idea from me being annoyed at a comment on the STAR*D trial by one of
the profs on the study. Basically he commented that the research
contacts made the placebo group results more effective which meant
antidepressants looked less effective (in fact those contacts were vital
to the STAR*D trial being a proper experiment where there's only one
variable).
I should see if someone smart's written a paper on this. I'm sure
someone must have thought of this. It's obvious.
This idea appeals to me because it's a total bargain. It's two for the
price of one. It's an offer little seen in mental health care economics.
I meander back in thought to my rants against the NICE Schizophrenia
Gudeilines when they were revised last year. The highest quality
systematic review showed CBT to have effectiveness close to the level of
the controls. It was enough to say it didn't work in the high quality
trails and limited effectiveness was shown in the 2006
mega-meta-analysis. I suggested recommended support groups would be a
cost effective alternative based on this data but provision of
psychological therapies - and a variety - was also important.
The idea's been rehashed into something that solves lots of problems.
The first is how shite the science is in mental health. Fuck. Some of
the measures are fucking laughable. There's so much room for error.
Fuck, attributional style alone is enough. Let alone considerations such
as the feminisation of the medicalisation of misery. This isn't a gender
thing btw. The majority of psychiatrists are male however the criteria
for depression has been observed to be feminised (this is the technical
term). The cluster of symptoms for depression disadvantages men more
than women based on a subjective assessment of unwellness (which men
also generally do less than women though not as much as you think).
I'm redefining the mental health system in this suggestion for research
as purely interested in the distress continuum rather than the
disorder/psychopathology one.
Some of the questions might be asked in therapy anyway but the content
is never recorded. The researcher would be expected to record the
interview and this is natural for a researcher, though some patients may
still prefer not to be recorded and their wishes should be respected.
Any which way the content is what's important. The questions asked by
the researcher could be anything. That may have to be planned or it may
be left to the individual to answer the research question how they see
fit. I'm not sure. I'll have to think that through. Will be applying
quantitative stuff to this which I'll get to in a bit. Anyway,
motivational interviewing is a technique that's proven cost effective
with certain disorders, specifically drug and alcohol abuse off the top
off my head. The research isn't an attempt at anything that's designed
to be therapeutic as a primary aim but there may be therapy involved.
The Hawthorne effect has many explanations and is used in many ways.
Part of the effect here may be the effect of having attention. An
attentive qualitative researcher is unlike any therapist I've met.
Therapists don't listen for a start. They tend to have their own
objectives tot the session and the course of therapy. Here another human
being is simply listening but unlike counselling it's not necessarily
offloading all the crap in your life and having someone tell you it's OK
and lets explore more. It's just someone asking about you. It's a really
nice feeling I think.
The questions are important and I perceive the value of this research is
in the development of useful measures of distress and the human
condition outside psychopathology. It's to learn how to ask questions in
the future. It's purpose also serves to truly inform on people's state
of mind and being. Rather than simply understand a person at a point in
time through a tick box this sort of longitudinal qualitative research
offers unique opportunities for the researcher to know the individual
better and the subject to trust and know the researcher more. It means a
person can be understood over the course of time, how they develop and
how their responses may change. All of this information becomes a
goldmine for truly understanding mental health and accurately applying
positivistic principles in the future. Simply, I think the measures in
mental health are total shite and if they don't work the whole science
breaks down. Positive mental health means different things to different
people just as happiness does. The measures themselves are flawed too
because they're too simplistic.
I also perceive some need to understand and quantify the researcher in
some way. Qualitative research side accepts the problems of bias in ways
I can't stomach. The recording of the interview is essential to this
process of attempting to compensate for the researchers listening style
and personal biases. There is so much interaction that goes in in an
interview outside the communication by language and I'd really like to
add the requirement of video to the data but I think that's a practical
impossibility which is a shame (unless someone can build a cheap,
portable video device that records 180 degree views...in fact I think I
can think of one....they're about £400). Let's say a researcher is cold,
clinical and theoretical. The responses they elucidate and the way they
interpret them will be different to an emotive, intuitive, empathic
person. How they interact with the individual will change how they
respond and the researcher's personality will change how they interpret
the responses. I don't perceive the use of scripts for the researchers
as a solution because they would stifle the interaction however they
would make the experiment better because the interviews would be
standardised. Or more so anyway.
It's just my personal experience that filling in those tick boxes don't
describe my mental health. Spending time understanding me and
understanding what I go through would help accurately describe what the
tick boxes can't. Understanding how I communicate and just how
individual that is is a first step to truly listening. My personal
values of what is happiness and what is mental health are vitally
important but little understood by current quantitative practice. It
makes it useless. This is a bad application of positivitic science but I
think there's hope that the techniques that got humankind onto the moon
can do similar things for internal space, the great uncharted area that
is the human mind.
I really think this will work as a healthcare intervention too. The
questions being asked are relevant to everyone's life and journey in
life. The contact and the attention given by a good qualitative research
rather than a therapist may have positive benefits. The social contact
alone definitely will. The non-objective, non-healthcare agenda of the
researcher means the individual may be more willing to engage and
continue throughout the study. I'm not sure what's cheaper: an
individual trained to be a good qualitative researcher or a person
trained to be a good therapist. The effect sizes seen in high quality
trials plus the additional value of the research as well as the
hypothesised healthcare benefits (based on good evidence of the controls
on PT trials often being as good or almost as good as the active therapy
group) mean the use of qualitative research as a healthcare intervention
is a total bargain.
But what do I know eh? Just a drunk.
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