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| Understanding the Question |
How to think about treatment effectivenessMost people, when they think about whether to take a drug or to enter psychotherapy or counseling for a psychological problem, make a decision about what to do on the basis of their knowledge of the effectiveness of that treatment. That knowledge may have been provided by a respected physician, friend or minister, or from reading about the problem. They may also respond to certain biases they had to begin with - "taking drugs means that you're mentally ill and I'm not mentally ill," or, "How can telling someone about your problems be of any help? I can get that from my best friend." Seldom do they take the time to really evaluate the effectiveness of a given treatment to aid them in making an informed decision. It is simply too much trouble or, they reason, they wouldn't know how to evaluate the information. While the latter point is something to consider, there exist distillations and summaries of the research literature for just about any disorder you can imagine that can be read and understood by the average person.The one outcome criterion that everyone is familiar with is simply, "Does the treatment work?" A somewhat more sophisticated question is "Does it work and what are the side effects?" Once a treatment has begun the individual sufferer may begin to ask still a third question - "What happens when the treatment is over? Will I still be O.K.?" These questions form the basis for determining the effectiveness of any treatment, any intervention. Experts in any field try to familiarize themselves with the answer to the question, "What is the best treatment for this individual with this problem?" To do this they search the research literature in which studies are reported that bear on the answer to that question. They then combine that information with their own clinical experience to decide upon which intervention to use. Of course, their choice of which intervention to use is somewhat determined by the profession they practice. Only physicians can administer medications, for instance. The sophisticated consumer can also avail herself of the information that experts use. However, the informed consumer should be interested in more than the effectiveness of a particular treatment. She should be interested in questions of how well the treatment is tolerated and what the relapse rate is once treatment is terminated. Some disorders, by their very nature, may require a lifetime of treatment. For these problems the question of relapse after terminating treatment is a meaningless one. For the majority of psychological problems, however, the question of relapse after the conclusion of treatment is reasonable and one, therefore, that should be asked. When research is conducted into the effectiveness of a given treatment information is often gathered on three criteria that can be used to judge outcome. These three criteria are:
When you ask these questions you begin to discover that different treatments lead to different answers. The reasons for these differences often provide the basis for a lot of speculation about the causes of the differences. One reason frequently given for differences among treatments in terms of dropout rates, for example, is the level of side-effects of the treatments. This is an especially important consideration when you are comparing one medication to another or when you are comparing a given medication to psychotherapy. Both psychotherapy and medications can be considered to produce side effects. Further, the outcome of psychotherapy can vary depending on the level of skill of the therapist while, it is presumed, medications are uniform in their effects. The point to be made here is that, regardless of the reasons, different interventions provide different answers to the three questions. Only when you have the answers to all three questions in hand can you make the most intelligent answer to the question, "Which is best?" |
Treatment DropoutsConsider the first question, "How many people drop out of treatment?" In any research study on the effectiveness of treatments for panic disorder and agoraphobia information is usually provided on the number of people who have dropped out of treatment. When the number of dropouts varies systematically between treatments, one can conclude that the systematic differences are attributable to the treatment itself and not just to chance variation. As indicated above people drop out of treatment for a variety of reasons. Only when one treatment continues to show either higher or lower dropout rates than would be expected should the search start for elements in the treatment itself that may be producing the difference. If a person drops out of treatment because the medication they are on is producing intolerable side effects that treatment, for them, can be said to be ineffective. Similarly, if a person drops out of treatment because the psychological intervention they are receiving is either being administered clumsily or has no immediately determinable benefit, that treatment may also be said to be ineffective. Accordingly, it is essential for the well-informed consumer to ask, "What is the dropout rate for the treatment you are offering me? Is this dropout rate different from that of other treatments? ; and What about this treatment produces the unusually high (or low) dropout rate?" |
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Treatment EffectivenessNext consider the second question - "Of those individuals that complete treatment how many improve?" This is the question that most people ask, in one form or other. The reason they ask this question, of course, is because it is the most important one to ask. It helps the sufferer determine what his expectations should be. It also helps the sufferer, once treatment is completed, evaluate his progress against that of the "expected" outcome. It is important to remember when considering the question of "how many people improve?" that the answer may vary depending on the definition of "improve." When considering treatments for panic disorder, for example, the definition of improvement may vary from "severity of panic attacks has decreased" to "has returned to normal functioning." Improvement rates for the latter are likely to be high while for the latter they are likely to be low. In addition, when examining the success rates for a given treatment, you need to focus on several related questions:
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Treatment RelapsesThe third important question to ask is "How many of those individuals successfully treated relapse and how many continue to enjoy a more positive outcome?" Assuming that you do not want to stay on medication the rest of your life or to be in psychotherapy the rest of your life you need to know how long treatment will last and what is a reasonable expectation for how long treatment effects will endure. Of course, often such predictions are extremely hazardous to make since they are often incorrect. Asking the more general question of what the relapse rate is for others who have gone through the treatment is less hazardous but still permits you to gauge the likely long-term effects of the intervention you are beginning. As with the second question, knowing the relapse rate for a given treatment approach is most significant when it is compared with other existing treatments. With that comparative information you can then identify which intervention is most likely to lead to the most positive long-term outcome. |
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Disclaimer: This site contains general reference information and is not intended as a substitute for consulting with your physician. © 2005 by Self-Change Systems ALL RIGHTS RESERVED |
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