How do we determine if a treatment is working?
Measuring treatment quality is important if treatment professionals wish to improve it. If you don’t know if something is broken, how will you know that it needs to be fixed? There are several ways of measuring treatment effectiveness. One way is to look at treatment outcome. If patients take their medication and their schizophrenia symptoms worsen, they do not have a good outcome. Another way to measure how a treatment is working is through compliance.
If patients stick with their treatment and participate in it, then they are treatment compliant. If a patient is not compliant with a specific treatment it may mean one of the following:
1) the treatment itself if causing harm and the patient stops taking it in order to feel better,
2) there are other variables in the patient’s life that are making it difficult to continue treatment, or
3) the treatment works so well the patient thinks they are cured and stops taking their medication.
Measuring treatment compliance can help clinicians figure out what part of a specific treatment is working and what needs to be changed.
Measuring treatment success is difficult. Information about outcome might come from several sources. A therapist might record his impression of a patient at the beginning of treatment and then at the end. Alternatively, treatment success might be measured by a patient’s report of his or her own progress. Some outcome measures include questionnaires or worksheets that are completed multiple times over treatment.
All these options have their strengths and weaknesses. One weakness is that outcome measures can be biased. Because therapists want to believe that they are helping their patients, they might believe they see improvement even when there is none. Alternatively, a patient might be motivated to lie about his own progress because he wants to leave treatment. Another way that patients may provide inaccurate information about their improvement may come from a desire to please the therapist. Patients may want to make their therapists feel good and like them, and, in so doing, may pretend that their symptoms are improving. Finally, although questionnaires can be helpful at measuring symptom change, they are incomplete and can obscure other important symptoms. One example of this is measuring behaviors versus emotions.
Consider the relationship between suicide and depression. You might assume that the more depressed people are, the more likely they are to be suicidal. But this is not the case. Many patients, when profoundly depressed, lack the energy to commit suicide. Thus, when their depression begins to improve, they are actually more likely to attempt suicide than when they were more severely depressed. If researchers are interested in how well a treatment program is working on suicide attempts, they must obtain information about both depression and suicidal thoughts and behaviors. A questionnaire might not reveal a complete picture of the patient.
Successfully measuring treatment outcome requires as comprehensive an approach as does treatment design. Researchers need to better understand the therapist-patient relationship in schizophrenia. They need to figure out how to keep a patient in treatment in order to determine whether a specific approach is working. Finally, they need to consider measuring improvement in all areas of the illness, including positive and negative symptoms, side effects, social and occupational functioning, and interpersonal skills.
Schizophrenia research progresses every day. Clinical trials examining the effectiveness of existing medications are yielding more and more information about the kinds of patients that may be helped by specific treatments. Researchers are working on developing more sophisticated medications that improve symptoms with fewer side effects. Therapists are working on designing psychological interventions that provide information and support to patients suffering from schizophrenia. Finally, social workers are focusing on how to identify the needs of patients in order to help them obtain the resources they need to live independently.
Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.