Empirical research must rely on simulations of naturalistic, real-life circumstances. The trustworthiness of empirical research relies on a prevailing assumption that evidence-based research results are good as gold, hence the term gold standard. However, of recent, this gold standard assumption has come under intense scrutiny from researchers.
Ioannidis (2005) stated “there is increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims” (pg. 0696). In fact, the trustworthiness and validity of research findings rests on certain assumptions; that prior research was accurate, and that the statistical power of the study, and level of statistical significance are valid (Calhoun et al., 2003; Ioannidis, 2003, 2014 & 2016).
This concern should not come as much of a surprise. The idea of false research findings in empirical studies have been repeatedly substantiated (Wachholder et al 2004 & Risch, 2000). To this point research bias has become an even greater concern and comes in many forms. For instance, there may be manipulation of collected data during the analysis phase, selective reporting of facts, distorted research results, and of course ‘reverse bias’ in which researchers use data inefficiently, or worse, fail to notice statistically significance relationships.
This is often the case when there are significant vested interests involved who provide the funding of such research, which often comes with high expectations for specific results (Kelsey et al., 1996). Additionally, there may be conflicts of interest, which necessitate the hiding of significant findings for profit, power, or prestige (Ioannidis, 2005 & Topol, 2004). Researchers argue empirical, evidence-based research should be conducted through organic, every day practice circumstances to ensure research results are applicable to real-life conditions.
To this point the validity of empirical evidence-based clinical research, and especially research through the VHA and DOD, on combat-related trauma, has received little to no scrutiny (Steenkamp et al., 2015; IOM, 2015). Obviously, questioning the results of government funded research can be a risky proposition. Steenkamp (2015) argues “posttraumatic stress in the military and veteran population is a complex and difficult-to-treat disorder” (p. 498). According to Steenkamp (2015) first-line, trauma-focused therapies are not necessarily the optimal treatments for PTSD, based upon their excessively high non-response and dropout rates.
Furthermore Steenkamp (2015) suggests focus on veteran’s treatment preference may improve treatment acceptance rates, while lowering dropout rates. Short-term, group-based treatment programs therapies have already displayed significant efficacy in varying degrees and appear to be popular among military personnel and veterans (Steenkamp, 2015).
It is apparent current first-line behavioral treatments such as CPT and PE, have not performed as anticipated, and in truth have fallen well short of expectations (Sloan et al., 2016; Steenkamp et al., 2015; Najavitis, (2015); & Hoge et al., 2004). To this point the way in which PTSD treatment is delivered, through individual or group-based therapies, must be explored as well (Held et al., 2019; Gutner, Suvak, Sloan, & Resick, 2016).