The probability that people suffering from depression will complete treatment can be increased significantly by asking them three questions before beginning therapy, according to a new study undertaken at the University of Haifa. "Asking these three questions will save a lot of time in identifying the most appropriate treatment for the patient. The answers will help solve a dilemma that many patients face in choosing the best type of treatment," explains Prof. Sigal Zilcha-Mano, who undertook the study.
One in five patients with depression drops out of treatment before it is completed, and most of these patients return to their pre-treatment condition. Prof. Zilcha-Mano notes that many people suffering from depression find it difficult to decide to seek treatment. When they do make this decision, it is based on a recommendation from a friend or a name they happen to encounter, without examining whether the form of treatment is necessary suitable for them.
The present study was undertaken by Prof. Zilcha-Mano in cooperation with the research student Avinadav Rubin from the Department of Psychology at the University of Haifa and a team of researchers from the Department of Psychology at the University of Pennsylvania and Adelphi University in New York. In light of the high proportion of patients who ultimately drop out of treatment, the researchers sought to examine whether any traits or characteristics that can be identified prior to treatment can predict the type of treatment that will minimize dropout. To this end, 156 patients diagnosed as suffering from clinical depression were divided into three treatment groups on a random basis. The first group (51 patients) underwent psychotherapy; the second group (55 patients) received 50-200 mg of an SSRI-type antidepressant; and the third group (50 patients) were given a placebo. Before beginning treatment, all the participants were asked various questions about different characteristics, some related to the treatment and others unrelated.
Many of the characteristics were found to have no predictive significance, including the patient's gender, whether they avoid intimate relationships, their education, and their expectations regarding the success of treatment, the study identified three questions that can predict which treatment will be most effective: the patient's expectations regarding the relationship with the therapist ("alliance expectations,") their level of vindictiveness, and their age.
The findings showed that the more an individual expects a positive relationship with the therapist, the greater their chances of completely psychotherapy and the lower their chances of completing medication. It was also found that people who show a high level of vindictiveness in their interpersonal relationships are at higher risk of dropping out from medication. Lastly, it was found that people over the age of 45 have a higher chance of completing medication, whereas those below that age have a better chance of completing treatment if they opt for psychotherapy.
For the researchers, the ramifications are clear: before beginning treatment, therapists should ask the patient to state their age, their level of vindictiveness (in an appropriate professional way, of course), and above all - their expectations on the personal level regarding the therapist. Accordingly to the answers, the therapist can determine whether the patient should undergo psychotherapy or be referred to a psychiatrist who can prescribe medication. "Within the hopelessness that forms a key part of depression, people try to find the strength to turn to treatment," Prof. Zilcha-Mano commented. "When they manage to do so, they sometimes find themselves in therapy that isn't suitable for them, and accordingly they soon drop out, thereby become even more pessimistic about the chances of overcoming depression. Accordingly, this study has enormous potential to identify the most appropriate treatment for each patient, so that when people find the strength in their depression to seek treatment, they can truly benefit from it."
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