Is it possible to measure the effectiveness of therapy?
However, having outcome research that demonstrates the general effectiveness of therapy is only a start. It does not let you know whether therapy will help you specifically. This is where measuring therapy progress and outcomes while you are engaged in therapy can be helpful.
How do you measure the effectiveness of a new intervention?
For example, in order to gauge the effectiveness of a new intervention, a team may elect to use a “reversal design,” in which the target behaviors are monitored with and without the intervention in place.
What is the proof of effectiveness of therapy?
The proof of effectiveness is in the measured outcomes, e.g., student test scores, lowered blood pressure, or in the case of therapy, concrete measures of progress, effectiveness, and outcome. 1. Miller, S., Wampold, B. and Varhely, K. (2008).
How do you evaluate a potential treatment option?
A first step when presented with a potential treatment option is to investigate its scientific record. One can certainly ask the marketer (or therapist, interventionist, clinician, etc.) for examples of peer-reviewed studies examining the effectiveness of their recommended intervention.
How is effectiveness measured in psychology?
There are three main ways in which treatment effectiveness is measured: the patient's own impression of wellness, the therapist's impression, and some controlled research studies.
How do you measure progress in therapy?
6 Progress-in-Therapy IndicatorsYour moods and emotions have improved. Depending on the reasons for entering therapy, check if any of your symptoms have improved. ... Your thinking has shifted. ... Your behaviors have changed. ... Your relationships with others are better. ... You have better life satisfaction. ... Your diagnosis changes.
What determines if therapy was effective for the patient?
The proof of effectiveness is in the measured outcomes, e.g., student test scores, lowered blood pressure, or in the case of therapy, concrete measures of progress, effectiveness, and outcome. 1.
How do you evaluate the effectiveness of group therapy?
Pre/Post Surveys. The most common method of measuring the effectiveness of our groups is through pre/post surveys. Some counselors choose to give a pre/post survey to your students. I recommend only doing that if they're 5th grade or above.
How do you monitor the progress of a client?
How to Track Client ProgressProgress reports. Structured progress reports are a simple and effective means of helping clients evaluate progress and focus on their goals. ... 'Before and after' photos. Sometimes a simple visual reminder can speak volumes. ... Workout or nutrition records. ... Communication.
How is treatment effectiveness measured?
There are three main ways in which treatment effectiveness is measured: the patient's own impression of wellness, the therapist's impression, and some controlled research studies.
How is psychological effectiveness measured?
Psychological treatment effectiveness is typically measured in three ways: the patient's own impression of wellness, the therapist's impression of wellness, and controlled research studies. Explore how to measure treatment effectiveness, the role of attitude and empathy, and how stigmas can make people avoid treatment. Updated: 10/23/2021
What happens if a therapist acts inappropriately?
On the other hand, therapists who behave inappropriately can hinder therapeutic progress, or even do more harm than good. Therapists who act with prejudice, or without understanding of cultural differences between them and their patients, can end up making the patient distrustful of the therapist and of therapy in general. Those who, in a Freudian model, try to produce false memories of past trauma can end up setting a patient back in recovery. Finally, it should be obvious that a sexual relationship between a patient and therapist could be harmful to recovery; still, it happens, and is a serious ethical violation.
Why is it important to have a patient's impressions?
Obviously if a patient feels better, that's great. So in one sense, a patient's impressions are extremely important--the goal of therapy is, after all, to restore her to mental and emotional well-being. But for the purposes of determining which treatments are most effective in which situations, there are several problems with a patient's own impressions of her progress. The first is simply that people in distress tend to get better. This is known as regression to the mean, or average, and it's when people have a tendency to move toward an average level of functioning or happiness from whatever state they are in. If you're really happy, you're most likely to get sadder, and if you're really sad, you're most likely to get happier. People spend most of their time feeling average, so moods that are above or below average are likely to return to this average. Since people usually enter treatment because they're feeling especially bad, they're likely to get better over time not because of anything the therapist is doing, but simply because they're regressing to the mean.
Why do people with schizophrenia have lower recovery rates?
Patients least likely to get better tend to think negatively and behave hostilely. For reasons therapists don't thoroughly understand , personality disorders and psychotic disorders, like schizophrenia, tend to have lower rates of recovery in general.
Why is cognitive therapy effective?
These kinds of studies have shown that for depression and panic disorders, cognitive therapy is most effective, potentially because these disorders are in part caused by the kind of negative thinking directly addressed by cognitive therapy.
What are the shortcomings of a therapist's evaluation?
Shortcomings of Therapist's Evaluations. Therapists' evaluations of patients are subject to all of the same problems as patients' evaluations. They, too, may mistake regression to the mean for positive effects of treatment.
What is the validity of clinical trials?
Validity of clinical trials hinges upon balancing patient prognosis at the initiation, execution, and conclusion of the trial. Readers should be aware of not only the magnitude of the estimated treatment effect, but also its precision. Finally, urologists should consider all patient-important outcomes as well as the balance of potential benefits, harms, and costs, and patient values and preferences when making treatment decisions.
Why are trials stopped early?
However, early termination may introduce bias secondary to chance deviations from the “true effect” of treatment which would decrease if the trial was continued to completion. [15] Small trials and those with few outcome events are particularly prone to this bias if stopped early.[2] For this reason, critical readers of the urology literature should interpret trials terminated early with caution. In the case of the REDUCE trial, it appears that the trial went to completion, so this is not a concern in terms of the validity of the trial.
What is the purpose of randomization?
The purpose of randomization is to balance both known and unknown prognostic factors between control and experimental groups. When successful, randomization assures us that the only prognostic difference between experimental and control groups is the treatment under investigation, and thus, any observed effect of therapy is due to that treatment.
How to minimize bias in RCT?
Therefore, important methodological safeguards , which minimize bias should be reported for any RCT. At the beginning of an RCT, subjects in the experimental and control groups should have a similar prognosis. In order to minimize prognostic differences, patients should be randomized, the randomization process should be concealed, and a balance of known prognostic factorsshould exist between members of each group in the trial.
Why is prognostic balance less certain?
At study's completion, the question of prognostic balance is less certain because of a relatively high rate of loss to follow-up.
Why is blinding important in clinical trials?
Blinding is important to maintaining prognostic balance as the study progresses, as it helps to minimize a variety of biases, such as placebo effects or co-interventions. Empirical evidence of bias exists in trials where blinding was not utilized or was ineffective.[10,11] Five important groups should be blinded, when feasible: patients, clinicians, data collectors, outcome adjudicators, and data analysts [Table 1]. Frequently readers will see the terms “double-blind” or “triple-blind.” These terms may be confusing, and it is preferable to state exactly which groups are blinded in the course of a trial.[12] In surgical trials it is often impossible to blind the surgeon, but it may be feasible to blind patients, and is almost always feasible to blind data collectors and outcome assessors.
What are the three interdependent questions in evidence based approach?
An evidence-based approach emphasizes sequentially asking three interdependent questions: (1) Are the results valid? (2) What are the results? (3) How can I apply these results to care of an individual patient? In the following sections, we will examine the REDUCE trial using the lens of this three question approach.
How does clinical effectiveness affect schizophrenia?
Clinical effectiveness in the treatment of schizophrenia is best reflected by the progression of change in the four outcome domains from the baseline assessment. Treatment interventions have a direct impact on clinical symptoms—and thereby on disease burden—and on treatment burden. In turn, disease and treatment burden interact with other factors to influence health and wellness ( Figure 1 ). Continuing assessment of outcomes involves short-term and long-term follow-up to track progress through the longitudinal course of illness.
What are the two scales used to measure symptoms?
Symptoms of disease. Two scales are often used to measure severity and change in positive and negative symptoms. The Brief Psychiatric Rating Scale (BPRS) was developed to assess change in severity of psychopathology among patients with psychotic illness, such as schizophrenia and psychotic major depression ( 76 ). The Positive and Negative Syndrome Scale (PANSS) was developed to assess psychopathology among patients with schizophrenia, with an emphasis on positive and negative symptoms but without neglecting other general psychopathology features ( 77 ). In the recovery model of Liberman and colleagues ( 9) symptom remission is defined as a score of 4 or less (moderate symptoms) for two consecutive years on each of the positive and negative symptom items on the PANSS.
How much did schizophrenia cost in 1990?
Rice ( 47) reported that the total economic burden of schizophrenia in 1990 in the United States was $32.5 billion, of which $17.3 billion was attributed to direct medical costs.
How does schizophrenia affect treatment?
A variety of intervening factors can affect treatment outcomes for patients with schizophrenia and should be considered in the evaluation of clinical effectiveness. These factors can be grouped by whether they apply to the patient, the family, the treating physician, the health care system, or society at large ( 4 ). Certain factors can directly affect treatment outcomes (for example, substance abuse), influence expectations about outcomes (for example, age), or affect both treatment outcome and expectations (for example, educational level and available resources); they may also influence choice of treatment (for example, age or education can affect whether vocational rehabilitation is chosen).
Why is goal setting difficult for schizophrenia patients?
Goal setting is often difficult for patients with schizophrenia because of core negative symptoms and cognitive deficits. Furthermore, an assessment of both real and perceived barriers—that is, the individual's level of disability—that may interfere with the achievement of defined goals is also needed. Ultimately, the clinical effectiveness of a treatment intervention will be reflected in the successful achievement of these predefined social, educational, vocational, and interpersonal goals.
What is the primary goal of schizophrenia?
Most clinicians agree that the primary treatment goal for patients with schizophrenia is to maximize the clinical effectiveness of the interventions employed to achieve the best possible outcome. A dearth of information exists in the literature about the meaning of the term "clinical effectiveness" as it applies to patients in real-world treatment settings. Furthermore, although standardized measures of efficacy in treating symptoms are available, there are not any generally accepted operational criteria that clinicians can use to measure the clinical effectiveness of the treatments they provide. To address this gap in knowledge, a roundtable entitled Towards Identifying Criteria for Clinical Effectiveness was set up so that a group of experts on schizophrenia who met in June 2002 could consider the following questions about the measurement of clinical effectiveness in real-world clinical practice: What do we mean by clinical effectiveness, and how does it differ from efficacy? What target outcome domains should be included in an assessment of clinical effectiveness? What tools can clinicians use to measure clinical effectiveness in those target areas? How can clinicians incorporate the concept of clinical effectiveness in their treatment planning?
Why is age important in treatment?
Age is an important patient variable in treatment selection and outcome expectations and warrants further examination. A discussion of treatment issues related to these particular patient populations will also illustrate how all the variables described above—patient, physician, institutional, and societal—interact to affect treatment outcomes.
How to evaluate the effectiveness of a treatment?
Once the committee identified the health conditions upon which to focus (see Chapter 2), it had to determine how to evaluate the effectiveness of treatments for those conditions. There are a number of ways to show that a given treatment is effective in treating a disease or clinical condition. Studies of treatments typically start either with laboratory studies establishing a possible or plausible effect of a treatment or with uncontrolled clinical observations of that effect. Small pilot studies, larger controlled trials, and, finally, studies of efficacy in large clinical populations gradually build a case for the value of a given treatment. There is no point along this sequence when a treatment is unequivocally “proven” efficacious, since no single study is totally free of all methodological flaws and even a set of studies may be flawed and produce misleading conclusions. The strength of evidence for or against a given treatment can be graded, however, and there is a point at which the medical and scientific communities can reach consensus about the efficacy (or lack thereof) of a treatment (Guyatt et al. 2000). In this chapter, we will review these “rules of evidence” and indicate how they can be applied to treatments for Gulf War veterans' health problems.
What is treatment effectiveness?
If an effective treatment is applied, some detectable improvement in a patient's condition should occur. If the treatment is not applied, no improvement occurs or the patient gets worse. If the treatment is applied in higher doses or more frequently (at least up to a point), the improvement should be greater or occur sooner. Because there may be other causes of improvement beside the treatment in question, the improvement must be shown in multiple patients in multiple settings and in circumstances where as many other possible causal factors can be ruled out.
What is effectiveness RCT?
An effectiveness RCT could be viewed as a hybrid that combines the real-world features of effectiveness studies with some of the study design features typically found in efficacy studies. In an effectiveness RCT, one would have relatively light (if any) patient exclusion criteria, so that the patients in the trial would be as similar as possible to those to whom the results would be generalized. The study would be run (to the extent possible) in a range of treatment settings rather than in a single academic medical center context. The treatment would be provided by the same kinds of providers (e.g., community physicians or nurses) who would provide the treatment in nonstudy settings. There would not be an elaborate data collection infrastructure (e.g., extra lab test or imaging studies) that would create a different “information environment” for treating clinicians and patients than the one that would be found in real-world treatment settings. Analysis would be done on an “intention to treat” basis. The study would have random assignment of patients to treatment arms and would have one or more control groups (e.g., placebo controls, waiting list controls, different dose or regimen controls, or other controls that would make sense for the question being asked).
How to provide evidence of efficacy?
Other kinds of studies (i.e., quasi-experimental designs) can provide evidence of treatment efficacy, too. In situations where it is technically or ethically impossible to run concurrent control groups, a series of “off/on” periods of treatment in a single group of patients can be studied. In these studies treatment is administered to a single group of patients and then taken away. Evidence of efficacy is provided if the benefit is consistently seen when treatment is given and the benefit disappears when treatment is not given. This is a specific example of a before-afterstudy design without controls. A single round of off/on provides very weak evidence for effectiveness unless results are unusual and dramatic, because many other things occurring at the same time as the treatment may have caused the result. Being able to repeat the effect over and over again strengthens the argument for the treatment, rather than something else, being the cause of the effect.
Why is there no evidence of treatment effectiveness for most medical problems in Gulf War veterans?
If we adhere to this terminology, we will find that there is very little formal evidence of treatment effectiveness for most treatments for medical problems in Gulf War veterans because relatively few true effectiveness studies have been done on any medical condition.
What are the features of a randomized trial?
Randomized trials typically include other features that increase the strength of the conclusions about cause-and-effect relationships between the treatment and the outcome of interest. Some patients may be excluded from the study because they have conditions that make it impossible to evaluate outcomes or gather data (e.g., extremely elderly patients may be excluded from a study of a cancer treatment because too many of them would die of other conditions before the end of a five-year follow-up period). The study of the efficacy of a drug may include lab tests that measure the level of the drug in the bloodstream. This is done to ensure that the patients assigned to the treatment group actually received the drug while the patients randomized to “no treatment” did not take it on their own. A study may include near-term clinical measures of benefit (e.g., reduction in blood pressure or cholesterol level) as well as long-term objective measures of benefit (e.g., remissions of tumors, mortality) or long-term subjective measures of benefit (e.g., self-reported pain or functional status levels).
What is a RCT?
The randomized controlled trial (RCT) is the most reliable methodology for assessing the efficacy of treatments in medicine. In such a trial a defined group of study patients is assigned to either receive the treatment or not, or to receive different doses of the treatment, through a formal process of randomization. A coin flip is the simplest example of a random process. In a study with two “arms” (e.g., treatment or no treatment), each eligible patient would receive whatever a coin flip indicated—heads for treatment and tails for no treatment. In a large number of patients, any clinical or demographic factors such as age, height, weight, illness history, other illnesses, or any other unknown factor that might affect the results of the treatment would be equivalent in the two groups. These will all be eliminated, then, as plausible competing explanations for any observed difference in outcome between the two groups.
Why is numerical data used in behavioral therapy?
The use of numerical data to measure the change of operationally defined target behaviors is one of the best ways for a treatment team to elevate their discussion above opinion, conjecture, and misrepresentation. If a pill, therapy, or gadget is helpful, there is almost assuredly a change in behavior.
What is an academic intervention?
An academic intervention should result in specific new academic skills (e.g., independent proficiency with particular math operations). An exercise purported to decrease the occurrence of challenging behavior will, if effective, result in a lower rate of specific challenging behaviors (e.g., tantrums, self-injury).
Is behavior change a gradual or a continuous change?
Behavior change is often gradual and may occur in “fits and starts” (i.e., the change is variable). In some cases the behavior may initially deteriorate. Also, our perception of behavior change can be impacted by any number of events (e.g., the co-occurrence of other therapies, our expectations for change).
Is a pill a change in behavior?
If a pill, therapy, or gadget is helpful, there is almost assuredly a change in behavior. And, that change is almost always quantifiable. Setting up a system to collect these numerical data prior to the initiation of the new intervention is a key to objective evaluation of intervention. Don’t do intervention without it.
