Randomized controlled trials (RCTs) are one of the fundamental building blocks for creating any empirically supported therapies (ESTs). This implies that ESTs should be standard and superior treatment as they are founded and based on scientific and quantifiable evidence, which, of course, is the goal of any science. However, the stance is widely controversial as it is derived from assumptions that have minimal support and consensus data such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). Due to its flawed foundation, opponents of this notion suggest that it should not be the only standard for advancing ESTs nor the most worthy determinant of efficacious treatment. In addition, RCTs do not always show promising results in
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RCTs assume that psychopathologies are malleable, meaning that their expression changes over time and can be alleviated with the right treatment (Westen et al., 2004). Specifically, proponents of ESTs have noted that after six to sixteen sessions of treatment, a change can be observed (Westen et al., 2004). The symptoms seem to dissipate after this ultra short period. A problem with short treatment is the high rate of remittance that follows. Although patients show improvement via a diminished or evaporated expression of symptoms, there is also an increasing probability of relapse shortly after the end of treatment (Westen et al., 2004). Meta-analytic studies that observe the outcome of ESTs after six months intervals for a variety of disorders suggest that most psychopathologies are resistant to change due to high relapse rates (Westen et al., 2004). This contradicts the EST assumption of malleability, and obviously is a limitation, as it does not prove that the treatment is effective in the long term. Furthermore, the window for treatment is kept very short as a rule of thumb for proper experimental design (Westen et al., 2004). As treatment duration is extended, there is an increasing risk of noise entering, which decreases the researcher’s ability from drawing conclusions from the study (Westen et al., 2004). Thus, short durations avoid …show more content…
It relies on the assumption that patients most likely express symptoms or maladaptive behaviours that accurately align with a particular axis one diagnosis (Westen et al., 2004). The inevitable truth, however, is that in clinical practice, most people who seek help for mental illnesses do not meet requirements for a DSM-IV diagnosis, meaning they either possess symptoms that do not fit or meet a sub-threshold level, or meet the requirements for multiple DSM-IV disorders (Westen et al., 2004). Thus treatment as a consequence of this assumption, alone, is unsatisfactory. Many patients, for this reason, do not respond to the first line ESTs for most disorders as manuals precisely target disorders classified by the DSM-IV. In order for patients to receive help, manuals that target “sub-threshold” diagnoses or other disorders not specified by the DSM-IV must be
RCTs assume that psychopathologies are malleable, meaning that their expression changes over time and can be alleviated with the right treatment (Westen et al., 2004). Specifically, proponents of ESTs have noted that after six to sixteen sessions of treatment, a change can be observed (Westen et al., 2004). The symptoms seem to dissipate after this ultra short period. A problem with short treatment is the high rate of remittance that follows. Although patients show improvement via a diminished or evaporated expression of symptoms, there is also an increasing probability of relapse shortly after the end of treatment (Westen et al., 2004). Meta-analytic studies that observe the outcome of ESTs after six months intervals for a variety of disorders suggest that most psychopathologies are resistant to change due to high relapse rates (Westen et al., 2004). This contradicts the EST assumption of malleability, and obviously is a limitation, as it does not prove that the treatment is effective in the long term. Furthermore, the window for treatment is kept very short as a rule of thumb for proper experimental design (Westen et al., 2004). As treatment duration is extended, there is an increasing risk of noise entering, which decreases the researcher’s ability from drawing conclusions from the study (Westen et al., 2004). Thus, short durations avoid …show more content…
It relies on the assumption that patients most likely express symptoms or maladaptive behaviours that accurately align with a particular axis one diagnosis (Westen et al., 2004). The inevitable truth, however, is that in clinical practice, most people who seek help for mental illnesses do not meet requirements for a DSM-IV diagnosis, meaning they either possess symptoms that do not fit or meet a sub-threshold level, or meet the requirements for multiple DSM-IV disorders (Westen et al., 2004). Thus treatment as a consequence of this assumption, alone, is unsatisfactory. Many patients, for this reason, do not respond to the first line ESTs for most disorders as manuals precisely target disorders classified by the DSM-IV. In order for patients to receive help, manuals that target “sub-threshold” diagnoses or other disorders not specified by the DSM-IV must be