Foundations of Treatment 149
would be the most appropriate. Among the biomedical treatments, medication
(most likely an SSRI) for Leon’s anxiety and depression would be a reasonable place
to start. Among the treatments targeting psychological factors, CBT is the one for
which there is the most research support for both social phobia and depression;
as we’ll see in Chapter 6, though, a variety of other treatments can help allevi-
ate depression. Among treatments targeting social factors, group therapy could be
particularly helpful for Leon’s social phobia— simply being in a group, whatever its
theoretical orientation, would be an exposure treatment for him. The social support
might also lessen his depression.
Choosing One or More Treatments
Some patients receive only one type of treatment, whereas other patients may receive
more than one type—why? A given patient may receive more than one form of
treatment, depending on the nature of the problem, the patient’s preferences, and
whether a single treatment suffi ciently alleviates symptoms or improves quality of
life. Moreover, constraints arising from health insurance coverage or fi nances can
infl uence which treatment(s) a patient receives. Severe or chronic problems, such as
schizophrenia, may be best addressed by two or more treatments, and some com-
bined treatments may be more effective for that disorder than a particular single
treatment (TADS Team, 2007). Each treatment may directly target a different factor.
Leon has two disorders: depression and social anxiety, and he might benefi t frommultiple treatments—one (or more) to target his depression, and one (or more) to tar-
get his social anxiety. One option would be to participate in group therapy for his social
anxiety (the treatment modality of choice for that disorder) and wait to see the extent
to which his depression lifts as his social anxiety diminishes. Alternatively, Leon might
choose to initiate two types of treatment, one directed at his social anxiety and one
at his depression. In this case, he might be in group therapy for his social anxiety and
either take medication or begin CBT or another type of therapy for his depression.
Even people with one disorder may receive more than one type of treatment.For example, people with depression may benefi t from a treatment that targets psy-
chological factors while also being involved in couples therapy. Similarly, children
with attention-defi cit/hyperactivity disorder may take medication and also be in
family therapy with their parents.
Some patients receive more than one treatment that targets the same type offactor. For instance, a depressed person may take more than one medication (target-
ing neurological factors), or an anxious woman might be in both couples therapy
and interpersonal therapy (both targeting social factors). A given patient may initiate
multiple treatments at the same time or start with one and add additional treatments
as needed.
Treatments can directly target neurological, psychological, or social factors, butany successful treatment ultimately affects all three types of factors. Thus, a variety
of paths can lead to the same general destination: reducing or eliminating symp-
toms and improving quality of life. However, as we shall see in subsequent chapters,
some treatments are more effective for certain disorders than others.
Key Concepts and Facts About Creating a Treatment Plan
- The treatment or treatments given to a particular patient depend
on the patient’s willingness to receive particular treatments, on
research results regarding specifi c treatments for the patient’s
problem, and on the expertise of the mental health clinician. - Some patients may receive more than one type of treatment,
depending on their specifi c problem(s), the effectiveness of a
given treatment, the patient’s interest in pursuing additional
treatments, and the patient’s insurance benefi ts and fi nances.- Although any given treatment targets only one factor, changes
brought about by an effective treatment in turn affect other
factors.