What are the characteristics of a 'good treatment'? On the example of psychotherapy and open-label placebo.
Submission type
Symposium
Scheduled
Parallel Session V: Roland Holst kamer, 09-06-2018, 09:00 - 10:30
Kernwoorden
good treatment; psychotherapy; open-label placebo
Onderzoeksgebied
Novel (therapeutic) approaches
Beknopte samenvatting van de totale bijdrage
In both, psychotherapy and placebo research, whether an intervention has succeeded is typically related to its short-term efficacy. This symposium explores potential additional factors of a 'good treatment': Has the intervention a sustainable benefit? Is it expedient, economical, and ethical? And: How do we transparently inform our patients?
Auteurs
The Big Four E: Effectiveness, Expediency, Economy, and Ethics as criteria for 'good' psychotherapy
Trachsel, MT (Manuel)
Abstract ID
1245
Submission type
Oral only
Introductie
In the last decades, psychotherapy research was mostly focused on efficacy, effectiveness, and modes of action. Likewise, many studies have been conducted with regard to indication and suitability which can be summarized as expediency. Indeed, effectiveness and expediency are and remain crucial aims of psychotherapy. Other aims of psychotherapy have been less debated and the following question is pivotal: What are the most important criteria for 'good' psychotherapy?
Materiaal en methodes
A literature review and theoretical analysis have been performed in order to define the fundamental criteria for 'good' psychotherapy.
Resultaten
Besides effectiveness and expediency, other important goals of psychotherapy seem to have been widely neglected in psychotherapy research. Although economy and ethics have been partially studied and considered to constitute quality criteria for psychotherapy, they are far of being acknowledged as sine qua non for 'good' psychotherapy.
Conclusie
Effectiveness, expediency, economy, and ethics are seen as equally important criteria and are proposed as “The Big Four E” of 'good' psychotherapy.
Auteurs
'Good Treatment' and Placebo Effects: The Importance of Treatment Rationales
Frey Nascimento, AFN (Antje)
Abstract ID
1246
Submission type
Oral only
Introductie
An implementation of deceptive placebos in clinical practice is incompatible with ethical key principles of openness. Contrarily, open-label placebos bare the potential to harness powerful placebo effects in the sense of 'good treatment'. Yet, comparisons between open-label and deceptive placebos are lacking and effects of plausible treatment rationales are rarely examined.
Materiaal en methodes
We assessed effects of open-label and deceptive placebos with an experimental heat pain paradigm in a RCT. Healthy participant (N = 160) were randomly assigned to no treatment (NT), open-label placebo without rationale (OPR-), open-label placebo with rationale (OPR+) and deceptive placebo (DP). Primary outcomes were measurements of heat pain. Apart from the NT, in all groups a placebo cream was administered.
Resultaten
Groups with a rationale (OPR+ and DP) reported diminished subjective heat pain ratings at posttreatment compared to the OPR- group. Interestingly, the OPR+ and the DP groups did not significantly differ in subjective heat pain ratings at posttreatment.
Conclusie
Our results question the necessity of concealment in placebo administration and emphasize the importance of transparency and communication of intervention rationales. In this view, open-label placebos illustrate an example of 'good treatment', complying with ethical key principals and offering a plausible treatment rational.
Auteurs
Are psychotherapeutic interventions 'good treatments'? A summary of meta-analytic findings focussing on the efficacy in the short- versus long-term.
Gerger, HG (Heike)
Abstract ID
1247
Submission type
Oral only
Introductie
Efficacy, expediency, economy and ethics have been presented as criteria for 'good treatment'. But what exactly does efficacy relate to? The present talk will summarize meta-analytic findings on short- vs. long-term outcomes of psychotherapeutic interventions in diverse areas of health care.
Materiaal en methodes
Meta-analyses on randomized controlled trials comparing the efficacy of psychotherapeutic interventions with control interventions.
Resultaten
Across diverse areas of health care—i.e. the treatment of posttraumatic stress disorder, of medically unexplained symptoms, and the enhancement of medication adherence in adults with human immunodeficiency virus—psychotherapeutic interventions are superior over control interventions immediately after the end of treatment, however, no long-term benefits of psychotherapeutic interventions over controls could be observed.
Conclusie
The lack of sustainable benefits of psychotherapeutic interventions over control interventions has several consequences regarding the consideration of psychotherapeutic interventions as 'good treatments': In addition to economical considerations, for instance whether an expensive treatment should indeed be implemented if benefits are of only short duration, patients need to be informed about the long-term perspective of psychotherapeutic intervention effects, in order to be able to make an informed choice regarding possible alternative treatment options.
Auteurs
Discussion of the findings and implications for clinical practice
Locher, CL (Cosima)
Abstract ID
1248
Submission type
Oral only
Introductie
The presentations in this symposium explored the question, “what characterizes a ‘good’ treatment'? In this discussion, the presented findings will be summarized and important conclusions will be drawn. Furthermore, patients’ as well as clinicians’ idiosyncratic perspectives on what makes a treatment ‘good’ will be explored.
Materiaal en methodes
We performed qualitative assessments with patients and clinicians in a Swiss clinic. We used semi-structured, open-ended questionnaires. The questionnaire guide was designed to elicit patients’ and clinicians’ narratives of what characterizes a good treatment. We based our qualitative methods on content analysis.
Resultaten
Multiple variables such as the clinician-patient relationship (eg “the talks with the clinician helped me to bring my thoughts in order“ [patient]), the expertise of the clinician (eg "the professional competence of the clinician“ [patient]), as well as the intensity of the intervention (eg "when I have the time to be really with the patient and his thoughts – when nothing disturbs me” [clinician]) characterize a good treatment according to patients and clinicians.
Conclusie
Knowledge of what factors characterize a ‘good’ treatment can guide clinicians, health care providers, and researches. Our findings highlight the importance of personalized healthcare and idiosyncratic procedures. The ethical question of how we transparently inform patients will be addressed.
Auteurs
