegiance bias

Allegiance bias (or allegiance effect) in behavioral sciences, denote to the finding or conclusions being crafted in a manner that reconciles best with the investigator's or researcher's perspectives and preferences, instead of retaining its empirical, innate or native state.[1]

A majority of the published meta-analyses and randomized controlled trials (RCTs) of psychotherapeutic treatments (and sometimes, even with the adversarial legal settings) seldom report and evaluate the allegiance effect. The results highlight a major lack of this information in their included studies, though meta-analysis perform slightly better than RCTs. Therefore, stringent guidelines have been adopted by journals in order to improve reporting and attenuate possible effects of researcher allegiance (RA) in future research.[2]

Evaluation

Allegiance is an essential topic and—bias or not—related researchers seem at least to agree that it should be taken into account effectively. Several sources of allegiance have been provided in order to clarify how allegiance could affect the outcome in RCTs.[3]

Despite the fact that researchers find the outcomes of psychological evaluations to be influenced from allegiance from a specific school of thought, the role of allegiance in the research field should be evaluated cautiously. Several meta-analyses have shown contradictory results between experimenter’s allegiance (EA) and assessment effect sizes in favor of the preferred conclusions.[4]

Psychotherapy

Researcher allegiance is widely discussed as a potential factor that influences a researcher's actions and the reporting of results in the conducted studies. However, information on the reporting of allegiance in published meta-analysis has not yet been systematically estimated and so, the criterion of selecting eligible meta-analysis based on a journal's impact factor are being considered with caution.[2]

Furthermore, the nature of psychotherapy, in contradiction to pharmacotherapy, is very difficult to study. Methodological weakness such as wait-list control groups, single group designs, small samples and subjective measurement of clinical improvement may allow RA to interfere. Along with the fact that in the field of psychotherapy, double-blind studies cannot be applied, RA may influence a researcher's actions and its reporting in the conducted studies[2] and this type of allegiance bias is not easily detectable either. Recently, a new mechanism has suggested that the RA effect may occur partly whenever researchers select biased therapists in study designs to begin with.[5]

Also, we should not include meta-analysis that examines a combination of psychotherapy and non-psychotherapy treatments (e.g., medication) if it was directly compared with another type of psychotherapy or meta-analysis evaluating direct comparisons between different types of psychotherapy. Meta-analysis assessing non-verbal techniques, web-based treatments and non-specific or miscellaneous treatments (e.g., yoga, dietary advice, recreation, biofeedback, etc.) should also be excluded.[4]

Forensic psychology

Most often forensic experts indulge in having formed a biased opinion of the assessment in favor of the party retaining their services as opposed to having it objective by means of the evidence available.[6]

A survey of 206 forensic psychologists tested the "filtering" effects of preexisting expert attitudes in adversarial proceedings. Results confirmed the hypothesis that evaluator attitudes toward capital punishment influence willingness to accept capital case referrals from particular adversarial parties. Stronger death-penalty opposition was associated with higher willingness to conduct evaluations for the defense and higher likelihood of rejecting referrals from all sources. Conversely, stronger support was associated with higher willingness to be involved in capital cases generally, regardless of referral source. The findings raise the specter of skewed evaluator involvement in capital evaluations, where evaluators willing to do capital casework may have stronger capital punishment support than evaluators who opt out, and evaluators with strong opposition may work selectively for the defense. The results may provide a partial explanation for the “allegiance effect” in adversarial legal settings such that preexisting attitudes may contribute to partisan participation through a self-selection process.[7] The law, and the various professions in which these experts are trained, generally presume that these experts will be impartial, participating as an objective expert by interpreting data on its own strength, rather than in a biased manner reflecting which side hired them.

However, a growing body of research demonstrates the biasing effects of the adversarial legal system on experts. Most of these studies are field studies that show evidence of forensic expert partiality in patterns of data from actual cases, but they cannot explain the reason for that partiality because they are not true experiments.[8][9]

Evaluations in Capital Cases

Capital punishment is one of the most fiercely debated issues in American society. It is a powerful legal, ethical, and moral issue about which many people have strongly held opinions. In capital cases, mental health practitioners may be asked to evaluate a defendant’s mental health to help the court adjudicate the case. Thus, it is possible that in capital case evaluations, examiner's attitudes toward capital punishment might influence their willingness to become involved or the specific ways in which they would become involved in the adversarial process.

The strength of an evaluator’s opinions toward the death penalty may influence whether and how clinicians become involved in capital case work. For instance, evaluators who strongly oppose the death penalty report being significantly less likely to accept a Competency for Execution (CFE) referral.[10][11]

Analysis

Very often RA is used as a moderator variable to look at differences between studies. Information on allegiance is not typically reported by the term ‘allegiance’ in original reports. Moreover, the definition of allegiance differs from study to study. Even if some authors of meta-analysis are familiar with this factor and are willing to investigate RA effects, they have to rely on non-standardised measuring methods like reprint analysis (i.e., analysis of the publication for the presence of attributes that may hint at allegiance) based on the limited information available in the published articles.[12]

The investigators of RCTs should have to report their methods (ex., outcome of interest or data analytical methods) before implementation of a clinical trial. Furthermore, the researchers should control for RA by balancing it, at least, when two different psychological aspects are compared in a clinical trial. They should also employ another set of researchers to make interpretations of the findings and perhaps, by this method of selecting blind assessors, the RA effects could be minimised. It is important for the behavioral sciences field to offer the best reliable guide to policy makers, clinicians and readers, endeavoring to evaluate the relative costs and benefits of choosing a particular therapy over others.[2]

Sensitivity

The analysis on direct comparisons did not address the quality of studies and neither did it have any significant association between allegiant and non-allegiant studies; whereas significant differences were observed in cases where treatment integrity was not evaluated.[13]

Even in psychological research where allegiance effects have been discussed and conceptualized very early, there is a lack of sensitivity for such potential biases. It was found that the RA was coded and analysed in a trivial number of meta-analysis. A plausible explanation is that the state of RA is still debatable in terms of possible bias and, although it may be universal in practice settings, its nature effects vary considerably in the literature.[14] It is a fact that RA stretches back to the famous Dodo verdict and also challenges in terms of a better performance in delivery of treatment.[15][16]

In legal cases, evaluator attitudes and other attributes may systematically influence from whom evaluators are willing to accept a referral. Filtering and selection effects in adversarial settings have been assumed to exist, but with few empirical tests of the hypothesis to date.[17][18] Current studies demonstrate that these experts have preexisting biases that may affect for whom they are willing to work in the adversarial system–thus, likely amplifying the effects of the system-induced biases when layered with preexisting expert biases.

Rating

In case that a review author included at least one own primary study (which he or she coauthored) into the review, these primary studies need to be retrieved and rated over researcher allegiance according to information presented in the primary study (note that a rating of researcher allegiance would not be possible in the reviews if the said reviews do not provide essential information to rate researcher allegiance according to established standards).[19]

Researcher allegiance is defined to be present if the author -

  1. Recommends the respective psychological therapy over another therapy
  2. Involved in the development of the respective psychological therapy
  3. Involved in research/development of the aetiological model of the psychological therapy.

Two independent researchers need to assess allegiance in the primary studies and disagreements are to be resolved with a third rater. If researcher allegiance was rated to be present in at least one of the primary studies included in a review, then the review were rated as afflicted by researcher allegiance.[20]

Remedies

Objective methods

Disclosures

Reporting policies

Systematic reviews and meta-analysis are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.[23]

QUOROM

Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analysis. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported.[24]

PRISMA

Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analysis) as an evolution of the original QUOROM guideline for systematic reviews and meta-analysis of evaluations of health care interventions.[25][26]

The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, they have explained the meaning and rationale for each checklist item & have include an example of good reporting, while also where possible, references to relevant empirical studies and methodological literature.[27]

Conflict of interest

Conflicts of interest (COI) are defined as a set of circumstances that creates a risk that a professional judgement or action regarding a primary interest will be unduly influenced by a secondary interest.[28][29]

Meta-analysis reflects the potential methodological deficits of the primary studies due to the presence of RA. Thus, meta-analysis could display the same methodological deficits as the primary studies in meta-analysis design, data analysis and interpretation of results because of RA by the authors of the meta-analysis. The developers of some specific psychological treatments may show more interest in the evidence-based practice of their own therapies than in others.[30][31] However, researchers should move forward, following what is accomplished with pharmaceutical industry trials and sponsorship biases.[32][20]

Researcher allegiance, i.e. that researchers concluded favourably about the interventions they have studied, as well as spin, i.e., differences between results and conclusions of the reviews, need to be rated by 2 independent raters. Non-financial COI, especially the inclusion of own primary studies into reviews and researcher allegiance, are frequently seen in systematic reviews of psychological therapies and need more transparency and better management. Primary studies included in these reviews were identified from the reference lists of the systematic reviews and retrieved if one of the coauthors of the review was an author of the respective primary study. These primary studies were then used to rate researcher allegiance.[33]

Assessment

All disclosed COI are to be extracted: financial COI (honoraria, e.g., for consulting, lectures, scientific articles, training courses, or money for research projects), non-financial COI (e.g., researcher allegiance to a psychological therapy, special qualification in a psychological therapy, enthusiasm for a psychological therapy in scientific publications, lectures and research, or inclusion of own primary studies in reviews) and personal COI (e.g., employee or private relationship to an employee of a company—regularly addressed as relationships to pharmaceutical companies). If no COI was reported, the websites of the respective journals as well as the guidelines for authors were screened for requirements of COI disclosures at the time of the publication of the review. In addition, what needs to be assessed is whether the review authors included their own studies on psychological therapies into the review and if such inclusion was disclosed.[33]

See also

References

  1. ↑ Wilson, G. Terence; Wilfley, Denise E.; Agras, W. Stewart; Bryson, Susan W. (2017-03-31). "Allegiance Bias and Therapist Effects: Results of a Randomized Controlled Trial of Binge Eating Disorder". Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association. 18 (2): 119–125. ISSN 0969-5893. PMC 4118818 Freely accessible. PMID 25089079. doi:10.1111/j.1468-2850.2011.01243.x.
  2. 1 2 3 4 Dragioti, Elena; Dimoliatis, Ioannis; Evangelou, Evangelos (2015-05-30). "Disclosure of researcher allegiance in meta-analyses and randomised controlled trials of psychotherapy: a systematic appraisal". BMJ Open. 5 (6). ISSN 2044-6055. PMC 4458582 Freely accessible. PMID 26033943. doi:10.1136/bmjopen-2014-007206.
  3. ↑ Staines, Graham L.; Cleland, Charles M. "Bias in meta-analytic estimates of the absolute efficacy of psychotherapy.". Review of General Psychology. 11 (4): 329–347. doi:10.1037/1089-2680.11.4.329.
  4. 1 2 Dragioti, Elena; Dimoliatis, Ioannis; Fountoulakis, Konstantinos N.; Evangelou, Evangelos (2015-09-15). "A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy". Annals of General Psychiatry. 14. ISSN 1744-859X. PMC 4570291 Freely accessible. PMID 26379758. doi:10.1186/s12991-015-0063-1.
  5. ↑ Falkenström, Fredrik; Markowitz, John C.; Jonker, Hanske; Philips, Björn; Holmqvist, Rolf (2013-05-01). "Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials". The Journal of Clinical Psychiatry. 74 (5): 482–491. ISSN 1555-2101. PMC 3683365 Freely accessible. PMID 23146326. doi:10.4088/JCP.12r07848.
  6. 1 2 "Identifying and managing potential bias in forensic evaluations". APA Div. 41: American Psychology-Law Society. Retrieved 2017-03-31.
  7. ↑ Neal, Tess M. S. (2016-04-28). "Are Forensic Experts Already Biased before Adversarial Legal Parties Hire Them?". PLoS ONE. 11 (4). ISSN 1932-6203. PMC 4849669 Freely accessible. PMID 27124416. doi:10.1371/journal.pone.0154434.
  8. ↑ DeMatteo, David; Edens, John F.; Galloway, Meghann; Cox, Jennifer; Smith, Shannon Toney; Formon, Dana (2014-06-01). "The role and reliability of the Psychopathy Checklist-Revised in U.S. sexually violent predator evaluations: a case law survey". Law and Human Behavior. 38 (3): 248–255. ISSN 1573-661X. PMID 24127888. doi:10.1037/lhb0000059.
  9. ↑ DeMatteo, David; Edens, John F.; Galloway, Meghann; Cox, Jennifer; Smith, Shannon Toney; Formon, Dana. "The role and reliability of the Psychopathy Checklist—Revised in U.S. sexually violent predator evaluations: A case law survey.". Law and Human Behavior. 38 (3): 248–255. doi:10.1037/lhb0000059.
  10. ↑ BA, Gianni Pirelli; PhD, Patricia A. Zapf (2008-04-16). "An Investigation of Psychologists' Practices and Attitudes toward Participation in Capital Evaluations". Journal of Forensic Psychology Practice. 8 (1): 39–66. ISSN 1522-8932. doi:10.1080/15228930801947294.
  11. ↑ Deitchman, Mary Ann; Kennedy, Wallace A.; Beckham, Jean C. (1991-06-01). "Self-selection factors in the participation of mental health professionals in competency for execution evaluations". Law and Human Behavior. 15 (3): 287–303. ISSN 0147-7307. PMID 11654262.
  12. ↑ Leykin, Yan; DeRubeis, Robert J. (2009-03-01). "Allegiance in Psychotherapy Outcome Research: Separating Association From Bias". Clinical Psychology: Science and Practice. 16 (1): 54–65. ISSN 1468-2850. doi:10.1111/j.1468-2850.2009.01143.x.
  13. ↑ Weisz, John R.; Jensen-Doss, Amanda; Hawley, Kristin M. "Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons.". American Psychologist. 61 (7): 671–689. doi:10.1037/0003-066x.61.7.671.
  14. ↑ Wampold, Bruce E.; Budge, Stephanie L.; Laska, Kevin M.; Del Re, A. C.; Baardseth, Timothy P.; Fluckiger, Christoph; Minami, Takuya; Kivlighan, D. Martin; Gunn, Wade (2011-12-01). "Evidence-based treatments for depression and anxiety versus treatment-as-usual: a meta-analysis of direct comparisons". Clinical Psychology Review. 31 (8): 1304–1312. ISSN 1873-7811. PMID 21996291. doi:10.1016/j.cpr.2011.07.012.
  15. ↑ Munder, Thomas; Gerger, Heike; Trelle, Sven; Barth, Jürgen (2011-11-01). "Testing the allegiance bias hypothesis: A meta-analysis". Psychotherapy Research. 21 (6): 670–684. ISSN 1050-3307. PMID 21797736. doi:10.1080/10503307.2011.602752.
  16. ↑ Munder, Thomas; Gerger, Heike; Trelle, Sven; Barth, Jürgen (2011-11-01). "Testing the allegiance bias hypothesis: a meta-analysis". Psychotherapy Research: Journal of the Society for Psychotherapy Research. 21 (6): 670–684. ISSN 1468-4381. PMID 21797736. doi:10.1080/10503307.2011.602752.
  17. ↑ Murrie, Daniel C.; Boccaccini, Marcus T.; Guarnera, Lucy A.; Rufino, Katrina A. (2013-10-01). "Are forensic experts biased by the side that retained them?". Psychological Science. 24 (10): 1889–1897. ISSN 1467-9280. PMID 23969777. doi:10.1177/0956797613481812.
  18. ↑ Murrie, Daniel C.; Boccaccini, Marcus T.; Guarnera, Lucy A.; Rufino, Katrina A. (2013-08-22). "Are Forensic Experts Biased by the Side That Retained Them?". Psychological Science. 24 (10): 1889–1897. doi:10.1177/0956797613481812.
  19. ↑ Gaffan, E. A.; Tsaousis, I.; Kemp-Wheeler, S. M. (1995-12-01). "Researcher allegiance and meta-analysis: the case of cognitive therapy for depression". Journal of Consulting and Clinical Psychology. 63 (6): 966–980. ISSN 0022-006X. PMID 8543719.
  20. 1 2 Roseman, Michelle (2011-03-09). "Reporting of Conflicts of Interest in Meta-analyses of Trials of Pharmacological Treatments". JAMA. 305 (10). ISSN 0098-7484. doi:10.1001/jama.2011.257.
  21. ↑ Robinson, L. A.; Berman, J. S.; Neimeyer, R. A. (1990-07-01). "Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research". Psychological Bulletin. 108 (1): 30–49. ISSN 0033-2909. PMID 2200072.
  22. ↑ Imel, Zac E.; Wampold, Bruce E.; Miller, Scott D.; Fleming, Reg R. (2008-12-01). "Distinctions without a difference: direct comparisons of psychotherapies for alcohol use disorders". Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors. 22 (4): 533–543. ISSN 0893-164X. PMID 19071978. doi:10.1037/a0013171.
  23. ↑ Moher, David; Tetzlaff, Jennifer; Tricco, Andrea C.; Sampson, Margaret; Altman, Douglas G. (2007-03-27). "Epidemiology and reporting characteristics of systematic reviews". PLoS medicine. 4 (3): e78. ISSN 1549-1676. PMC 1831728 Freely accessible. PMID 17388659. doi:10.1371/journal.pmed.0040078.
  24. ↑ Moher, D.; Cook, D. J.; Eastwood, S.; Olkin, I.; Rennie, D.; Stroup, D. F. (1999-11-27). "Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses". Lancet. 354 (9193): 1896–1900. ISSN 0140-6736. PMID 10584742.
  25. ↑ Wen, Jin; Ren, Yu; Wang, Li; Li, Youping; Liu, Ya; Zhou, Min; Liu, Ping; Ye, Lu; Li, Yi (2008-08-01). "The reporting quality of meta-analyses improves: a random sampling study". Journal of Clinical Epidemiology. 61 (8): 770–775. ISSN 0895-4356. PMID 18411041. doi:10.1016/j.jclinepi.2007.10.008.
  26. ↑ "The reporting quality of meta-analyses improves: a random sampling study". Journal of Clinical Epidemiology.
  27. ↑ Liberati, Alessandro; Altman, Douglas G; Tetzlaff, Jennifer; Mulrow, Cynthia; Gøtzsche, Peter C; Ioannidis, John P A; Clarke, Mike; Devereaux, P J; Kleijnen, Jos (2009-07-21). "The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration". The BMJ. 339. ISSN 0959-8138. PMC 2714672 Freely accessible. PMID 19622552. doi:10.1136/bmj.b2700.
  28. ↑ Thompson, Dennis F. (2009-01-01). "The challenge of conflict of interest in medicine". Zeitschrift Fur Evidenz, Fortbildung Und Qualitat Im Gesundheitswesen. 103 (3): 136–140. ISSN 1865-9217. PMID 19554887.
  29. ↑ Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice (2009-01-01). Lo, Bernard; Field, Marilyn J., eds. Conflict of Interest in Medical Research, Education, and Practice. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC): National Academies Press (US). ISBN 9780309131889. PMID 20662118.
  30. ↑ Maj, Mario (2008-08-01). "Non-financial conflicts of interests in psychiatric research and practice". The British Journal of Psychiatry: The Journal of Mental Science. 193 (2): 91–92. ISSN 0007-1250. PMID 18669986. doi:10.1192/bjp.bp.108.049361.
  31. ↑ Maj, Mario (2008-08-01). "Non-financial conflicts of interests in psychiatric research and practice". The British Journal of Psychiatry. 193 (2): 91–92. ISSN 0007-1250. PMID 18669986. doi:10.1192/bjp.bp.108.049361.
  32. ↑ Roseman, Michelle; Milette, Katherine; Bero, Lisa A.; Coyne, James C.; Lexchin, Joel; Turner, Erick H.; Thombs, Brett D. (2011-03-09). "Reporting of conflicts of interest in meta-analyses of trials of pharmacological treatments". JAMA. 305 (10): 1008–1017. ISSN 1538-3598. PMID 21386079. doi:10.1001/jama.2011.257.
  33. 1 2 Lieb, Klaus; von der Osten-Sacken, Jan; Stoffers-Winterling, Jutta; Reiss, Neele; Barth, Jürgen (2016-04-26). "Conflicts of interest and spin in reviews of psychological therapies: a systematic review". BMJ Open. 6 (4). ISSN 2044-6055. PMC 4853969 Freely accessible. PMID 27118287. doi:10.1136/bmjopen-2015-010606.
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