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chapter 17 - 6 - Chpi 1 Treatment of Mental Disorders 8...

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Unformatted text preview: Chpi 1'! Treatment of Mental Disorders 8 3.6 [It is more effective In some cases than in others, especially In those patients who feel they have a strong sense of alliance with their therapist and in patients who are fully motivated and optimistic about their changes of recovery. Improvement is also more likely with more therapy sessions than with less. And some disorders are more responsive to psychotherapy than others (phobias. for example are quite responsive to psychotherapy; schizophrenia is not).] [There is evidence that for treating various kinds of problems some modes of therapy are more effective than others, as follows: 1) Behavior therapy is best for anxiety disorders, especially phobias. 2) Cognitive therapy ls effective for mood disorders—perhaps as much as drug treatment and more longer-lasting. it is also useful for panic disorder. 3) Experiential therapies can alleviate depression and anxiety disorders. 4) Psychodynamic therapies, especially interpersonal therapy, do seem effective for depression. ironically, the form of therapy that historically came firsts—Freud's psychoanalytic technique—doesn’t seem to have much going for It] IDeterigmflon effects: 5% to 10% of patients get worse as a result of therapy rather than better. One cause seems to be a bad therapist-patient relationship or outright incompetence. However, psychotherapy sometime disrupts what, though unhealthy. may be stable in the patient's iife yet provides no substitute, with the result that the patient becomes depressed] How Should Therapy Be Evaluated? [What Is the evidence for the above claims for a therapy’s benefits'fl Evidence-Based Practice {ERB} *[In 1961 a study of the success rates of psychotherapy, by the British psychiatrist, Hans Eysenck, found that 60% of neurotic individuals receiving psychotherapy improved as a result of treatment. However, about 70% of those not receiving treatment showed spontaneous recovery— a result that did not at the time argue well for the efficacy of psychoanalysis as a treatment. Since then, his study has been discredited on procedural grounds. Nevertheless, it alerted the field of psychotherapy about how important it is for the outcomes of Its clinical practice to be evaluated based on solid research. Accordingly, much research has been done since then in examining the succeés outcomes of various types of psychotherapy, a consideration of which now foliowe.] The Logic of Outcome Research *[The most obvious approach to evaluating the effectiveness of a treatment is to administer the treatment to a group of mental patients for some period and then make a before-and-after assessment But should the patients Improve after trea'b'nent, this improvement in-and-of-itself Is not sufficient cause to conclude that the treatment was the cause of that improvement. i.e., that the treatment Is an effective one for further use. The following are reasons for improvement that may occur during beau-Item but which may have nothing to do with the exact nature of the treatment itself-.1 {Cancelling for spontaneous improvement} '[To control for the possibility that improvement is not due to the treatment but, rather, would have happened anyway, a randomized clinical trial {36! l procedure should be used. it compares two groups of patients matched ily random assignment from the same flpulatlon both groups of which are assessed at the beginning and end of the study but only one of which gets the treatment in between. If improvement is NOT due to spontaneous Improvement, only the group getting the treatment should show it.) [Dear Student, relate the above to the discussion about evaluating the drug WellbutrInJ Placebo Effects {Controlling for placebo effects In drug studies} ‘[in many instances of illness, improvement seems to be significantly affected by the patient‘s belief in the efficacy of the treatment received rather than solely being caused by some factor in the treatment itself. To assess how much of a treahnent's beneficial effects are due to the treatment itself rather than to the patient's belief in the treatment, a placebo ("sugar pill") control should be run. Again, using using the RCT procedure already described. some of the patients used in an experiment to study the effect of. say, a drug should be given a "look-alike“ version of the drug that is minus its reputed active ingredient and some should be given the drug with its active Ingredient. Their improvement under this placebo treatment should be compared with improvement exhibited by patients receiving the "mat McCoy"—the real drug. To the degree that the patients In the placebo control group show an Improvement comparable to those receiving the real dmg, one can conclude that belief In the drug plays a very significant effect in the . patients' response to it and that the active ingredient plays less of a role (and sometimes an entirely negligible role).] ' {Controlling for expectationgzplacebo dug effects—in those who administer a treatment} *[Sornelimes the beneficial effects of a drug can arise not from the patients' belief in the efficacy of drug but from the doctor's andlor hospital staff's belief about its efficacy. if those who care for the patient think the drug being administered is going to work effectively, they may feel more optimistic about the drug, communicate this optimism to the patient, and actually even give the patient better care. Under those conditions, the patient may have a better prospect for recovery than under conditions where the health care administers have little or no faith in the drug. So the placebo effect of a drug. applies to these health care administers often as much as it applies to the patient. Therefore, in assessing the efilcacy of the drug's active ingredients, it is necessary also to control for the belief in drug as hold by the hearth care administers as much as It necessary to control for the patient's own beiief in the drug. This is done by running a “double ...
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