Distorting the probability of treatment success to justify treatment decisions

This research examines the value-induced bias: do people justify medical decisions by distorting their perception of relevant probabilities? Subjects were given a “close-call” decision which involved weighing one week of treatment side effects with a low probability of treatment success against seven more weeks of having the disease symptoms. They were told a numeric probability estimate of treatment success for the population as a whole. Those subjects with the ability to justify getting (not getting) treatment inflated (reduced) their numeric probability judgment of treatment success relative to those without this ability. As in cognitive dissonance reduction, risk perceptions can be distorted to align beliefs with preferences. Distorted risk perceptions may lead to suboptimal medical decisions.     

Psychological science treatment

New discoveries in psychological science have changed our understanding of some basic psychological processes. The new science, however, has not of yet been properly incorporated into the practice of psychotherapy. This has created a confusing state of affairs, lacking clear distinctions between therapy interventions rooted in lore and personal insight and those based on systematic scientific inquiry. In this paper, I discuss the problems caused by the current situation and propose a new distinction by which the psychological (science) treatment of psychological disorders is differentiated from psychotherapy. The implications of the proposed distinction for clinical research and training are discussed.     

Optimizing treatment in social phobia: a review of treatment resistance

Over the last 25 years, there has been a rapid expansion of our knowledge base of social phobia (SP). Although there are a number of well-validated treatment modalities, including pharmacotherapy and cognitive-behavioral therapy, significant gaps remain in our ability to achieve full remission in most patients. Despite advances in the neurobiology of SP, the etiology has yet to be determined. Investigations examining potential predictors of response have provided little guidance in selecting an appropriate treatment modality. These gaps in our knowledge have pushed us to examine issues related to treatment resistance. This paper presents a review of the current literature and issues related to treatment-resistant SP, including a discussion of the functional impairment associated with SP, definitions of treatment response and remission, as well as outcome measures that have been used in clinical investigations of SP. In addition, criteria for a standard treatment trial, predictors of treatment response, a review of treatment resistance studies, and potential directions for future research are examined. The most promising strategies to attain remission, will likely involve augmenting selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors with agents such as anticonvulsants, benzodiazepines, and antipsychotics as well as combining pharmacotherapy with cognitive-behavioral therapy. Our current treatment target of simply attaining a response needs to be refocused, so that an asymptomatic state and high end state functioning become the final goal of treatment.     

Evaluation of a mental health treatment court with assertive community treatment

Without active engagement, many adults with serious mental illnesses remain untreated in the community and commit criminal offenses, resulting in their placement in the jails rather than mental health facilities. A mental health treatment court (MHTC) with an assertive community treatment (ACT) model of case management was developed through the cooperative efforts of the criminal justice and mental health systems. Participants were 235 adults with a serious mental illness who were booked into the county jail, and who volunteered for the study. An experimental design was used, with participants randomly assigned to MHTC or treatment as usual (TAU), consisting of adversarial criminal processing and less intensive mental health treatment. Results were reported for 6 and 12 month follow-up periods. Clients in both conditions improved in life satisfaction, distress, and independent living, while participants in the MHTC also showed reductions in substance abuse and new criminal activity. Outcomes are interpreted within the context of changes brought about in the community subsequent to implementation of the MHTC.     

Web-based, psychosocial treatment for substance use disorders in community treatment settings

The purpose of this multisite clinical trial was to evaluate the effectiveness of a web-based version of the Community Reinforcement Approach, plus motivational incentives, within community-based, outpatient substance abuse treatment. This ongoing study is being conducted within the National Drug Abuse Treatment Clinical Trials Network, funded by the National Institute on Drug Abuse. Midway through the enrollment of 500 participants, the study is being implemented in 10 treatment programs across the United States. Information is provided on design, sample, intervention and technology, and preliminary lessons learned.     

The role of treatment acceptability in the initiation of treatment for ADHD

Approximately 50% of families of children with ADHD fail to pursue, or adhere to, recommended treatments. The present study examines parent ratings of the acceptability of pharmacological and behavioral treatments for ADHD and the relationships between these ratings and subsequent pursuit of treatment. Fifty-five families whose children received an evaluation for ADHD completed questionnaires and were contacted 3 to 4 months later to assess their pursuit of treatment. Consistent with previous research, parents rated behavior therapy as more acceptable than medication. Parent ratings of medication acceptability significantly predict pursuit of pharmacological treatment, whereas ratings of the acceptability of behavior therapy do not predict pursuit of this treatment. Preliminary analyses found that Caucasian parents' ratings of medication are significantly higher than those of non-Caucasian parents. Furthermore, Caucasian families were more likely to pursue a recommendation for pharmacological treatment than non-Caucasian families. The clinical and research implications of these results are considered.     

Chaplain contacts improve treatment outcomes in residential treatment programs for delinquent adolescents

This is a report of a study of 828 delinquent adolescents who completed behavioral treatment during 1995, 1996, 1997 in Holy Cross Children's Services programs. The research focused on a measure of chaplain contact time with each youth, and three outcome variables: "planned release" (program completion), living situation at 12 months after discharge, and a calculated cost of care for the 12 month graduates. The findings include statistically significant correlations between chaplain time and all three preferred outcome measures. The results were significant when age, number of prior incarcerations and religiosity variables were controlled for in a regression analysis. When the costs of aftercare for the graduates were computed, the average cost-of care-per-day of the no-Chaplain-contact graduates was significantly higher than that of the high-contact group. Based on the findings, the author suggests that chaplain involvement in the behavioral treatment of delinquent adolescents improves outcomes and is cost effective.     

Evidence-based treatment of stuttering: IV. Empowerment through evidence-based treatment practices

Assertion-based treatments for stuttering have historically been more popular than evidence-based treatments. In this paper it is argued that the use of evidence-based treatments for stuttering is professionally empowering for clinicians, but that the use of assertion-based treatments is a circular process that inhibits professional development. The arguments in favor of evidence-based treatment are elaborated under headings of "professional investment," "professional development and diversity," and "optimizing treatment efficacy." EDUCATIONAL OBJECTIVES: The reader will understand and be able (1) to describe the distinction between assertion-based and evidence-based treatment practices (2) to present a series of arguments that evidence-based treatment practices are professionally empowering.     

Combining psychodynamic and behavioral treatment approaches in the treatment of hospitalized adolescents

This article describes a treatment approach for hospitalized adolescents which attempts to address the "response generalization" problem encountered with behaviorally based treatment milieus. The program is described and preliminary data is given to support its techniques. The treatment program attempts to combine behavioral/objective techniques that are so effective in program management, with subjective/clinical strategies.