Jung At Heart

...Ramblings About Psychotherapy and Whatever Else Comes to Mind...

Another skirmish in Brain vs. Mind

I've written before about the big battle ground in mental health -- the one between brain and mind. It's quite likely in the end that some wise soul will be able to demonstrate that this is not an either/or problem, that it is indeed a both/and issue. It is interesting to me that even as we urge people to pay attention to the ways their emotional and mental state impacts physical health, in mental health we are being pushed into seeing everything as a matter of biochemistry. Interesting paradox there.

Some time ago I noted this study reported on WebMD which says a great deal about the battle and about the heavy contribution of mind. It is a fairly large study, 335 patients, mostly male, identified as depressed. The patients were asked what treatment they preferred -- medication, therapy, or both medication and therapy.

All patients were asked what kind of treatment they preferred. Fifteen percent preferred medication, 24% preferred psychotherapy, and 61% preferred both. Most of this latter group, Chaney says, actually had no strong preference and were considered "matched" with their preferred treatment if they received either antidepressants or psychotherapy.

I'm not sure why they concluded that those expressing a preference for both were considered matched regardless of which group they were assigned to. If I ran the study I would considered looking further into this group and not assigned them to either of my study groups.

All patients' depression improved after treatment.

But after three months of treatment, the 72% of patients matched with their preferred treatment were significantly less depressed than those not matched. Patients who got their preferred treatment also tended to be less depressed after nine months.

This is strong evidence, in my mind at least, that what patients believe about their problems and their cause is of huge importance. A factor not looked at is the interaction of patient belief with therapist/doctor belief. I suspect that it is an element of "good-fit" that best outcomes in treating mental health problems is the result of both patient and professional sharing a common belief in what causes the problem and what is the best treatment.

No mention is made in this study of another done about 7 years ago -- and I do not have the reference at hand -- that did a meta-analysis of  pooled studies on the efficacy of SSRI's. And the results were that only 17% of the improvement noted was due to the effects of SSRIs themselves. The largest factor was the placebo effect.

I've more thoughts on this but no time right now. Here's a thought -- placebo effect is the most potent tool we have and the least studied as it is viewed as a contaminant in studies where medications are involved.

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