Missed Opportunities in Clinical Psychology: What About Running Factorial Design Internet Trials and Using Other Outcomes Than Self-Report?

Clinical psychology and in particular research on and implementation of psychological treatments can be regarded as a success story (Hofmann et al., 2012). Many treatment guidelines and recommendations now acknowledge that psychological treatments can serve as adjuncts to pharmacological treatments, and they are also described as standalone and first-line recommended treatments for mild to moderate psychological prob­ lems and diagnoses like major depression and the anxiety disorders. The reason for this is not based on opinion and consensus (which used to be the case in medicine and psychiatry 100 years ago), but increasingly well conducted research studies inform health care and the practice of clinical psychology. Not only controlled intervention studies change practice but also research on mechanisms and processes including self-report measures, brain-imaging and tests of information processing, to give a few examples. In particular, when it comes to cognitive-behavioural treatments (CBT), it can rightfully be argued that there is less need for new studies repeating the same finding that getting CBT is often better than not getting it (there might still be a need to study different psy­ chotherapy orientations like psychodynamic psychotherapy). One way to bring interven­ tion research forward is to use factorial designs in order to discern effective components (Watkins & Newbold, 2020). As I will return to it has not been possible to obtain large enough sample sizes in regular clinical research to run factorial design trials but the use of the internet and modern information technology has changed this (Andersson et al., 2019).