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We opened this volume with sobering stories of the dire global challenges before us. Indeed, one would not be hard pressed to find stories of the urgency of our various environmental and social crises. While we wrote this book, the COVID-19 pandemic raged, towns in the Arctic reached unprecedented temperatures, countless hectares of forests fell while fossil fuels continued to be violently extracted from the earth, and Black, Indigenous and people of colour continued to be exploited and oppressed. Yet, despite all this, or rather because of it, we wish to begin our conclusion with hope and determination. Drawing on Solnit (2016), we believe that there is a spaciousness in the uncertainties posed by the challenges before us in that they offer new possibilities for being, thinking and acting – for renewal and purposeful redirection in our trajectory – and it is through a reawakened awareness of our rich and dynamic relationships to place that we can find a better way forward.
It is now well established that humans are the most powerful influence on the environment. The scale, pace and intensity of human activity is fundamentally altering earth’s climate system (IPCC, 2014) and driving global biodiversity and ecosystem decline (IPBES, 2019). Simultaneously, new forms and patterns of mobility are emerging and accelerating in a world driven by globalised market forces, new technologies, media transformations and related cultural trends of late modernity (Stokols, 2018; Boccagni, 2017; Cresswell, 1996). Indeed, during the final stages of preparing this volume we are experiencing a global pandemic of COVID-19 that is reshaping society – from the way we travel to how we relate to one another (see the Preface). While many of the global challenges addressed in this volume are not new, they are accelerating to such a degree that they are challenging our sense of ‘ontological security’ in the world, a concept that has been useful in international relations research, and most recently climate change research, to articulate relationships between identity and security (Farbotko, 2019; Kinnvall, 2004). Our expectations for the stability and continuity of our habitats and lifestyles are increasingly being challenged.
Global challenges ranging from climate change and ecological regime shifts to refugee crises and post-national territorial claims are rapidly moving ecosystem thresholds and altering the social fabric of societies worldwide. This book addresses the vital question of how to navigate the contested forces of stability and change in a world shaped by multiple interconnected global challenges. It proposes that senses of place is a vital concept for supporting individual and social processes for navigating these contested forces and encourages scholars to rethink how to theorise and conceptualise changes in senses of place in the face of global challenges. It also makes the case that our concepts of sense of place need to be revisited, given that our experiences of place are changing. This book is essential reading for those seeking a new understanding of the multiple and shifting experiences of place.
The placebo response in depression clinical trials is a major contributing factor for failure to establish the efficacy of novel and repurposed treatments. However, it is not clear as to what the placebo response in treatment-resistant depression (TRD) patients is or whether it differs across treatment modalities. Our objective was to conduct a systematic review and meta-analysis of the magnitude of the placebo response in TRD patients across different treatment modalities and its possible moderators.
Searches were conducted on MEDLINE and PsychInfo from inception to January 24, 2020. Only studies that recruited TRD patients and randomization to a placebo (or sham) arm in a pharmacotherapy, brain stimulation, or psychotherapy study were included (PROSPERO 2020 CRD42020190465). The primary outcome was the Hedges’ g for the reported depression scale using a random-effects model. Secondary outcomes included moderators assessed via meta-regression and response and remission rate. Heterogeneity was evaluated using the Egger's Test and a funnel plot. Cochrane Risk of Bias Tool was used to estimate risks.
46 studies met our inclusion criteria involving a total of 3083 participants (mean (SD) age: 45.7 (6.2); female: 52.4%). The pooled placebo effect for all modalities was large (N = 3083, g = 1.08 ,95% CI [0.95-1.20)I 2 = 0.1). The placebo effect in studies of specific treatment modalities did not significantly differ: oral medications g = 1.14 (95%CI:0.99-1.29); parenteral medications g = 1.32 (95%CI:0.59-2.04); ayahuasca g = 0.47 (95%CI:-0.28-1.17); rTMS g = 0.93 (95%CI:0.63-1.23); tDCS g = 1.32 (95%CI:0.52-2.11); invasive brain stimulation g = 1.06 (95%CI:0.64-1.47). There were no psychotherapy trials that met our eligibility criteria. Similarly, response and remission rates were comparable across modalities. Heterogeneity was large. Two variables predicted a lager placebo effect: open-label prospective design (B:0.32, 95%CI: 0.05-0.58; p:0.02) and sponsoring by a pharmaceutical or medical device company (B:0.39, 95%CI:0.13-0.65, p:0.004)). No risk of publication bias was found.
The overall placebo effect in TRD studies was large (g = 1.08) and did not differ among treatment modalities. A better understanding of the placebo response in TRD will require: standardizing the definition of TRD, head-to-head comparisons of treatment modalities, an assessment of patient expectations and experiences, and standardized reporting of outcomes.