Morita therapy for anxiety disorders in adults

Classified as probably not a substantial claim. May combine two claims.

Continuous data from rating scales were included only if the measuring instrument had been described in a peer-reviewed journal and was self-report or completed by an independent rater or relative.

“We included continuous data from rating scales only if the measuring instrument had been described in a peer-reviewed journal (Marshall 2000), and the instrument was either self report or completed by an independent rater or relative (not the therapist) (Li 2010).”

• cites Marshall 2000 sourceSupported
• cites Li 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Well-designed RCTs remain a gold standard methodology due to their potential for minimising bias.

“well-designed RCTs remain a gold standard methodology due to their potential for minimising bias.”

• cites Andrews 1999 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Overall, participants ranged from 16 to 60 years old, and the mean age was 33 years (SD 8).

“Overall, participants ranged from 16 to 60 years old, and the mean age was 33 years (SD 8).”

May combine two claims.

Only two studies reported data for drop-outs for any reason, and only two provided limited description of adverse effects.

“Only two studies reported data for drop-outs for any reason (primary outcome) (Mei 2000;Shi 2011).Only two studies provided limited description of adverse effects (Lu 2008b;Shi 2005).”

• cites Mei 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Shi 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Lu 2008bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Six studies applied CCMD-3 as the diagnostic instrument, while one used CCMD-2-R.

“Six studies applied CCMD-3 as the diagnostic instrument, while one used the Chinese Classification of Mental Disorder, Second Edition, Revised (CCMD-2-R) (Mei 2000).”

• cites Mei 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Unclear randomisation methods, lack of blinding, and low quality reporting of outcomes were common in the included studies.

“Unclear randomisation methods, lack of blinding and low quality reporting of outcomes were common in the included studies.”

May combine two claims.

All studies were conducted in hospitals in the People's Republic of China between about 1994 and 2007; two recruited outpatients and the remaining recruited inpatients.

“All studies were conducted in hospitals in the People's Republic of China between about 1994 and 2007.Two studies recruited outpatients while the remaining studies recruited inpatients.”

May combine two claims.

All trials were parallel-group RCTs; there were no cluster-randomised trials, cross-over trials or trials with multiple treatment groups.

“There were no cluster-randomised trials, cross-over trials or trials with multiple treatment groups.All trials were parallel-group RCTs.”

May combine two claims.

The mean sample size of included studies was 64, ranging from 36 to 108, and all included studies had small sample sizes.

“The mean sample size of included studies was 64, ranging from 36 to 108.All included studies had small sample sizes.”

May combine two claims.

Only two comparisons were possible: Morita therapy versus pharmacological therapy; and Morita therapy plus pharmacological therapy versus pharmacological therapy.

“Only two comparisons were possible: Morita therapy versus pharmacological therapy; and Morita therapy plus pharmacological therapy versus pharmacological therapy.”

May combine two claims.

In comparison 1, pooled RR of global state was 1.85 (95% CI 1.27 to 2.69; two studies, 75 participants), indicating a significant difference between groups favouring Morita therapy in the short term; NNTB was 3 (95% CI 2 to 5).

“Pooled RR of global state was 1.85 (95% CI 1.27 to 2.69; two studies, 75 participants; Analysis 1.1), indicating a significant difference between groups favouring Morita therapy in the short term.The NNTB was 3 (95% CI 2 to 5).”

May combine two claims.

In comparison 1, data showed no statistically significant difference between groups in the short term in measures of anxiety (MD -0.13, 95% CI -0.54 to 0.28; one study, 39 participants) and depression (MD -0.01, 95% CI -0.37 to 0.35; one study, 39 participants).

“Data showed no statistically significant difference between groups in the short term (overall mean endpoint score of 'Anxiety' and 'Phobic anxiety' in SCL-90, higher scores = poorer response, mean difference (MD) -0.13, 95% CI -0.54 to 0.28; one study, 39 participants; Analysis 1.2).”

• Also stated in: § Measures of depression · plain

  “No significant difference was found between groups in the short term (overall average endpoint score of 'Depression' in SCL-90, higher scores = poorer response, MD -0.01, 95% CI -0.37 to 0.35; one study, 39 participants; Analysis 1.3).”

May combine two claims.

One OCD study reported incomplete data of global state, and the outcome of global state was missing in the other three studies.

“One of the OCD studies reported incomplete data of global state while the outcome of global state was missing in the other three studies.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Information pertaining to drop-outs for adverse effects in the adjunct comparison was unclear.

“Information pertaining to drop-outs for adverse effects was unclear.”

May combine two claims. The quote only partly states this claim.

Seven studies with 449 participants were included in the systematic review, of which six were included in meta-analyses.

“We included seven studies in the systematic review, of which six were included in meta-analyses.”

• Also stated in: § Results of the search · plain

  “We were able to include seven studies, with 449 participants.”

May combine two claims.

All participants were diagnosed with anxiety disorders (social phobia in two studies, OCD in three studies, GAD in one study and anxiety neurosis in one study).

“All participants were diagnosed with anxiety disorders (social phobia in two studies, OCD in three studies, GAD in one study and anxiety neurosis in one study).”

May combine two claims.

Of the four studies of Morita therapy plus pharmacological therapy versus pharmacological therapy alone, three were for OCD (228 participants) and one was for GAD (60 participants).

“Four studies (288 inpatients) investigated the effect of Morita therapy plus pharmacological therapy versus pharmacological therapy alone, three studies for the treatment of obsessive-compulsive disorder (OCD) (228 participants) and one study for generalised anxiety disorder (60 participants).”

May combine two claims.

Most inpatient trials completed the four-phase Morita therapy, while the majority of outpatient trials modified Morita therapy by clinic interviews and home practice afterwards.

“Most inpatient trials completed the four-phase Morita therapy, while the majority of outpatient trials modified Morita therapy by clinic interviews (mostly on a weekly basis) and home practice a erwards.”

Probably not a substantial claim: may not pass S4 (based).

To date, there has been no systematic review to investigate the strength of evidence for Morita therapy in anxiety disorders.

“To date, there has been no systematic review to investigate the strength of evidence for Morita therapy in anxiety disorders.”

• Also stated in: § Why it is important to do this review · plain

  “to date there has been no systematic review to investigate the strength of evidence for Morita therapy in anxiety disorders.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No description of adverse effects was provided in the social phobia comparison.

“Data regarding drop-outs was insufficient and no description of adverse effects was provided.”

May combine two claims.

Five inpatient studies compared Morita therapy plus pharmacological therapy with pharmacological therapy alone; three focused on OCD, one on GAD, and one on anxiety neurosis.

“Five inpatient studies compared Morita therapy plus pharmacological therapy with pharmacological therapy alone (Lu 2008a;Lu 2008b;Mei 2000;Shi 2005;Shi 2011).Three of the studies focused on OCD (Mei 2000;Shi 2005;Shi 2011), one on GAD (Lu 2008b), and one on anxiety neurosis (Lu 2008a).”

• cites Lu 2008aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Lu 2008bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Mei 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The quality of evidence for the social phobia comparison was graded very low, mainly due to high risk of bias in the studies and insufficient information in the results.

“We graded the quality of the evidence for this comparison as very low, mainly due to high risk of bias in the studies and insufficient information in the results.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

There were three short-term trials (up to 12 weeks), three medium-term trials (13 to 52 weeks) and one long-term trial (more than 52 weeks); duration of Morita therapy varied from six weeks to 12 months.

“According to our categories of duration of treatment, there were three short-term trials (up to 12 weeks), three medium-term trials (13 to 52 weeks) and one long-term trial (more than 52 weeks).Duration of Morita therapy varied from six weeks (Lu 2008a) to 12 months (Shi 2011).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Du 2002 was excluded because it was a quasi-randomised trial with allocation by odd or even number of visit order.

“Study type: a quasi-randomised trial, allocation by odd or even number of visit order.Information obtained from personal contact with trialists”

Probably not a substantial claim: may not pass S3 (load-bearing).

Bian 2004 was excluded because the intervention 'Morita therapy' did not meet the inclusion criteria of at least 2 phases.

“Intervention: 'Morita therapy' did not meet the inclusion criteria of at least 2 phases”

Probably not a substantial claim: may not pass S3 (load-bearing).

Aposhyan 1994 was excluded because it was a quasi-randomised trial with participants self-selected to groups.

“Study type: a quasi-randomised trial, participants were self selected to groups”

May combine two claims.

In comparison 2, overall mean endpoint Y-BOCS from two OCD studies showed Morita therapy plus pharmacotherapy achieved lower scores than pharmacotherapy alone in short term (SMD -0.47, 95% CI -0.78 to -0.15) and medium term (SMD -0.88, 95% CI -1.21 to -0.55; two studies, 159 participants).

“Overall mean endpoint score of Y-BOCS (higher scores = poorer response) from two OCD studies showed Morita therapy plus pharmacotherapy achieved lower scores than pharmacotherapy alone (short term: SMD -0.47, 95% CI -0.78 to -0.15; medium term: SMD -0.88, 95% CI -1.21 to -0.55; two studies, 159 participants) (Analysis 2.5; Analysis 2.6) (Shi 2005;Shi 2011).”

• cites Shi 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Shi 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Yu 1999 was excluded because the comparison was Morita therapy versus other psychotherapy and pharmacological therapy, with no head-to-head comparison.

“Comparison: Morita therapy versus other psychotherapy and pharmacological therapy, no headto-head comparison”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Nie 2008, the short-term overall mean endpoint score for anxiety (SCL-90) was -0.13 (95% CI -0.54 to 0.28) mean difference.

“Nie 2008 19 1.8 (0.7) 20 1.9 (0.6) -0.13[-0.54,0.28]”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Nie 2008, the short-term overall mean endpoint score for depression (SCL-90) was -0.01 (95% CI -0.37 to 0.35) mean difference.

“Nie 2008 19 1.5 (0.6) 20 1.5 (0.5) -0.01[-0.37,0.35]”

Probably not a substantial claim: may not pass S3 (load-bearing).

Li 2012 was excluded because participants were not all diagnosed with anxiety disorders.

“Population: participants were not all diagnosed anxiety disorders”

Classified as probably not a substantial claim.

Deng 2008 was excluded because the comparison was modified Morita therapy vs. traditional Morita therapy vs. traditional Morita therapy + pharmacological therapy, with no non-Morita therapy control group.

“Comparison: modified Morita therapy vs. traditional Morita therapy vs. traditional Morita therapy + pharmacological therapy, no non-Morita therapy control group”

Probably not a substantial claim: may not pass S3 (load-bearing).

Morita therapy is mainly used as an alternative therapy for anxiety disorders in Asian countries such as Japan and China.

“It is mainly used as an alternative therapy for anxiety disorders in Asian countries such as Japan and China.”

• Also stated in: § Description of the intervention · plain

  “Morita therapy is used mainly in Japan and China.”

• cites Wen 2001Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Morita therapy is a systematic psychological therapy for anxiety disorders based on Eastern philosophy, first proposed in 1919.

“Morita therapy, first proposed in 1919, is a systematic psychological therapy for anxiety disorders that is based on eastern philosophy.”

• Also stated in: § Description of the intervention · plain

  “An alternative treatment of anxiety disorders is Morita therapy, founded in 1919 by Shoma Morita (1874 to 1938), which is a systematic psychological therapy based on Eastern philosophy (Kitanishi 1995;Miura 1970;Takeda 1964).”

• cites Kitanishi 1995 sourceNot checked — no full text of the source
• cites Miura 1970 sourceNot checked yet

  Checked before — its earlier verdict is held back until a new check runs.

• cites Takeda 1964 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The review inspected all included studies from clinical perspectives for heterogeneity.

“We inspected all included studies from clinical perspectives for heterogeneity, such as participant resources, intervention methods, etc. (Li 2010).”

• cites Li 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review used a Chi2 test with a P value of 0.10 and the I2 statistic with thresholds for moderate, substantial and considerable heterogeneity.

“We used a Chi 2 test with a P value of 0.10 to assess heterogeneity.We also used the I 2 statistic, which provides an estimate of the percentage of inconsistency thought to be due to chance, with 30% to 60% representing moderate heterogeneity, 50% to 90% substantial heterogeneity and 75% to 100% considerable heterogeneity (Higgins 2011).”

• cites Higgins 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

If more than 40% of data were unaccounted for by 12 weeks or longer, the review did not reproduce or use these data in analyses.

“if more than 40% of data were unaccounted for by 12 weeks or longer we did not reproduce these data or use them in analyses (Li 2010).”

• cites Li 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The quality of reporting in studies was low; there was insufficient information on methods of randomisation, blinding and attrition, and no information on sponsorship, therapist qualifications or treatment fidelity.

“The quality of reporting in studies was low.There was insufficient information on the methods of randomisation and blinding as well as attrition in included studies.Reporting of expected outcomes of interest was of low quality.Additionally, the studies provided no information of sponsorship, therapist qualifications or treatment fidelity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review did not use funnel plots for outcomes because there were fewer than 11 studies and all studies were of similar sizes.

“We did not use funnel plots for outcomes because there were fewer than 11 studies and all studies were of similar sizes.”

May combine two claims.

Any findings from these included studies should be interpreted carefully, since it is very likely to be biased to favour Morita therapy and overestimate the effect.

“Therefore, any findings from these included studies should be interpreted carefully, since it is very likely to be biased to favour Morita therapy and overestimate the effect (Juni 2001).”

• cites Juni 2001 sourceNot checked — no full text of the source

May combine two claims.

All trials were described as 'randomised' but few described the method used; two generated random numbers by computer and assigned by admission order, three authors could not recall the method, and one applied minimisation.

“All trials were described as 'randomised' but few described the method used.By means of personal contact with first authors, we found out that two studies generated a series of random numbers by computer and assigned numbers to participants according to admission order (Mei 2000;Shi 2005).Three authors could not recall which allocation method they had used (Lu 2008a;Lu 2008b;Zhang 2003).One study”

• cites Mei 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Shi 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Shi 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review presented skewed, incomplete and non-quantitative data descriptively in narrative forms and did not include them in meta-analyses.

“We presented skewed data, incomplete data and non-quantitative data descriptively in narrative forms and did not include them in meta-analyses (Li 2010).”

• cites Li 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Two review authors independently assessed risk of bias using the Cochrane 'Risk of bias' tool.

“Two review authors (CL and HW) independently assessed risk of bias using the 'Risk of bias' tool described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).”

• cites Higgins 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Two authors independently selected studies and extracted data.

“Two authors independently selected studies and extracted data.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review employed a fixed-effect model to calculate RR for dichotomous outcomes and SMD for continuous outcomes, and would have used a random-effects model if heterogeneity of intervention effects existed (I2 >= 50%).

“We employed a fixed-effect model to calculate RR for dichotomous outcomes and SMD for continuous outcomes for analyses; if heterogeneity of intervention effects existed during clinical inspection or statistical calculation (I 2 ≥ 50%) (Higgins 2011), we would have used a random-effects model.”

• cites Higgins 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review searched multiple databases including CCDANCTR, Dissertation Abstracts International, and four main Chinese medical databases, with no date or language restrictions, and contacted experts for supplemental data.

“We applied no date or language restrictions.We contacted experts in the field for supplemental data.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The assessment of the quality of the body of evidence followed the GRADE system.

“The assessment of the quality of the body of evidence followed the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, which combines consideration of risk of bias, directness, heterogeneity, precision and publication bias (GRADE Working Group 2004;Guyatt 2008a;Guyatt 2008b;Schünemann 2006).”

• cites GRADE Working Group 2004 sourceNot checked — no full text of the source
• cites Guyatt 2008aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Guyatt 2008bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review planned to perform sensitivity analyses but did not conduct them because there were insufficient data.

“We planned to perform sensitivity analyses to investigate the effect of decisions made in the review process.However, there were insufficient data included in the review, so we did not conduct sensitivity analyses.”

May combine two claims.

One trial gave insufficient information on randomisation and allocated twice the number of participants to the experimental group than the control group (Zhang 2003; 36 participants), raising doubts about implementation of randomisation.

“We also found that one trial gave insufficient information on randomisation and allocated twice the number of participants to the experimental group than the control group (Zhang 2003;36 participants).This raises doubts as to their implementation of randomisation.”

• cites Zhang 2003Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Quality of life and functioning measures require a long period of clinic visits, which make a study very difficult to perform with low drop-outs.

“Quality of life and functioning measures require a long period of clinic visits, which make a study very difficult to perform with low drop-outs.”

May combine two claims.

In Shi 2005, there was clear evidence of selective reporting bias because the study did not report on all outcomes of interest and did not report on all outcomes listed in the Method.

“The study did not report on all of the outcomes of interest that we considered to be expected outcomes.It did not report on all outcomes listed in the 'Method' and so there was clear evidence of selective reporting bias”

May combine two claims.

The review set broad inclusion criteria (the intervention had to include two or more phases of Morita therapy instead of all four phases) in order to retrieve as many relevant trials as possible; this approach might have introduced heterogeneity or omitted other usable data on efficacy.

“We set what we believed to be broad inclusion criteria (the intervention had to include two or more phases of Morita therapy instead of all four phases) in order to retrieve as many relevant trials as possible.However, this approach might have introduced heterogeneity or omitted other usable data on efficacy.”

May combine two claims.

None of the studies described adequate sequence generation and allocation concealment; some first authors could not recall randomisation methods, suggesting a lack of scientific rigor.

“None of the studies described adequate sequence generation and allocation concealment.Some first authors that we contacted were not able to recall randomisation methods, which suggests a lack of scientific rigor in their randomisation procedures.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Shi 2005, random sequence generation was at low risk of bias because random numbers were generated by computer and assigned to participants according to admission order.

“Low risk Randomised.Random numbers were generated by computer and assigned to participants according to admission order”

Probably not a substantial claim: may not pass S2 (checkable).

It was possible that there was 'marked interest' towards favourability of Morita treatment by the trialists conducting the studies.

“Therefore, it was possible that there was 'marked interest' towards favourability of Morita treatment by the trialists conducting the studies.”

Classified as probably not a substantial claim.

The authors of the included studies reported outcomes focusing on evaluation of anxiety elimination/symptom reduction, which misinterpreted the goals of Morita therapy.

“The authors of the included studies reported outcomes focusing on evaluation of anxiety elimination/symptom reduction, which misinterpreted the goals of Morita therapy.”

May combine two claims.

In comparison 2, acceptability was good in both groups and there was no significant difference, suggesting the possibility that Morita therapy could be as well tolerated as pharmacological therapy, though the result was limited to Chinese people with OCD.

“Acceptability was good in both groups; there was no significant difference between groups, which suggests the possibility that Morita therapy could be as well tolerated as pharmacological therapy (though the result was limited to Chinese people with OCD).”

May combine two claims.

The review made no conclusions from comparison 1 because evidence was judged very low quality due to small sample size, imprecise results and high risk of bias.

“However, we judged evidence from this comparison to be of very low quality due to small sample size, imprecise results and high risk of bias.Therefore, we made no conclusions.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Allocation concealment is a fundamental part of any trial methodology.

“Allocation concealment is a fundamental part of any trial methodology.”

Classified as probably not a substantial claim.

The present review revealed the need for more high-quality studies in this area.

“The present review revealed the need for more high-quality studies in this area.”

May combine two claims.

Treatment fidelity and therapist qualifications are essential to this type of psychotherapy; none of the studies reported providing treatment manuals and credentials of therapists, which brought doubts about the implementation of the technique.

“Treatment fidelity and therapist qualifications are essential to this type of psychotherapy.However, none of the studies reported providing treatment manuals and credentials of therapists, which brought doubts about the implementation of the technique.”

• AssumptionRests on an assumption: Treatment fidelity and therapist qualifications are essential to this type of psychotherapy.

Probably not a substantial claim: may not pass S3 (load-bearing).

In Shi 2011, incomplete outcome data was at unclear risk of bias because data of 2 drop-outs from the experimental group and 3 from the control group were not taken into the final analysis.

“Unclear risk Data of 2 drop-outs from experimental group and 3 from control group were not taken into the final analysis”

May combine two claims.

All included studies were published reports, and the review did not find any unpublished data and references; thus, publication bias cannot be excluded.

“All included studies were published reports, and we did not find any unpublished data and references.Thus, we cannot exclude publication bias.”

Classified as probably not a substantial claim. May combine two claims.

The review set the primary outcomes to be global state (clinical response) and acceptability (drop-outs for any reason) in order to focus on clinical performance and to enable retrieval of usable data from current studies; however, these measurements are not wholly aligned with the goals of Morita therapy and might not represent the most appropriate way to measure its effectiveness.

“We set the primary outcomes to be global state (clinical response) and acceptability (drop-outs for any reason) in order to focus on clinical performance and to enable us to retrieve usable data from current studies.However, these measurements are not wholly aligned with the goals of Morita therapy and so might not represent the most appropriate way to measure its effectiveness.”

May combine two claims.

In comparison 2, data on secondary outcomes showed Morita therapy plus pharmacological therapy was more effective at alleviating symptoms of anxiety, depression, obsession and compulsion in people with OCD than pharmacological therapy alone in the short-to-medium term, but evidence was limited and of very low quality, so no conclusions were made.

“Data on the secondary outcomes showed that Morita therapy plus pharmacological therapy was more effective at alleviating symptoms of anxiety, depression, obsession and compulsion in people with OCD than pharmacological therapy alone in the short-to-medium term.However, the evidence was limited and of very low quality; therefore, we made no conclusions.”

May combine two claims.

The review found extremely large effect sizes in both comparisons, which deviated dramatically from expected outcomes of well-conducted trials of psychological therapies compared head-to-head with pharmacotherapies and add-on treatments.

“We found extremely large effect sizes in both comparisons, which deviated dramatically from expected outcomes of well-conducted trials of psychological therapies compared head-to-head with pharmacotherapies and also add-on treatments (Roshanaei-Moghaddam 2011).”

• cites Roshanaei-Moghaddam 2011 sourceNot checked — no full text of the source

May combine two claims.

In Zhang 2003, blinding of participants and personnel was at high risk of bias because the study was single-blinded and because of the nature of Morita therapy as a psychological therapy.

“High risk Single, no further description; likely to be high risk of bias because of the nature of Morita therapy as a psychological therapy”

Probably not a substantial claim: may not pass S2 (checkable).

Well-designed RCTs on Morita therapy are challenging to conduct because of the nature, goals and methods of the therapy.

“Well-designed RCTs on Morita therapy are challenging to conduct because of the nature, goals and methods of the therapy.”

May combine two claims.

The data reported in this review were inconclusive and the efficacy of Morita therapy for anxiety disorders remains unclear.

“The data reported in this review were inconclusive and the efficacy of Morita therapy for anxiety disorders remains unclear.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Double-blind assessment of the outcomes of a psychological therapy is extremely difficult.

“Double-blind assessment of the outcomes of a psychological therapy is extremely difficult.”

May combine two claims.

In Nie 2008, there was clear evidence of selective reporting bias because the study did not report on all outcomes of interest and did not report on all outcomes listed in the Method.

“The study did not report on all of the outcomes of interest that we considered to be expected outcomes.It did not report on all outcomes listed in the 'Method' and so there was clear evidence of selective reporting bias”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Expanding criteria (such as including quasi-RCTs, anxiety disorders as secondary diagnosis, any phases of Morita therapy) is very likely to weaken the quality of evidence further, increase heterogeneity and raise uncertainty of Morita therapy implementation.

“Expanding criteria (such as including quasi-RCTs, anxiety disorders as secondary diagnosis, any phases of Morita therapy) is very likely to weaken the quality of evidence further, increase heterogeneity (both clinically and statistically) and raise uncertainty of Morita therapy implementation.”