Beyond random assignment
What do you do as a psychological researcher in a war zone or its aftermath? Hardly anyone has been left unscathed, whether physically or mentally, and immediate psychological interventions and care are needed. Is such an intense setting really the place for scientific psychological research?
As psychology students, in university, whether at the Undergraduate, Masters, or PhD level, we are taught to think scientifically. We are taught to scrutinize tests and measures used in research for their reliability and validity, and to use study designs that will put reliability and validity at as high a level as possible given the circumstances.
In a research context involving the ebb and flow of people, of refugees coming through camps and relocating, of children losing and finding parents, of people receiving news of loved ones’ deaths, it is difficult to set up a well-controlled study environment. Some might argue that research in such situations cannot produce any reliable results, or even that money should not be spent on “science” when humanitarian needs are so dire. But would it really be better to hastily treat people with untested and potentially ineffective treatments? As Jensen notes, “while many clinicians feel that they know what is best for a given patient, a cursory review of the history of medicine should be sufficient to evoke clinical modesty from even the most ardent advocates of any particular program or intervention”. Research can test existing interventions’ effectiveness in order to improve these interventions and can also generate hypotheses for future potentially effective interventions. Scientific research and humanitarian interventions ought to work side by side to optimally help those in need.
However, certain research techniques and study designs that one may have been taught to use in an academic or more controlled clinical setting may not be applicable in such a violent context. For example, the RCT, or randomized controlled trial, is typified as the “gold standard” for clinical trials. This study design, which relies on random assignment to different treatment or intervention conditions (typically including a condition where the participants receive a placebo treatment/intervention), is generally unethical and often impossible to carry out in a situation where all participants are in serious need of treatment. An alternate way of conducting a controlled intervention study is by finding another population, other than the one at risk, to serve as a control group, thus helping to ensure that the results of the intervention being tested are not simply caused by subjects’ maturation or another event. This is, of course, an imperfect solution, since, as Jensen points out, “the investigator chooses where to implement the intervention based not on random factors but on such factors as community characteristics, leadership, attitudes — and it may be these variables that are responsible for the differences in treatment outcomes in the two groups”.
Research in violent settings requires a departure from scientific gold standards and a move towards finding creative solutions. Although some researchers may find it difficult to accept this, particularly those coming directly from an academic setting, the best results will be found when researchers collaborate with those providing services and seek to adapt their designs to the situation at hand, unpredictable though it may often be. This will aid in the development of relevant and critical research questions. Furthermore, it can provide insight into how to develop tests for interventions that appeal to both the humanitarian and the scientific mind, which should never be seen as mutually exclusive and which will ideally work in harmony. In achieving this, open-mindedness and creativity are key.
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Inspired by Peter S. Jensen’s chapter, “Practical Approaches to Research with Children in Violent Settings”, from the book Minefields in their Hearts (editors: Roberta J. Apfel and Bennett Simon)
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