Intent-to-fail treatments

Westen et al. (2004, p. 651) on “intent-fo-fail” conditions in randomised controlled trials comparing two interventions with each other:

‘Researchers should also exercise caution in labeling control treatments not constructed to maximize their efficacy ([…] what might be called intent-to-fail conditions) with brand names that are readily confused with genuine treatments and create sleeper effects in the literature. For example […] to test the efficacy of CBT for bulimia, Garner et al. (1993) developed a treatment they called supportive– expressive therapy, an abbreviated treatment described as nondirective and psychodynamically inspired, in which clinicians were forbidden to discuss the target symptoms with the patient and were instead instructed to reflect them back to the patient. Such a practice is not in fact characteristic of psychodynamic therapies for eating disorders (e.g., Bruch, 1973) and is analogous to a researcher creating a cognitive therapy comparison condition in which the therapist is instructed to say, β€œThat’s irrational,” every time a patient tries to discuss the symptom.’


Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The Empirical Status of Empirically Supported Psychotherapies: Assumptions, Findings, and Reporting in Controlled Clinical Trials. Psychological Bulletin, 130(4), 631–663.