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Dentistry is also trying out a dental hygienist who can drill and fill.
Using the same arguments about lack of rural access, I might add.
Dentistry is also trying out a dental hygienist who can drill and fill.
It seems like every profession uses that argument to expand their scope of practice. I know optometrists have used that argument to be able to do some simple eye surgeries.Using the same arguments about lack of rural access, I might add.
Coming back to this particular aspect of the discussion because we all touched on it some but I'm curious to think/learn more about it. In my region/training program, dynamic therapy is something that is, in a way, expected to take a while to lead to results. There can be an initial both worsening of symptoms (no longer avoiding difficult emotions) and improvement (stable alliance/feeling held/not alone), but I don't think either really reflects the possible future results. CBT is also not really practiced in the "12 weeks and done" fashion unless you get a patient who responds very quickly to the intervention (rare). So both types of therapy end up being something that goes on for multiple months--sometimes with patient-reported improvement and sometimes not. But also some patients, for their dynamic reasons, would be very reluctant to admit any improvement unless things were way better (depressive PD / transferrence of inadequate prior object.) So how do you use a brief trial to judge effect if the interventions actually tend to take a while and are known to sometimes initially worsen symptoms?It's fine if you want to start for a 3 month trial of Brief Dynamic, and assess for response. If not effective then switch to IPT or CBT, or perhaps schema therapy or TFP, etc.
Definitely depends on the treatment and the population. In my old clinic when I did PTSD treatment, mainly using PE, I'd say the majority of people had pretty significant improvements in avoidance and re-experiencing symptoms by 6-8 weeks. This was a somewhat motivated, treatment seeking sample, but I was still surprised by the consistency of improvements within 1-2 months. I also saw a fair amount of people with panic disorder w and w/o agoraphobia, and those improvements were pretty start, usually even within the first month.CBT is also not really practiced in the "12 weeks and done" fashion unless you get a patient who responds very quickly to the intervention (rare).
CBT is also not really practiced in the "12 weeks and done" fashion unless you get a patient who responds very quickly to the intervention (rare). So both types of therapy end up being something that goes on for multiple months--sometimes with patient-reported improvement and sometimes not.
It should be! That's how the treatment is designed and how all the trials are run. It's also not rare at all that people respond very quickly (and 3 months is not all that quick...)
We don't have great long term RTC data on most meds, either.
Regarding CBT (ect.) trials, they are great at saying that the average person gets y BDI points better after 12 weeks, but say nothing about what to do for the large percentage of non-responders and the plaurality of partial responders. To answer these questions, we really need large trials with, for example, SMART designs.
What do you do when someone started CBT and went from severe MDD to moderate MDD over 12 weeks? Say, congratulations, you got the expected BDI improvement but now since there is no adequate clinical trial to inform us on what to do we'll stop the CBT?
We don't have great long term RTC data on most meds, either.
Regarding CBT (ect.) trials, they are great at saying that the average person gets y BDI points better after 12 weeks, but say nothing about what to do for the large percentage of non-responders and the plaurality of partial responders. To answer these questions, we really need large trials with, for example, SMART designs.
What do you do when someone started CBT and went from severe MDD to moderate MDD over 12 weeks? Say, congratulations, you got the expected BDI improvement but now since there is no adequate clinical trial to inform us on what to do we'll stop the CBT?
Definitely depends on the treatment and the population. In my old clinic when I did PTSD treatment, mainly using PE, I'd say the majority of people had pretty significant improvements in avoidance and re-experiencing symptoms by 6-8 weeks. This was a somewhat motivated, treatment seeking sample, but I was still surprised by the consistency of improvements within 1-2 months. I also saw a fair amount of people with panic disorder w and w/o agoraphobia, and those improvements were pretty start, usually even within the first month.
In comparison, doing PE in the VA? Um....not so good, but then we have an incentive seeking population who sees more benefits the sicker they are, so I'd hardly use these as equal comparisons.