Measuring Outcomes: Reducing harmful outcomes associated with treatments

Measuring Outcomes: Reducing harmful outcomes associated with treatments

Despite numerous systematic efforts to assess the efficacy of structured treatment protocols, there has been little research done on how treatment interventions could be potentially harmful to clients. Treatment interventions are not assessed thoroughly, nor have there been proper standards upheld with regards to harmful events being reported. Harmful effects could be multifaceted, encompassing factors such as deterioration of functioning and worsening of symptoms, client dropout within the interventions due to deterioration of functioning, the therapeutic alliance and its role in symptom improvement being uncertain other than for the prevention of client dropout, family members and loved ones viewing  interventions as a form of abuse; producing  false allegations against the practicing clinician, and interventions assuaging the initial presenting symptom but then causing adverse effects to develop in other areas functionally.

Evaluation of harm from interventions need to be regularly and systematically assessed. Solutions would entail statistical evaluation of potential benefits and harm from treatment based upon routine reporting of the number of clients needed to be treated to attain clinically notable improvement (NNT) and the number of clients needed to be treated before one is harmed (NNH). Measurement-based care (MBC) and the systematic collection of patient-reported measures are also important for improvement of assessing possible harm. Overall, these routine assessments can help clinicians better determine when their treatment is becoming insufficient or aversive and modify their choice of interventions accordingly.

References: McKay, D., & Jensen-Doss, A. (2021). Harmful treatments in psychotherapy. Clinical Psychology: Science and Practice, 28(1), 2–4. https://doi-org.ruby.uhv.edu/10.1037/cps0000023

 

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Obsessive-Compulsive Disorder (OCD) describes a condition in which an individual has uncontrollable thoughts and/or behaviors (i.e., compulsions) that are problematic on an ongoing basis (National Institute of Mental Health), and these symptoms can be experienced by adults as well as children and adolescents. Common treatments for OCD involve exposure therapy, which is sometimes combined with a selective-serotonin reuptake inhibitor (SSRI) medication (International OCD Foundation). However, recent advances in treatment for OCD are now including Acceptance and Commitment Therapy (ACT), which is a form of therapy that encourages individuals to accept unwanted thoughts without judgment, separate themselves from their thoughts, engage in activities that move the individual toward life values, and mindfulness (see contextualscience.org/act for more information). Although there is growing evidence for ACT as a component of treatment for OCD, the majority of these studies have been conducted with adults. Therefore, Armstrong and colleagues (2013) evaluated the effects of ACT for three adolescents (ages 12-13 years old) diagnosed with OCD.

Participants in this study reported fears about contamination and dying which were linked to problematic behaviors such as excessive hand washing, frequent reassurance-seeking, and lengthy bedtime routines. Treatment occurred weekly over the course of 8 weeks and involved a variety of components. A few examples of treatment components were 1) identifying differences between obsessions and compulsions; 2) drawing activities; 3) education about and activities surrounding the futility of fighting thoughts; 4) identifying life values; 5) accepting unwanted thoughts; and 6) mindfulness. Each treatment session was 50 min and included related homework assignments. The results of this study showed that self-reported compulsions decreased by 40%, and these effects were maintained at a 3-month follow up, and treatment was rated as highly acceptable by participants as well as their parents.

Armstong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27, 175-190.