Evaluation And Improvement Of The Implementation Of The Intention To Treat Model In Controlled Trials Of Psychotherapies
Funder
National Health and Medical Research Council
Funding Amount
$409,000.00
Summary
Randomized controlled trials (RCTs) are the best way to determine whether patients benefit from a new treatment. In these trials patients are randomly assigned to the new, active treatment, or to a placebo or existing treatment. The groups are compared at the end of the trial. RCTs may be mounted for psychotherapy and educational programs as well as for new drugs and other medical procedures. A major problem for RCTs concerns their statistical analysis when some participants drop out before the ....Randomized controlled trials (RCTs) are the best way to determine whether patients benefit from a new treatment. In these trials patients are randomly assigned to the new, active treatment, or to a placebo or existing treatment. The groups are compared at the end of the trial. RCTs may be mounted for psychotherapy and educational programs as well as for new drugs and other medical procedures. A major problem for RCTs concerns their statistical analysis when some participants drop out before the end of the trial. Dropout is common in trials. Participants may drop out because they feel no benefit from the treatment, dislike side effects, or even because they have recovered quickly. Thus, to compare the groups remaining at the end of trial may introduce serious bias. The Intention to Treat (ITT) principle which has been widely adopted states that outcomes from all patients who enter a trial should be compared at its end. To achieve this, the last available observation for a participant who withdraws is often 'carried forward' to the end of the trial. While currently believed to be conservative, there is evidence that this approach is not always optimal. This project will examine the way in which dropout is treated in trials of two common psychiatric conditions: depression and anxiety disorders. The project will also undertake simulation research to investigate which of a number of modern methods of data analysis yield the most accurate results when participants drop out, and how changes in the design of trials might improve accuracy. The project is important because it will enable researchers to improve the conduct of trials in the future. Erroneous conclusions drawn from RCTs stand to condemn those suffering from disorders to ineffective treatment and to lead to the premature abandonment of potentially useful interventions which are falsely claimed to lack efficacy.Read moreRead less
Theoretically Guided Improvement In The Treatment Of Social Phobia: A Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$302,830.00
Summary
Social phobia is a serious mental disorder that affects up to 13% of the population across their lifetime and causes marked life interference and costs to the community. Treatments for social phobia have been improving over the past decades and currently, there is good outcome with standard treatment packages. However, several authors have pointed out that treatment outcomes, while good, are far from perfect. We have recently developed a model of social anxiety that points out how people with so ....Social phobia is a serious mental disorder that affects up to 13% of the population across their lifetime and causes marked life interference and costs to the community. Treatments for social phobia have been improving over the past decades and currently, there is good outcome with standard treatment packages. However, several authors have pointed out that treatment outcomes, while good, are far from perfect. We have recently developed a model of social anxiety that points out how people with social phobia may be different to the average. Based on this model, we can make several predictions for potential improvements to current treatment packages. The current grant seeks to test these improvements. The proposal is to compare people with social phobia who receive a standard treatment package with those who receive this packaged plus the newly predicted components. It is predicted that the addition of these extra components will results in considerably greater improvements in both the short and long terms.Read moreRead less
What's In A Conversation? Discourse Correlates Of Concepts In The Conversational Model Of Psychotherapy
Funder
National Health and Medical Research Council
Funding Amount
$240,952.00
Summary
How and why does therapeutic talk assist people with mental health disorders to change and restore their sense of self? How do psychiatrists read the potential for such change in the discourse of their patients? This collaborative project, between psychiatry and linguistics, investigates the role of language in providing both strategies for change and evidence of change in the Conversational Model of psychotherapy. The project will examine the linguistic patterns that occur in the forms of talk ....How and why does therapeutic talk assist people with mental health disorders to change and restore their sense of self? How do psychiatrists read the potential for such change in the discourse of their patients? This collaborative project, between psychiatry and linguistics, investigates the role of language in providing both strategies for change and evidence of change in the Conversational Model of psychotherapy. The project will examine the linguistic patterns that occur in the forms of talk used by therapists employing the Conversational Model of Psychotherapy, in order to produce a better understanding of certain mental illnesses, and how they can be treated. Specifically, it will: 1. describe, linguistically, four key discourse categories of the Conversational Model that are taken as indicators of progress in patients with Borderline Personality Disorder 2. explain the therapeutic work of such discourse - what is it about these particular language resources that facilitates the observed changes in patients' discourse and mind? 3. assess the stability of key discourse categories of the Conversational Model, and test the ability of a linguistic profile to reliably distinguish between key therapeutic categories as used by different clinicians. The positive effects of Conversational Therapy on incidence of self harm, violence, hospital stays, drug use and self-reported symptoms in this group have been well documented and are especially impressive given that many of the patients in these studies had been turned away from other forms of treatment as unresponsive. By understanding better how this therapy works in a patient group that is typically resistant to treatment but responsive to this particular treatment, we hope to improve health outcomes for people diagnosed with Borderline Personality Disorder. In the longer term we expect this research to help improve techniques for enhancing the mental health of Australians more generally.Read moreRead less