Is the allegiance effect an epiphenomenon of true efficacy differences between treatments? A meta-analysis.

Munder, Thomas; Flückiger, Christoph; Gerger, Heike; Wampold, Bruce E.; Barth, Jürgen

doi:10.1037/a0029571

Cited by 79Psychotherapy Techniques and ApplicationsMeta-analysis and systematic reviewsPosttraumatic Stress Disorder Research

Is the allegiance effect an epiphenomenon of true efficacy differences between treatments? A meta-analysis.

Munder, Thomas, Flückiger, Christoph, Gerger, Heike, Wampold, Bruce E., Barth, Jürgen·2012·Journal of Counseling Psychology

DOI 10.1037/a0029571

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Abstract

Many meta-analyses of comparative outcome studies found a substantial association of researcher allegiance (RA) and relative treatment effects. Therefore, RA is regarded as a biasing factor in comparative outcome research (RA bias hypothesis). However, the RA bias hypothesis has been criticized as causality might be reversed. That is, RA might be a reflection of true efficacy differences between treatments (true efficacy hypothesis). Consequently, the RA-outcome association would not be indicative of bias but an epiphenomenon of true efficacy differences. This meta-analysis tested the validity of the true efficacy hypothesis. This was done by controlling the RA-outcome association for true efficacy differences by restricting analysis to direct comparisons of treatments with equivalent efficacy. We included direct comparisons of different versions of trauma-focused therapy (TFT) in the treatment of posttraumatic stress disorder (PTSD). RA was measured from the research reports. Relative effect sizes for symptoms of PTSD were calculated. Random effects meta-regression was conducted. Twenty-nine comparisons of TFTs from 20 studies were identified. Initial heterogeneity among relative effect sizes was low. RA was a significant predictor of outcome and explained 12% of the variance in outcomes. The true efficacy hypothesis predicted the RA-outcome association to be zero; however, a substantial association was found. Thus, this study does not support the true efficacy hypothesis. Given findings from psychotherapy research and other fields that support a biasing influence of researcher preferences, RA should be regarded as a causal factor and conceptualized as a threat to the validity of conclusions from comparative outcome studies.

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Authors: Munder, T., Flückiger, C., Gerger, H., Wampold, B. E., & Barth, J.
Affiliations: University of Zurich (CH)
University of Bern (CH)
University of Wisconsin–Madison (US)
ORCID: Flückiger, Christoph
Gerger, Heike
Wampold, Bruce E.
Barth, Jürgen
Venue: Journal of Counseling Psychology
Publisher: American Psychological Association (APA)
Published: 2012
Volume: 59
Issue: 4
Pages: 631-637
ISSN: 0022-0167 (ISSN-L)
1939-2168
DOI: 10.1037/a0029571
OpenAlex: W2032387399
Cited by: 79
References: 46
Citations by year: 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 2 · 2020: 7 · 2019: 11 · 2018: 6 · 2017: 5 · 2016: 11 · 2015: 8 · 2014: 6 · 2013: 6
FWCI: 7.24
Type: journal article
Language: en
Open access: closed
Locations: Journal of Counseling Psychology (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Bern Open Repository and Information System (University of Bern) (submittedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Funders: Swiss National Science Foundation (105314-118312/1)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords: relative treatment effect, post-traumatic stress disorder, trauma-focused psychotherapy
MeSH terms: Humans, Interprofessional Relations, Psychotherapy, Regression Analysis, Research Personnel, Stress Disorders, Post-Traumatic, Bias, Causality, Randomized Controlled Trials as Topic, Comparative Effectiveness Research

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Is the allegiance effect an epiphenomenon of true efficacy differences between treatments? A meta-analysis.

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