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Ashley

Evidence Based Treatments - Your Thoughts

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Hello Gang,

Happy New Year..... not sure I have said that yet.

Later in the spring I have been asked to talk at a conference about effective care and treatment and share my views as a service user with reference to evidence based treatments (not just OCD, i.e. depression, anxiety etc).

As I try and formulate the focus of my talk I just wondered what you guys thought on the subject.

  • When you seek treatment, are you expecting (initially) to receive treatment that is evidence based?
  • Would you want the health professional (GP / therapist) to make you aware of non evidence based treatments?
  • Is being informed about the evidence base for treatment A over treatment B helpful or not?
  • Is your understanding of the expected treatment helpful?  (so if you understand CBT, and seek treatment you can recognise if you're just receiving the B part, common (or just the C part, less common but not unheard of)?

Your thoughts are welcomed, along with any examples I may be able to use within my presentation (can be anonymous). 

Thanks. 

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I haven't gone for treatment in a while but I'll offer my thoughts. 

Question 1) Yes absolutely, I would for any medical problem. I'd be really annoyed if I found out i had been given something without an evidence to show it worked. What a waste of my time and what a way to prolong someone's suffering. It would also massively impact on my faith in health professionals, it would affect my trust and then possibly any subsequent treatment affects.

2) Not really unless all of the evidence based treatment had been exhausted. I think in that instance anyone would be open to trying something new. 

3) It might be if someone asks but i don't think it would be routinely necessary. I think just saying that evidence suggests this is the best treatment for OCD is enough. One thing though, health professionals should be open to have it questioned, I'd be upset if I couldn't ask them to justify it's use over something else. 

4) Yes absolutely. My first and only therapist focused almost entirely on behaviour, it affected my faith in therapy for years after. 

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Hi Ashley,

I will print this off and give it some thought in the next couple of days :)

Roy 

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12 hours ago, Ashley said:

When you seek treatment, are you expecting (initially) to receive treatment that is evidence based?

Yes, at this point I would be at my lowest and most distrustful of practitioners, so scientific studies and statistical evidence would be what I would base my treatment choice on.

12 hours ago, Ashley said:

Would you want the health professional (GP / therapist) to make you aware of non evidence based treatments?

No

12 hours ago, Ashley said:

Is being informed about the evidence base for treatment A over treatment B helpful or not?

Very helpful. It is good to have access to all the detail so to make an informed decision.

12 hours ago, Ashley said:

Is your understanding of the expected treatment helpful?  (so if you understand CBT, and seek treatment you can recognise if you're just receiving the B part, common (or just the C part, less common but not unheard of)?

Yes, because it means you will be involved in your own treatment and be able to see and assess your own recovery progress and to judge whether the therapist is good or not

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On 14/01/2019 at 11:19, Ashley said:

When you seek treatment, are you expecting (initially) to receive treatment that is evidence based?

Yes. 

 

On 14/01/2019 at 11:19, Ashley said:

Would you want the health professional (GP / therapist) to make you aware of non evidence based treatments?

If they thought it might be helpful. But I would require them to advise me of why they thought they might be helpful in my particular case. 

 

On 14/01/2019 at 11:19, Ashley said:

Is being informed about the evidence base for treatment A over treatment B helpful or not?

I have real faith in the value of this, but only if under the jurisdiction of a therapist or self-help book. 

On 14/01/2019 at 11:19, Ashley said:

Is your understanding of the expected treatment helpful?  (so if you understand CBT, and seek treatment you can recognise if you're just receiving the B part, common (or just the C part, 

On 14/01/2019 at 11:19, Ashley said:

less common but not unheard of)?

My knowledge is full on this, but generally I don't think people recognise this. 

 

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4 hours ago, taurean said:
On 14/01/2019 at 11:19, Ashley said:

Is being informed about the evidence base for treatment A over treatment B helpful or not?

I have real faith in the value of this, but only if under the jurisdiction of a therapist or self-help book.

Just to clarify, I imagine we are talking about theory A v theory B?

I think this needs to be done, as a behavioural experiment, under professional guidance or supervision. It would lose value if the sufferer feels compelled to re-run the experiment (e.g.their OCD not accepting the conclusion of the experiment)  without a professional, under these circumstances, explaining what is going on. 

The idea is it's a one-off conclusive experiment to uncloak the OCD - not a compulsion to be re-run to prove a different answer (in favour of the OCD really, allegedly, being true). 

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On 14/01/2019 at 11:19, Ashley said:

 

  • When you seek treatment, are you expecting (initially) to receive treatment that is evidence based?

I think quite often when we first initially seek treatment we are unaware what to expect and what is to be offered to us, we just know we need help. So often (I think I am right to say) we are looking for a miracle cure or magic wand(so to speak to). I think finding a therapist that offers evidence based treatment that as proven successful to other patients gives us hope that we can also get better if we work along side our therapist. 

 

On 14/01/2019 at 11:19, Ashley said:

Would you want the health professional (GP / therapist) to make you aware of non evidence based treatments?

I think just because it’s not evidence based doesn’t mean it might not work for some individuals. What works for one doesn’t work for all. I think the most important concern here would be, why do they think that this treatment would be more suitable for me and could it possibly cause me to have a major setback or make things worse than what they already are? 

 

On 14/01/2019 at 11:19, Ashley said:

 

  • Is being informed about the evidence base for treatment A over treatment B helpful or not?
  • Is your understanding of the expected treatment helpful?  (so if you understand CBT, and seek treatment you can recognise if you're just receiving the B part, common (or just the C part, less common but not unheard of)

I think that evidence based treatment gives you the hope needed, an important part of recovery. 

Definetly, understanding CBT is a major part of the journey which can’t be learnt over a few weeks, in fact I’m still learning. I think one of the big downfalls of treatment and having to keep returning again and again is the lack of knowledge regarding CBT and more importantly understanding it.

If I’m honest and I’m sure I’m not alone when I say this but the biggest part for me was understanding what words were used for what eg: (going over things over and over again in your mind, this is how I would have explained it before, so understanding when someone said you spend a lot of time ruminating was referring to this. Understanding what is your obsession, what is your compulsion etc, when you first seek treatment you are unaware of what they are never mind what they are called, you are just aware that you have to do things in a certain way or a certain number of times etc. To find CBT affective you need to be aware of what they are, how the therapist refers to them so you can apply the appropriate treatment, with a correct understanding of what you are doing and why you are doing it. I think that group sessions prior to CBT therapy would prove to be very affective and give you a better understanding before starting to apply it for these reasons. 

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On 14/01/2019 at 11:19, Ashley said:

As I try and formulate the focus of my talk I just wondered what you guys thought on the subject.

  • When you seek treatment, are you expecting (initially) to receive treatment that is evidence based?
  • Would you want the health professional (GP / therapist) to make you aware of non evidence based treatments?
  • Is being informed about the evidence base for treatment A over treatment B helpful or not?
  • Is your understanding of the expected treatment helpful?  (so if you understand CBT, and seek treatment you can recognise if you're just receiving the B part, common (or just the C part, less common but not unheard of)?

1. Absolutely. I would neither expect nor accept non-evidence based treatment.

2. Not as a first line option, no- never. Any discussion of non-evidenced based treatments should be reserved for those who have failed to respond to the evidence based treatments and even then only treatments which have some evidence of efficacy (though inadeqate to qualify as 'evidence based') should be considered, with the pros and cons openly discussed in some depth. Fuller understanding by the patient is required when considering treatment which is not fully evidence based.

3. I don't think so. Unless the patient raises the option of a non-based treatment when it may be necessary to explain why they aren't being offered this and why treatment A is better.

4. I think a reasonable understanding of any treatment offered is essential for it to be efficacious. Mental health treatments are about changing how you think. That can't be achieved without patient understanding and cooperation. It's not like surgery where you can chop out the dysfunctional/diseased part whether or not the person understands what is being done.

Particularly with CBT it is helpful for the sufferer to be to recognise which bits of their therapy are cognitive and which are behavioural. The idea is we become our own therapists so learning from the outset when you're doing C and when you're doing B is essential. Then later you can apply the correct self-therapy. If you don't undrerstand which is which when you do it with a therapist then you'll always need the help of a therapist to progress (and be reliant on the therapist offering the correct/most suitable/personalised combination while you are treated 'blind'. I can'yt imagine a single case likely to be successful at changing how a person thinks if they are blindly unaware of what they are trying to achieve and the processes they need to use to get themselves there.

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Thanking the other respondees for some clarity on point 3, I see we are talking treatments not theories. 

For me the prime treatment has to be CBT and there is substantial evidence in support of that. 

There may also be evidence - and certainly in my case - for The Four Steps and Mindfulness being beneficial but only as  add-ons to the fundamentals of CBT treatment. 

I would doubt any evidence that might be presented to support meds by preference. Meds won't in my opinion resolve the underlying OCD core beliefs, they might mask them and /or reduce anxiety. So the OCD is simply held in suspension. 

SSRI meds in support of CBT can balance mood swings (as SSRIs are anti-depressants too) and - again from my own experience - boost resilience, enabling the sufferer to better engage with therapy. 

Mindfulness for me shifts my focus away from obsessing and carrying out compulsions, including over past events, and into the present in the moment. 

But it wouldn't work on its own, as again the underlying OCD would be latent, ready to bounce back - unresolved. 

Roy :)

 

 

 

Edited by taurean

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Thank you for your replies guys, and your responses are all generally what I would have expected, but you've also offered some good clarity to out into context, so thank you for that.  Whilst researching I have stumbled across some fascinating stats from Mind surveys which again back all this up, which once I collate I will share with you. 

If anybody's had any experiences of being offered non evidence based treatment for any mental health problem I would be keen to hear your thoughts on that.

 

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