Q & A With Psychological Scientist Alan Kazdin (Part 2)

Below is part 2 of Kazdin’s Q & A:

1. Do therapists you know believe that expanding their media outlets interfere with patients’ progress or encourage it?

I do not have knowledge of what therapists currently believe about the important question you ask. The nice feature is that our beliefs can serve as a basis for doing the research to find out what does and does not interfere with progress. We know already that patients can profit enormously from media-based (e.g., web, internet, smartphone) treatment. As a mode of delivering treatment there are many examples that this can be done effectively. Some models of treatment might well expect that a given focus or feature of treatment interferes with progress. We know also that approximately 7 of 10 individuals in need of treatment are not receiving any. How can we better attend to the progress we want them to make?

2. If self-help is promoted as a mode of intervention for mental illness, won’t it become another fad like before?

The danger of something becoming a fad is a wise warning. Here is the issue from my perspective. Some self-help treatments have impressive evidence on their behalf. They can, for example, effectively treat many forms of anxiety, depression, and trauma. Our task is to identify these (not difficult) and to get these to prospective patients and to the millions in need of services who receive nothing. There is no one answer but there are piles of little answers that could make a difference.

3. Would there be a case for saying businesses should not invest in individual coaching if individual therapy doesn’t work?

Individual therapy has a great deal of evidence on its behalf and many therapies now have an empirical basis. To me, the evidence is compelling for many treatments that are administered individually and one-to-one. There is a qualifier: most treatment used in practice and the vast majority of available treatments have not been studied empirically. Yet my main point and concern lies elsewhere.

Individual therapy, as valuable as it is, is not likely to be able to reach most people in need of services. If most people in need cannot obtain the service, new options ought to be considered. The option Stacey Blase and I advance is to shift the focus from individual therapy to interventions that have a much better reach. There is a serious mental health social problem—many need the benefit of psychological treatment and are definitely excluded if we retain individual therapy as the dominant model of delivery.

4. You mentioned that a quarter of Americans have a psychiatric disorder? Just curious about the source of that data?

Kessler, R.C., & Wang, P.S. (2008). The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health, 29, 115-129.

Kessler, R.C., Demler, O., Frank, R.G., Olfson, M., Pincus, H.A., Walters, E.E., Wang, P.S., Wells, K.B., & Zaslavsky, A.M. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352, 2515-2523.

5. With the technology growing will there be an increase in the help given?

Excellent question.  With technology growing I see an increase in the potential help that could be given. My worry is that this will not actually materialize unless graduate training programs introduce novel treatments and are allowed  for accreditation and if internship experiences, required of Ph.D. level clinical psychologists, allow technology interventions as part of their care, and if licensing requirements are more flexible to allow more current interventions—any one of these raises enormous obstacles.

An alternative, involves more non-advanced degree individuals to administer treatments that could reach people. This might be the first line of intervention, saving a more intensive focus only when clearly needed.  This alternative has huge obstacles at professional and state levels. The frustration is that techniques are available right now that could help many more people but we do not have an infrastructure and perhaps a clear will to deliver them.

6. Is this issue different from health-care in general? Or should it be treated with the same attention?

Physical health care is profiting too from novel models of delivery. Home testing (e.g., pregnancy, diabetes) and shopping mall testing (e.g., blood pressure, cholesterol) and care (with hospital back-up) are examples.  Phone and tablet applications are changing health care (e.g., assessment and feedback on biological processes) and maybe medicine can help pioneer some critical paths that will move us more quickly.