Evidence - Based Adjunctive Treatments

di O' Donohue - Cummings • 2008 • dettagli prodotto

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DESCRIZIONE

Face to face psychotherapy is useful, but expensive, in terms of direct professional fees and associated administrative costs. Moreover, conventional face-to-face therapy also has significant indirect costs such as stigma, and opportunity costs (e.g., time and effort required to attend sessions). Finally, this mode of therapy is simply not available to some individuals because of the uneven distribution of expertise in certain geographical areas. These barriers result in a number of individuals needing care to go untreated or receiving less than optimal treatment. Moreover, a persistent problem with many therapies is that they have a high rate of relapse. There is significant attention being placed in attempts to remedy these problems. For example, President Bush’s recent New Freedom Commission on Mental Health report stressed the role of telehealth, psychoeducation, consumer driven treatment planning and wrap around services in redesigning mental health service delivery in the U.S. Adjunctive treatments in which patients are provided additional modalities that can assist in their behavior change or the maintenance of their behavior change have a useful role in addressing these problems. In a stepped care model, patients meeting certain criteria (e.g., lower intensity of the problem) can perhaps first be triaged to one or more of these adjunctive therapies. Alternatively, these adjunctive therapies can be prescribed commitently with ongoing face to face therapy. A third possibility is that one or more of these interventions can be prescribed post-face-to-face therapy in an attempt to maintain positive changes and to prevent relapse. These adjunctive therapies are all based on improving patient’s self management of their problems or the factors that exacerbate their problems. The web can help them gain additional information and support; bibliotherapy (such as David Burn’s very successful Feeling Good) can allow them to efficiently learn more treatment options and behavior change techniques. Lifestyle changes such as improvements in exercise have recently been shown to be as effective as anti-depressant medication. This approach is consistent with the recent movements related to patient centered care and consumer driven health care. These and the other possibilities discussed in the book are currently underutilized in treatment planning and this book in part is meant to correct this gap. There is no current book that has this perspective. This book will be unique in drawing together all of these adjunctive therapies. It will examine the evidence base for each of these and identify problems where the data show that they are efficacious. Practical suggestions will be given for the timing and coordination for the use of these. The chapter authors will be asked to identify key elements that appear to be related to quality. Finally, since these is a relatively new field, authors will be asked to discuss the research and the knowledge dissemination issues. The book is broadly organized into two sections. The first gives a broad overview of the major adjunctive modalities while the second concentrates on a systematic description of their role in the treatment of a number of special populations. The book editors are individuals with histories in organized systems of mental health care, brief and cost-effective psychotherapies, research, teaching, and innovations in each of these. Thus, we believe the book will gain attention. It meets a significant need in the managed care industry: how to promote innovations that at once produce healthier individuals and bring down costs. Compared to physical medicine, the behavioral health industry has been slow to innovate, and slow to adopt modern technologies such as web based interventions, and this results in unnecessary costs and less healthy patients. This book is an attempt to help spur these innovations.