Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper proposes a biomedical model to address the personalisation agenda in psychological therapy, arguing that current methods (e.g., RCTs, network meta-analysis, neuroscientific analysis) are inadequate. The authors suggest a tiered approach combining low- (placebo), medium- (CBT), and high-intensity (trauma therapies) interventions, alongside psychosocial treatments/exercise, as a theoretically synergistic solution grounded in placebo studies and neuroplasticity.

But author Overstatement of Current Failures:

The claim that "diverse attempts to resolve the personalisation agenda are failing" overlooks empirical successes. For example:

Algorithmic personalisation: Adaptive CBT platforms (Chekroud et al., 2021) show measurable (albeit modest) gains in engagement and symptom reduction.

The paper should acknowledge these advances while positioning the biomedical model as complementary.

This is a thought-provoking hypothesis paper with potential to stimulate debate, but its claims are occasionally overstated. With revisions to incorporate counterevidence and mechanistic clarity, it could make a stronger contribution to the personalisation literature.

This is a provocative hypothesis paper with potential to stimulate debate, but its claims are occasionally overstated and lack empirical grounding. The biomedical model is a promising but untested framework that would benefit from:

Nuanced engagement with existing personalisation research.

Stronger mechanistic and clinical evidence.

Integration of psychosocial perspectives.

Author Response

Please see the attachment 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article initially presents psychological and biological treatments separately, neglecting to discuss their potential interaction and complementary nature within a theoretical framework. 
Furthermore, in the first section, it incorrectly states that there are 750 million suicides annually; this statistic should be corrected. 
The discussion of poverty and inequality is limited, portraying them primarily as disabilities in psychotherapy, which oversimplifies the complex interplay of biological, psychological, social, and cultural factors contributing to mental disorders. The author also inaccurately claims that psychotherapy has no impact on reducing the prevalence of mental disorders, contradicting research and meta-analyses demonstrating its effectiveness. The critique of RCTs is extreme and lacks balance, failing to acknowledge advancements in trial design. It would be better for the author to point out the advances in trial design and take a more balanced stance.
In the third section, there is again repetitive material about RCTs, which would be better to focus on newer, less biased material and newer approaches.

Author Response

Please see attached file 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Jeremy Seymour's article raises an important and urgent issue in the field of mental health – the personalization of psychological therapy. The author rightly notes that despite numerous studies, it is still not possible to effectively select the appropriate therapy for a particular patient, taking into account his unique characteristics and concomitant disorders.
The biomedical approach proposed by the author, based on the gradation of therapies in intensity and synergy with other treatment methods, looks promising. The idea of combining a "low-intensity" placebo, "medium-intensity" cognitive behavioral techniques, and "high-intensity" trauma-oriented therapies complemented by psychosocial support and exercise may be the key to more effective and personalized treatment.
At the same time, it is important to take into account that the biomedical model is only one of the possible approaches. The importance of psychological factors such as the therapeutic alliance, the motivation of the patient and his social environment cannot be ignored. Further research is needed to confirm the effectiveness of the proposed model and develop practical recommendations for its application. The article raises important questions and stimulates further discussion about the future of personalized psychiatry, but at the same time, I propose to finalize the article taking into account the following theses: 
1. It is necessary to divide the "Biomedical model and its application" into more specific sub-items. This will make the logic of the article clearer. For example: the basic principles of the biomedical model - here you need to explain how this model classifies interventions (low, medium, high intensity) and why it is useful. 
2. The proposed protocol is based on a biomedical model, it is required to detail the combination of methods (placebo, CBT, trauma-based therapy) and the rationale for such a combination. 
3. The supposed advantages of the biomedical model, it is important to emphasize why this model can solve the problem of personalization where other approaches fail.
In my opinion, it is important to add critical issues and potential objections to this model.:
1. Criticism of the biomedical model. What are the potential disadvantages of this approach? For example, could dividing therapy into "intensity" be too simplistic? How to account for individual differences in response to different types of therapy?
2. Ethical considerations of using a placebo. Does the use of placebos for therapeutic purposes raise ethical issues related to patient deception? How can they be solved?
3. Limitations of the study. Specify the limitations of the study, such as the lack of empirical evidence to support the hypothesis. This is, in fact, a theoretical proposal.
Conclusion:
The proposed biomedical model represents a promising, albeit hypothetical, approach to the personalization of psychological therapy. It requires further research and empirical verification, but it can become the basis for the development of more effective and affordable treatments for mental disorders.

Author Response

Please see attached file 

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

This article proposes a biomedical approach to the personalization agenda and presents limitations and advantages. Overall, I consider the article to be well-written and interesting; however, I have some observations.
1. The most relevant causes of the personalization agenda's failure could be mentioned in the introduction.
2. A diagram could be included to highlight the four sections into which the article is divided.
3. What does point 7 in the conclusion refer to regarding many mental disorders? The point of this point is unclear. Please clarify.
4. How many articles on average based on depression support the biomedical model? It would be interesting to explain the obstacles that would arise when generalizing this model to other mental disorders.
Best regards.

Author Response

Please see attached file 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The author has addressed all the requested revisions appropriately. The manuscript has been revised accordingly, and no further issues remain.