AUTHOR: DON'T THROW EVERY TREATMENT IN BOOK AT MENTAL DISORDERS

Brad Schmidt

 

"It's really difficult to determine who responds best to what kind of treatment."


COLUMBUS, Ohio - Combining medication with behavior modification therapy may not be the best way to help a patient overcome a psychological disorder.

Intuition leads many mental health professionals to believe that the most effective way to deal with a psychological disorder is to throw every treatment in the book at it and hope for a good result, said Brad Schmidt, an associate professor of psychology at Ohio State University.

"We don't know a whole lot about the benefits of combined treatments," he said.

"There isn't compelling evidence to support the use of combined therapies - the few studies that have been done show that combining treatments isn't always the best way to go."

Schmidt, is co-editor of the new book Combined Treatments for Mental Disorders (American Psychological Association, 2001.)

It addresses the viability of combining treatments for a variety of psychological disorders, from nicotine addition to obsessive/compulsive disorder.

"Behavioral treatments for certain disorders, such as anxiety and phobias, are often better than drug treatments,"
Schmidt said. "They also don't carry the risks of dependence that sometimes result from using certain medications."

Certain conditions do appear to benefit from combined treatments, such as schizophrenia and bipolar disorder. But the advantage of combining treatments to treat other disorders, such as major depression, isn't as clear.

Some studies on major depression have shown combination therapies to be more effective than either behavior or drug therapy alone, particularly for patients with severe or chronic depression.

Yet behavioral treatments may be the best option for patients with less severe cases of depression, research indicates. Historically, behavioral therapies have resulted in higher compliance rates, fewer adverse side effects and lower relapse rates after therapy ends.

"Half of all patients with a mental disorder may be helped with medication and the other half may do best with behavioral treatments," Schmidt said. "It's really difficult to determine who responds best to what kind of treatment."

Schmidt, who also directs the Anxiety and Phobia Disorders Clinic at Ohio State, is particularly interested in which treatments work best for patients seen in his clinic.

"We know a good deal about singular treatments used for phobic anxiety conditions, but relatively little about combined treatments," he said. "But still, combined treatments are widely used and accepted in practice.

Some studies have shown immediate, short-term benefits to combined treatments to treat anxiety disorders. But it appears these benefits don't last much longer than the treatment phase.

"Many anxiety disorders may be better treated with behavioral interventions, rather than medication, or use of both treatments together," Schmidt said.

For instance, changing the patient's behavior seems to be the treatment of choice for social phobia. While some medications work, behavioral interventions consistently show equal or better effectiveness, Schmidt said. Moreover, behavioral treatments don't have the same relapse rates and side effects associated with drugs. However, since phobic anxiety is often quite debilitating, a physician might be tempted to use all available remedies.

"There's no evidence that this 'shotgun' approach helps control phobic anxiety any better than singular treatments," Schmidt said. "In some cases, combined treatments may lead to poorer outcomes. It's a little surprising that combined treatments aren't more clearly beneficial for patients with phobic anxiety disorders."

Also, using medication to treat a condition may lead a patient to believe that hers is a biological problem, and therefore believe that the only solution to the problem is to take medication. And becoming too dependent on medication may make the patient less apt to practice her behavioral skills.

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Contact: Brad Schmidt; 614-292-2687; Schmidt.283@osu.edu
Written by Holly Wagner, 614-292-8310; Wagner.235@osu.edu

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(Last updated 10/8/01)