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ehinchcl's picture

Individuality...

So one thing that I was struck by throughout our conversation was how much in psychotherapy individual difference plays a role. There are a few main things that I wanted to relate this to, and see what everyone else thought. (I would also love to hear Dr. Yadin's views on if this variation is good or bad for CBT as a treatment)

First, even using pure statistical results, we find that individuals vary quite a lot in terms of responsiveness to treatment. Some respond to CBT, some to drugs, some to neither (ex. CBT or drugs work 48% of the time, together they work 73%). I think its interesting that it seems like we approach these therapies on a rather general level, and then tailor them to specific individuals. Can we really say we understand the mechanism for our treatment when we can't get it to work for every patient? Are there other ways we should be approaching it to try and get it to work generally-- or is it good that the tailoring occurs?

Second, and somewhat more interesting to me, was the idea of the patient population being somewhat self-selecting. It seems that to do treatment like CBT you must be highly motivated, and you must consider yourself to HAVE a "disorder." The idea that anything that impedes normal functioning is a disorder is interesting to me-- like we've talked about all along, isn't this 'normal functioning' somewhat of a societal construct? However, being realistic, whether or not it is societal or biological the manifestations still deserve to be treated if the person wants them to be. However, this want is a big thing-- I don't know about you all, but i certainly don't approach my fears/worries head on all the time and allow myself to think about them and then let them go. (Seems to me like perhaps CBT would be useful for 'normal' people as well). I think it therefore requires a lot of dedication for something like CBT to be useful, which may decrease its success. Drugs are so much easier-- you pop a pill and feel better-- and in our current culture of instant gratification i think CBT may seem to be more and more of a hassle. This is worrisome, as I feel that what Dr. Yadin said was correct-- that we should use the brain itself for fixes first (if we have the plasticity, why not use it!?!) and drugs second because drugs can be removed and leave the initial problem. But is it ethical to deny people the 'quick fix' if it works for them? Denying treatment doesn't sound like the way to go either... Should we force people to try CBT first? Again, not so ethical.

I'd be interested to know what you guys think,

Emily

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