Even when problems like these are insurmountable though, that doesn't make results from trials like these any more reliable than they would be is the same trial design had been used for homeopathy/pharmaceuticals, etc.
If I was to put it all into the RoB 2 calculator it would probably come up with "Some risk of bias", so moderate most likely. Then a judgement call - it's about as rigorous as a study could be on this topic - to say that it's probably moderate-low
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re cognitive aspects. eg:That participants knew they were being encouraged to adopt cognitive strategies emphasising a sense of control, etc, make it difficult to judge that lack of blinding was unlikely to have on influence on self-reports on how IBS interferes with their life.
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For 4.5 of RoB 2 they give "patient-reported symptoms in trials of homeopathy" as an example of an outcome where knowledge of intervention received would be likely to influence assessment of outcome. Why do you think this would be less of an issue with CBT?
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