Eclectic+approaches+to+treatment

=Eclectic approaches=

** Introduction **
Definition Based on individual need
 * Incorporates principles/techniques from various systems theories


 * Uses strengths of each treatment tailored to that need
 * Example of depressive patient with suicidal tendencies

Approaches depend on the disorder
 * Current research indicates multifaceted approach most efficient – biopsychosocial approach
 * Can include drug treatment, individual therapy (CBT), group therapy
 * Focuses on individual as ‘client’ not ‘patient’ – not ‘sick’, just in need of help with problems

Also an argument for the biopsychosocial approach
 * This approach is often adopted “//around 30 – 40% of Canadian and US psychologists describe themselves as eclectic in approach//” – Glassman, 2000

** Paragraph 1 - **
Evidence that Drugs are not effective in all cases //__Evidence 1__// //A study by Kirsch and Sapirstein (1998)//
 * Statement: Research on treatment demonstrates that taking action to cope with or change behavior can be more effective in a long-term situation **
 * Drug therapies alone have significant relapse rates
 * Rush et. al. – higher relapse rate because just giving drugs does not give patients coping strategies to deal with depression, whereas cognitive therapy programs do
 * //Procedure://
 * o //Analysed 19 studies, covering 2318 patients treated for depression with Prozac (an SSRI)//
 * //Findings://
 * o //Prozac only 25% more effective than placebos//
 * o //No more effective than other drugs, such as tranquillizers//

//__Evidence 2__//
 * //Arroll et al. (2005)//
 * o //Up to 40% of depressed persons fail to respond to an antidepressant//
 * //Supported by Lambert (2008)//
 * o //Antidepressants effective for only 56-60% of patients using them//

//__Evidence__// //Study by DeRubeis et. al. (2005)//
 * //Comparison of CT and antidepressant drugs in a randomized placebo controlled experiment including moderately and severely depressed patients//
 * o //1 group was given Paxil; 1 group was given CT; 1 group was given a drug placebo//
 * //Findings//
 * o //after 8 weeks positive symptom reduction found in//
 * § //50 % of Paxil group//
 * § //43% of CT group//
 * § //25% of placebo group//
 * //Conclusion//
 * o //Moderate and severe cases responded better to both drugs and CT than a placebo//
 * o //CT just as effective as drugs when administered by a qualified therapist//
 * //Caveat//
 * o //APA and NIMH recommend that severely depressed patients need drug treatments. This study’s results do not support that.//

**Paragraph 2 -**
__//Evidence 1//__ //Riggs et al (2007): effectiveness of CBT in combination with a placebo or an SSRI.//
 * Statement: CBT is effective but CBT with a combination of biomedical drugs is proven to be most effective in cases of chronic depression.**
 * 1) // Randomized double-blind with 126 adolescents (13-19 yrs) who suffered from depression. //
 * // 20 were not able to be followed up or participated. //
 * 1) // Participants were rated afterwards by a physician who found that 67% of patients in the CBT + placebo group and 76% of patients in the CBT + drug group were classified as “very much or much improved.” //
 * 2) // Conclude that the treatment with CBT and rugs is effective but with placebo and CBT is almost just as effective. //

//__Evidence 2__// //Study by DeRubeis et. al. (2005)//
 * //Comparison of CT and antidepressant drugs in a randomized placebo controlled experiment including moderately and severely depressed patients//
 * //1 group was given Paxil; 1 group was given CT; 1 group was given a drug placebo//
 * //Findings//
 * //after 8 weeks positive symptom reduction found in//
 * //50 % of Paxil group//
 * //43% of CT group//
 * //25% of placebo group//
 * //Conclusion//
 * //Moderate and severe cases responded better to both drugs and CT than a placebo//
 * //CT just as effective as drugs when administered by a qualified therapist//
 * //Caveat//
 * //APA and NIMH recommend that severely depressed patients need drug treatments. This study’s results do not support that.//

Paragraph 3 - Cultural considerations
Issues with group therapy
 * Cite Mutlaq and Chaleby (1995) with group therapy in Arab cultures (make sure you can identify 3)

Combining western psychotherapy and indigenous healing practices some therapies are not appropriate
 * Malaysia – Koranic verses + prayer + psychotherapy
 * Chinese Taoist cognitive psychotherapy (Taoist verses for reading and reflection + psychotherapy)


 * Japanese are reluctant to take antidepressants
 * Buddhists in Sri Lanka also reluctant (Jamison page 244)

Miller (2000) proposes community based treatment – using the community as a support network – ecological model -> //therefore work within the culture (also connected to group approach)//
 * Uses relationships between people and their surroundings
 * Identifies community resources for healing and healthy adaptation
 * Enhances coping strategies
 * Collaborative culturally grounded community interventions – get members to solve own problems with help of community
 * **Specific example if you need it** - // Fifteen randomized trials have evaluated substance use outcomes for adolescents and their families (for reviews: Kaminer & Slesnick, in press; Ozechowski & Liddle, 2000; Stanton & Shadish, 1997). All adolescent family therapy studies showed significant pre to posttreatment reductions in substance use for the family-based intervention utilized, with eight of the twelve studies that used a non-family therapy control showing superior effects for those youth assigned to family therapy //