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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by jane d on January 25, 2003, at 21:12:34
Really fascinating presentation. It answered many of the questions I've had after reading the news reports about earlier studies and gave me lots more. I can't wait to see the results of the next study. I'd be grateful for answers to any of the following questions.
The cognitive therapy patients were more likely to have some residual symptoms after treatment. Was there any type of symptom that was more likely to remain, for example sleeping and eating disturbances as opposed to guilt and hopelessness or ability to slog thru daily activities? Also, did CT or meds make a difference in whether patients had the same symptoms when they relapsed as when they entered the study?
I also wondered how many of the subjects had been on medication prior to the study. I've heard that most people are prescribed SSRI's right off the bat - frequently by their family doctor - so I would have thought that most people coming into a study would have tried an SSRI even if it wasn't Paxil and that it didn't work for them.
Were any medication adjustments allowed in the continuation phase and how often were the follow up medication visits?
On the CT side was there any provision for matching particular therapists with patients - honoring patient gender preferences for example?
I've always felt that the explanations for how cognitive therapy and medication work are somewhat mutually exclusive with my own belief being that emotions drive cognitions rather than the other way around and that medication works on the emotions resulting in a less negative outlook. Since both approaches seem to work does that mean that the explanations for why one or both work are wrong or are they not truly mutually exclusive after all?
Posted by Dr. Bob on February 12, 2003, at 8:05:49
In reply to Hollon: Difference in response profile etc, posted by jane d on January 25, 2003, at 21:12:34
> The cognitive therapy patients were more likely to have some residual
> symptoms after treatment. Was there any type of symptom that was more
> likely to remain, for example sleeping and eating disturbances as
> opposed to guilt and hopelessness or ability to slog thru daily
> activities? Also, did CT or meds make a difference in whether
> patients had the same symptoms when they relapsed as when they
> entered the study?We just haven't looked yet at specific residual symptoms, although we will. My impression is that concentration problems tend to be the most likely residual problems left in CT alone.
> I also wondered how many of the subjects had been on medication prior
> to the study. I've heard that most people are prescribed SSRI's right
> off the bat - frequently by their family doctor - so I would have
> thought that most people coming into a study would have tried an SSRI
> even if it wasn't Paxil and that it didn't work for them.Many of the patients had prior histories of medication treatment, but only some had adequate trials.
> Were any medication adjustments allowed in the continuation phase and
> how often were the follow up medication visits?Treating psychiatrists were free to adjust medication levels as needed during continuation (they sometimes raised but rarely lowered) and also free to augment - whatever they needed to do to keep the patient well.
> On the CT side was there any provision for matching particular
> therapists with patients - honoring patient gender preferences for
> example?We did not match patient to therapist - for the rare patient with a strong preference we typically asked them to try the next available therapist and offered to switch them if it didn't work out - after a session or two nobody asked to be switched.
> I've always felt that the explanations for how cognitive therapy and
> medication work are somewhat mutually exclusive with my own belief
> being that emotions drive cognitions rather than the other way around
> and that medication works on the emotions resulting in a less
> negative outlook. Since both approaches seem to work does that mean
> that the explanations for why one or both work are wrong or are they
> not truly mutually exclusive after all?I doubt that they are mutually exclusive - if I start thinking about past slights I start getting angry, but if something gets me angry everything becomes a provocation - most of the science I have seen suggests that thinking can drive emotion (try dwelling on a past disappointment and see what happens to your mood) but that emotion also influences thinking.
Posted by jane d on February 14, 2003, at 0:09:42
In reply to from Dr. Hollon: Difference in response profile, posted by Dr. Bob on February 12, 2003, at 8:05:49
Please thank Dr. Hollon for his answers to all the questions. I will be following his research with interest from now on.
And thank you for coordinating his appearance here.
Jane
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