chapter 17 - 7 - Chpt 17 Treatment of Mental Disorders 88.7...

Info icon This preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
Image of page 1
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Chpt 17 Treatment of Mental Disorders 88.7 blind" RCT study in which both the patients and the doctors and nursing staff are kept in the dark by the experimenters as to which patients are getting the "sugar pill“ and which are getting the “real McCor'. Later, of course. the Improvement of the ”real McCoy" patients are compared with the improvement of the "sugar pill" patients] {Problems in controlling for placebo effects in psychotherapy studies} [Just as with drug studies, it is important to control for placebo effects (again using RCT methodology} in assessing the effectiveness of the various therapies, because a patient's distress might be alleviated by her belief In her therapy. rather than by the therapy itself. However. It Is seldom clearwhat the placebo for a therapy would be. Would we want the placebo group to went: with a therapistwho listens but without warmth? A therapist who expresses warmth. but provides no counsel? A therapist who otters counsel irrelevant to the palient's problems? The choice between these (or other) options is not clear. making this one source of ambiguity In interpreting RCT data for psychotherapy] Manualized Therapy {more problems in controlling for placebo effects in psychotherapy studies} [In drug studies it is easy to see that both the drug group and placebo group get exactly the same treatments except for the critical difference, the active ingredient. But how can we ensure. in a study of therapy, that each patient gets exactly the same treatment—with the same constituents and the same dose? The answer In many cases has been to develop a treatment manual that tells the therapist exactiy how to proceed during the shrdy. But there are wade-offs in doing so: On the positive side. this manualized therapy procedure seems our best hope for learning whether a particular type of treatment works or not. On the negative side. what might, hereby, be learned may have little relevance to the ttrerapy in “real-life" where conditions are not at all controlled and may even be so different as to change the outcome drasticalty from what a "pure" application of the therapy would do.}' Efficacy versus Utility [Despite ambiguities about how to design a ptacebo group when evaluating psychotherapy, and concerns about the use of manualized therapies, RCT_data are nonetheless extremely useful in allowing us to identify certain therapies as “empirically validated." Still, there are legitimate arguments that, although an RGT might Inform us about a therapy’s efficacy (whether It works in carefully designed tests), It may not tell us about its clinical util'g {mother it works In more typical circumstances). Besides the concern over manualized therapy. there are concerns that the patient groups used in many RCT are not well-defined. In addition to the diagnosis under therapy treatment Investigation. the Individuals, selected for-the study because of it, also often have other symptoms on morbid with it—but unreliabiy the same from one person to the next or responsive to the treatment in the same way—so that it Is hard to conclude anything about the treatment outcome‘s validity. (Dear student. please see the second full paragraph on p.662 for more detail” Meta-Analyses of Therapy Outcome [Dear Studen . please study pool-663 for the logic and methodology allowing many studies to be combined from both RCT studies and less-controlled clinical studies into what is called a meta-analysis that essentially permits one to assess a treatment’s efficacy over a broad range of conditions and subject constellations] '[According to such meta-snags“. the picture that emerges is much more optimistic in support of psychoanalysis as a beneficial treatment. For eaarnple, one of the findings Is that the "average person who receives psychotherapy is better off at the end of It than 80% of the persons who do not receive psychotherapy.“ These improvements are still found when patients are studied months or years alter treatrnent] Comparing Therapies [The Dodo Blrd verdict (“Everyone has won and all must have prizes”). Apparently. the various psychotherapies are about equally effective as treatments but this conclusion is actively being reconsidered as the first topic under “Evaluating Therapeutic Outcome" above has already indicated-.] . SOME FINAL THOUGHTS: FAR, BUT NOT YET FAR ENOUGH ...
View Full Document

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern