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There are several methods utilized in the treatment of mental health-related issues. CBT, DBT, PE, CPT, Behavior therapy, reality therapy, and REBT are just a few of those common therapies. It is not uncommon for patients to also consider alternative treatment methods such as acupuncture, hypnosis, religious/spiritual counseling, ECT, pharmacology, cultural healer/medicine man etc. For this paper, you will discuss various types of treatment approaches, both psychotherapeutic and alternative therapeutic practices, as well as the role of the clinical manager in supporting the clinician during the patient's treatment process.

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  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
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Write a paper (1,250-1,500 words) discussing the various types of treatment approaches, both psychotherapeutic and alternative therapeutic methods, as well as the role of the clinical manager in supporting the clinician during the patient's treatment process. Include the following in your paper:

  • A brief identification and explanation of one psychotherapy treatment and one non-traditional or alternative treatment approach.
  • A research-based contrast of the application of these treatments when working with clients presenting anxiety, depression, personality disorder, or PTSD.
  • A research-based discussion of the role of the clinical manager when working with a clinician serving a client that expressed interest in including an alternative treatment method as part of the overall treatment plan.
  • A research-based argument for the acceptance of a psychopharmacology approach for some disorders.


A brief identification and explanation of one psychotherapy treatment and one non-traditional or alternative treatment approach is thoroughly presented.

A research-based contrast of the application of these treatments is thoroughly presented. Ideas are supported with scholarly current or seminal research.

A research-based discussion of the role of the clinical manager is thoroughly presented. Ideas are supported with scholarly current or seminal research.

A research-based argument for the acceptance of a psychopharmacology approach is thoroughly presented. Ideas are supported with scholarly current or seminal research.

Synthesis of source information is present and is scholarly. Argument is clear and convincing, presenting a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

All required elements are present. Scholarly research sources are topic-related, and obtained from highly respected, professional, original source.

Thesis and/or main claim are clear and comprehensive; the essence of the paper is contained within the thesis.

The document is correctly formatted. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

Reference and material to read:

Wheeler, R. B. (2012). Alternative treatments for mental health. Everyday Health.

Mehl-Madrona, L. E. (n.d.). Development of an integrated program with conventional American medicine and evaluation

of effectiveness. Traditional (Native American) Indian Medicine.

Unformatted Attachment Preview

Journal of Consulting and Clinical Psychology 2012, Vol. 80, No. 6, 995–1006 © 2012 American Psychological Association 0022-006X/12/$12.00 DOI: 10.1037/a0030452 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Comparative Effectiveness of Medication Versus Cognitive-Behavioral Therapy in a Randomized Controlled Trial of Low-Income Young Minority Women With Depression Juned Siddique Joyce Y. Chung Northwestern University National Institute of Mental Health, Bethesda, Maryland C. Hendricks Brown Jeanne Miranda University of Miami University of California, Los Angeles Objective: To examine whether there are latent trajectory classes in response to treatment and whether they moderate the effects of medication versus psychotherapy. Method: Data come from a 1-year randomized controlled trial of 267 low-income, young (M ⫽ 29 years), minority (44% Black, 50% Latina, 6% White) women with current major depression randomized to antidepressants, cognitivebehavioral therapy (CBT), or referral to community mental health services. Growth mixture modeling was used to determine whether there were differential effects of medication versus CBT. Depression was measured via the Hamilton Depression Rating Scale (Hamilton, 1960). Results: We identified 2 latent trajectory classes. The first was characterized by severe depression at baseline. At 6 months, mean depression scores for the medication and CBT groups in this class were 13.9 and 14.9, respectively (difference not significant). At 12 months, mean depression scores were 16.4 and 11.0, respectively (p for difference ⫽ .04). The second class was characterized by moderate depression and anxiety at baseline. At 6 months, mean depression scores for the medication and CBT groups were 4.4 and 6.8, respectively (p for difference ⫽ .03). At 12 months, the mean depression scores were 7.1 and 7.8, respectively, and the difference was no longer significant. Conclusions: Among depressed women with moderate baseline depression and anxiety, medication was superior to CBT at 6 months, but the difference was not sustained at 1 year. Among women with severe depression, there was no significant treatment group difference at 6 months, but CBT was superior to medication at 1 year. Keywords: personalized medicine, paroxetine, buproprion, CBT, growth mixture model Major depression, a disorder with early onset and an often chronic course, imposes a high individual burden of pain, suffering, and disability. Ethnic minority and poor individuals are less likely to receive treatment, particularly guideline-informed care, for major depressive disorder than are White and middle-class individuals (U.S. Department of Health and Human Services [DHHS], 2001). This may be related to the fact that most depression treatment studies include primarily White and middle-class populations (DHHS, 2001), so that little is known about the usefulness of established treatments for more disadvantaged populations. Establishing the effectiveness of depression care in this population is particularly important because rates of depression are elevated in women, younger age cohorts, and those living in or near poverty (Andrade et al., 2003). Because low-income women with depression have few resources and many challenges to overcome to begin and continue with treatment, it is important to make thoughtful, personalized decisions regarding the most effective intervention for a given patient. If an initial treatment strategy is This article was published Online First October 22, 2012. Juned Siddique, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; Joyce Y. Chung, National Institute of Mental Health, Bethesda, Maryland; C. Hendricks Brown, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine; Jeanne Miranda, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. This work was supported by Agency for Healthcare Research and Quality Grant R03-HS018815, National Institute of Mental Health (NIMH) Grant R01-MH040859, and National Cancer Institute Grant K07-CA154862. None of the funding agencies played a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the article. Juned Siddique, Joyce Y. Chung, and Jeanne Miranda do not have any conflicts of interest to disclose. C. Hendricks Brown is principal investigator on two NIMH grants that evaluate the impact of antidepressants (R01-MH040859 and R01-MH080122). He has also served as a principal investigator on a research grant funded by JDS Pharmaceuticals that supported the evaluation of a behavioral prevention program for suicide. Correspondence concerning this article should be addressed to Juned Siddique, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611. E-mail: 995 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 996 SIDDIQUE, CHUNG, BROWN, AND MIRANDA not effective, patients may not have the additional resources or the desire to pursue another course of treatment. In this article we describe an exploratory analysis to investigate whether there are latent trajectory classes in response to treatment and whether these latent classes moderate the effects of antidepressants versus cognitive behavioral therapy (CBT) in a sample of low-income young minority women. Comparative effectiveness research has recently received a considerable amount of attention due to the desire by many stakeholders to have more evidence about the relative merits and costs of medical interventions. The U.S. Congress asked the Institute of Medicine as part of the American Recovery and Reinvestment Act of 2009 to determine national priorities for comparative effectiveness research. Among the 100 highest priority research topics identified by the Institute of Medicine, Committee on Comparative Effectiveness Research Prioritization (2009), was “Compare the effectiveness of pharmacologic treatment and behavioral interventions in managing major depressive disorders in adolescents and adults in diverse treatment settings” (p. 111). There are three key features of comparative effectiveness research: (1) direct comparison of effective interventions, (2) their study under real-world conditions, and (3) research on what patients benefit the most from a given intervention (Sox & Greenfield, 2009; Wang, Ulbricht, & Schoenbaum, 2009). The need for comparative effectiveness research is particularly pressing in the area of mental disorders because only about one fourth of individuals with a mental disorder receive minimally adequate treatment (Wang, Demler, & Kessler, 2002). Effective treatments for major depression include antidepressant medications and psychotherapies (American Psychiatric Association [APA], 2000; Thase & Kupfer, 1996). Most U.S. psychiatrists favor selective serotonin reuptake inhibitors for first-line medication treatment (Olfson & Klerman, 1993), with treatment extended to at least 6 months to maintain clinical effectiveness (Agency for Healthcare Research and Quality [AHRQ], 1993). CBT is also an effective treatment for major depression. Several studies have found the effectiveness of psychological and medical interventions for depression to be similar (Bortolotti, Menchetti, Bellini, Montaguti, & Berardi, 2008; Casacalenda, Perry, & Looper, 2002; DeRubeis et al., 2005). Other work has shown that CBT produces sustained clinical gains compared with antidepressant medications that are withdrawn after clinical response (Blackburn, Eunson, & Bishop, 1986; Evans et al., 1992; Kovacs, Rush, Beck, & Hollon, 1981; Miller, Norman, & Keitner, 1989; Shea et al., 1992; Simons, Murphy, Levine, & Wetzel, 1986). In a study of responders to 16 weeks of treatment, patients treated with cognitive therapy were more likely to have a sustained response during 12-month follow-up than were those withdrawn from medications; and they were just as likely to have sustained response as patients who kept taking medications through the follow-up (Hollon et al., 2005). These results suggest that CBT may have important advantages over the long term by preventing relapse after treatment has ended. Here we performed a comparison of antidepressants versus CBT over the course of a year using data from the Women Entering Care (WECare) study—a clinical trial of predominantly poor young minority women with depression. Initial analyses of the WECare data examined the effectiveness of medication or CBT interventions versus community referral (Miranda et al., 2003, 2006). The WECare investigators found that both guidelineconcordant antidepressant medication and a cognitive-behavioral psychotherapy were significantly more effective than referral to mental health care in the community for lowering depressive symptoms and improving functioning at 6 and 12 months after depression was identified. At 6 months, depression treatment outcomes showed that 44.4% of medication, 32.2% of psychotherapy, and 28.1% of community referral patients had remitted (Miranda et al., 2003). At 12-months, remission rates were 51% for medication, 57% for CBT, and 37% for treatment as usual (TAU; Miranda et al., 2006). Unlike the present analysis, these earlier analyses assumed that all participants’ trajectories centered around a single average trajectory over time, an assumption that may not be reasonable in the presence of large amounts of between-subjects heterogeneity. In our study, we investigated whether a single underlying trajectory pattern is a valid assumption or whether a more complex model with multiple trajectories fits the WECare data better. Patients, practitioners, and third-party payers seek guidance as to the type, amount, and cost of treatments that are effective for depression. The current state of the field is that there is no good method to predict which patients with depression will do better on medications versus psychotherapy and, within each treatment modality, which agent or approach is more effective. For most people with depression, the current evidence base does not point to either medication or psychotherapy as working better than the other. In the present study, we compared the two active WECare interventions (medication and CBT) using a novel statistical method, growth mixture modeling (B. Muthén et al., 2002; B. Muthén & Shedden, 1999), which allowed us to identify and predict multiple response trajectories. We began by identifying several subtypes of clinical response trajectories among the WECare subjects and then compared the effectiveness of antidepressant medication versus cognitive-behavioral therapy within these trajectories. After modeling the various response trajectories in the WECare data, we classified participants into the response trajectories in terms of their baseline characteristics to identify which patients were more likely to benefit from a given intervention. Our overall goal was to contribute to the development of personalized interventions for individuals with depression. Method Study Design The data used in this analysis come from the WECare clinical trial conducted by Miranda et al. (see Miranda et al., 2003, 2006, for details on their design and methods). Details about participant selection, exclusion, and randomization are summarized the Appendix. Briefly, the study used the Primary Care Evaluation of Mental Disorders (Spitzer et al., 1994) as a depression screen in women attending social service agencies and safety net health clinics (e.g., Title X family planning clinics) in Prince George’s and Montgomery Counties, Maryland, and in Arlington and Alexandria, Virginia. Women who screened positive for major depression (11% of those assessed) were invited to participate in confirmatory psychiatric diagnostic telephone interviews. Subjects were excluded if they failed to meet a Composite International Diag- This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. COMPARATIVE EFFECTIVENESS OF MEDICATION VERSUS CBT nostic Interview (CIDI; World Health Organization [WHO], 1997) diagnosis of major depression; were bereaved; were suicidal; had symptoms of mania, psychosis, current alcohol, or other substance abuse; were pregnant or planned to become pregnant; were currently breastfeeding; or were currently receiving mental health care. Those women with confirmed major depressive disorder diagnoses who were willing to participate in the study were randomized to receive pharmacotherapy, CBT, or community referral. Raters were blinded to treatment assignment. The study recruited a diverse ethnic sample of women (i.e., Latinas born in Latin America and African American and White women). Ethnicity was self-reported based on options defined by the study investigators. The study was approved by the relevant institutional review boards, and all patients provided written informed consent. Two hundred sixty-seven women consented to treatment and were randomized to one of the three treatment groups. The pharmacotherapy group (n ⫽ 88) received paroxetine, with a mean dose of 30 mg daily and a range of 10 –50 mg (dosing protocol adjusted for response and reported adverse effects). The duration of this medication intervention was 6 months, in line with guidelines for the acute and maintenance phases of depression treatment (AHRQ, 1993). The study did not offer medication treatment after 6 months, but women could seek continued medication treatment elsewhere if desired. Paroxetine treatment was managed by primary care nurse practitioners under the supervision of a boardcertified psychiatrist (Joyce Y. Chung). Eighteen (20%) patients unable to continue paroxetine were switched to bupropion therapy (mean dose ⫽ 229 mg/day, range ⫽ 100 – 450 mg). Women in the CBT group (n ⫽ 90) received therapy from experienced psychotherapists who were previously trained in CBT. Therapists were supervised by a licensed clinical psychologist with CBT expertise who conducted weekly group supervision to ensure adherence to the treatment. The manual-guided treatment was eight weekly sessions administered in group or individual sessions (Muñoz, Aguilar-Gaxiola, & Guzman, 1986; Muñoz & Miranda, 1986). All patients in this arm were provided protocol-based CBT based on the course manual, and treatment involved homework and monitoring activities. Cognitive-behavior therapy could be extended an additional 8 weeks if the patient still met criteria for major depressive disorder and wanted additional therapy (15 [17%] received an additional course of CBT). Therapists attempted to get each woman randomized to CBT into group care for cost-effectiveness reasons. When strong preferences or scheduling issues prevented them from joining a group, women were offered individual CBT. Of the 90 women assigned to psychotherapy, 32 (35.5%) completed a course of CBT defined as six or more CBT sessions. Fifteen of the 32 received group CBT, and 17 received individual CBT. Both groups received the same manual-guided treatment. Latinas were much more likely to receive individual CBT compared with African Americans and Whites. Eighty-three percent of Latinas who completed a course of CBT received individual CBT, compared with 14% of African Americans and Whites. Otherwise, there were no significant differences between women who received individual CBT and those who received group CBT in terms of any of the other baseline variables in Table 1. Women in the community referral group (n ⫽ 89) were educated about depression and mental health treatments available in the community. Clinicians offered to make an appointment for the 997 women at the end of the clinical interview to facilitate the referral and to speak with the mental health clinician. Approximately one quarter of the women declined referral. Referred participants were contacted by the referring clinician within 1–2 weeks of referral to encourage them to attend the community care program. All women in the WECare study were followed for 12 months regardless of whether they continued to receive study treatments. Measures Our primary outcome was the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960). WECare participants completed a structured version of the HDRS (Williams, 1988) by telephone at baseline, monthly for 6 months, and at Months 8, 10, and 12. Both the American Psychiatric Association (APA; 2000) and the National Institute for Health and Clinical Excellence (NICE; 2009) have recommended using HDRS cutoff values of 7, 13, 18, and 22 to classify subjects into different depression categories. Participants with HDRS scores of 7 or less are referred to as “not depressed.” Cutoff values of 13, 18, 22, and ⱖ23 are used to classify participants into “mild,” “moderate,” “severe,” and “very severe” depression categories, respectively. These are the names given by the APA. NICE uses different names but the same cutoff points. Anxiety was measured at baseline, Month 6, and Month 12 using the Hamilton Anxiety Rating Scale (HAM-A; M. Hamilton, 1959), a 14-item rating scale that measures both psychic and somatic anxiety. Screening interviews assessed demographics, insurance status, income, and interest in treatment. Sample Demographic and clinical characteristics of the sample are presented in Table 1. The sample was made up of young minority women, the majority of whom were uninsured and living below or near the poverty level. There were no significant differences at baseline among the randomly assigned intervention groups on demographics, baseline depression, baseline anxiety, current diagnoses from the CIDI, and interest in treatment. Women randomly assigned to medications reported somewhat higher levels of depressive symptoms at baseline than did the other two groups, a difference that neared significance (p ⫽ .06). Based on diagnoses from the CIDI, about half the women were experiencing a mild to moderate episode and 47% a severe episode. Depression severity was determined based on responses to structured interview questions from the CIDI. In addition to a diagnosis of MDD, 46% of the women also had panic disorder, agoraphobia, social phobia, and/or generalized anxiety disorder. Most of the women were interested in receiving treatment. Table 2 provides mean HDRS scores, percentage missing, and cumulative measurement dropout at each time point by treatment group. By Month 6, approximately 84% of participants had been retained in the study. By Month 12, the retention rate was 76%. The difference in dropout rates across the three treatment groups was not significant (p ⫽ .27). Growth Mixture Modeling A frequent characteristic of depression clinical trials (including the WECare study) is that outcomes over time are subject to SIDDIQUE, CHUNG, BROWN, AND MIRANDA 998 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Table 1 WECare Variables at Baseline by Treatment Group Variable Total (n ⫽ 267) Age in years, mean (SD) Marital status, n (%) Married or living with partner Widowed or separated/divorced Never married No. of children, mean (SD) Ethnicit ...
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Medical Treatment
March 08, 2019


Medical Treatment

Over the past years, there are various approaches that medical specialists have used to
approach different diseases in society. Therapies are part of the medical treatment that has been
used in over a long period of time to cure and heal people. In modern society, mental health is an
issue that most people experience that requires proper medical attention from all stakeholders.
Medical institutions should ensure all proper methods and approaches are implemented or
enhanced to ensure good recovery from the illness. There are various therapies that are present
that helps a lot of various patients with different illness, such as Cognitive Behavioral Therapy
(CBT), Dialectical behavior therapy (DBT), Prolonged exposure (PE), Cognitive Processing
Therapy (CPT), reality, Rational Emotive Behavior Therapy (REBT), Behavior therapies among
Traditional healing practices are one of the remedies that both ancient and current still
use in different parts of the world such as Indians, Native Americans, and Africans.
Consequently, culture plays a big role in the traditional healing practices since illness is viewed
as a spiritual, mental or physical aspect. Over time, modern clinics through clinicians have
adopted this traditional technique that plays a significant role in the people who come to these
cultures in the healing process (Cromby, 2013). Consequently, numerous reviews of the
adequacy of traditional practices, correlative, and elective medical care observe a few ways to
deal with a guarantee for treatment of psychological instability, however, most clinical
preliminaries incorporated into these deliberate surveys have organizational restrictions.
Complementary and alternative medicine is also helpful and crucial in the mental health
implemented in modern society. It is...

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