Abnormal Psychology

Researching Abnormality 175

Researching Treatment

Let’s say that your interest in depression following breakups, plus your experiences

at the counseling center helping students like Carlos, have led you to develop a new

short-term treatment. In this treatment, which you have named “grief box therapy,”

you encourage patients to create “grief boxes”—boxes into which they place remind-

ers of their recently ended relationships, and objects that symbolize their feelings of

loss and hopelessness. Moreover, as part of the treatment, you strongly encourage

patients to be with other people—friends, family members, or coworkers—as much

as possible to counteract their feelings of loss. You—and other clinicians—will want

to know whether your treatment is effective; that is, is it better for treating depres-

sion (specifi cally the sort following a breakup) than other treatments? What specifi c

questions might you want to ask that research can help to answer? Research on

treatment helps mental health professionals decide what treatments to use with a

given patient who has a particular disorder.

As you will see in the following sections, research on treatment has challenges

above and beyond those we’ve already discussed for research on psychopathology.

And such research faces different challenges, depending on whether the target of

treatment is neurological, psychological, or social factors.

Researching Treatments That Target

Neurological Factors

Researchers and clinicians want to answer several questions when a new medication

is developed, when an existing medication is used in a new way (to treat different

symptoms), or when a new biomedical procedure is developed:

• Is the new treatment more effective than no treatment?


• If a treatment is effective, is it because of its actual properties (such as a medica-

tion’s particular ingredients) or because of patients’ expectations about what the

treatment will do?

• Is the treatment more effective than other treatments currently used for those

symptoms or problems?

• What are the treatment’s side effects, and are they troubling enough that patients

tend to stop the treatment? How does this dropout rate compare to that for the

other treatments?

To assess a treatment, researchers fi rst need to determine what specifi c vari-

ables should be measured and to defi ne what it means to be “effective.” Research

on treatment frequently relies on an experimental or quasi-experimental design;

in such studies, the independent variables might be the type of treatment, a spe-

cifi c technique, or type or dose of medication. And the dependent variables (the

things measured) might be any of the variables listed in any column of Table 4.1 (on

page 114), such as neural activity, specifi c mental contents, or family functioning.

These variables are often related to the symptoms listed in the DSM-IV-TR criteria

for the disorder under investigation.

Drug Effect or Placebo Effect?

One way to determine whether a treatment is effective is to compare it to no

treatment. If people receiving the treatment are better off than those who don’t

receive any treatment, the treatment may have made the difference. But with bio-

medical treatments, such a comparison has a built-in problem: Patients know

whether or not they have received the treatment. Perhaps people improve after tak-

ing a medication (or after ECT, TMS, or some other procedure) not because of the

properties of the treatment itself, but because they expect to improve after receiving

treatment. In fact, many studies have confi rmed that expecting a treatment to be

helpful leads to improvement, even if the individuals don’t receive any actual treat-

ment (Kirsch & Lynn, 1999). For example, having a TMS coil pressed on the scalp