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8 TREATMENT RESEARCH AND PREVENTION RESEARCH: A COLLABORATIVE FRONTIER
Pages 315-332

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From page 315...
... Treatment interventions attempt to alleviate or eliminate an episode or delay recurrence of a mental disorder among identified patients who have met the full criteria for diagnosis. Preventive interventions are aimed at preventing or at least delaying the onset of a mental disorder among persons who have not yet met these criteria and therefore are not yet classified as patients.
From page 316...
... Moreover, even if the preventive intervention fails to prevent the onset of the disorder, it may delay onset or may lessen the severity of the disorder. Many treatment interventions aimed at enhancing protective factors, such as literacy and academic and social skills, are generic and not specific to any one mental disorder, and they are good in and of themselves.
From page 317...
... Currently, whether those risk factors were part of the prodrome of the disorder can be known only in retrospect, after onset. Identification of prodromal phases could facilitate use of a treatment intervention to push the boundaries from treatment into an indicated prevention, which, because of its proximity to treatment on the intervention spectrum for mental disorders (see Figure 2.1)
From page 318...
... could be expanded to include identification and preventive intervention of early precursors associated with these and other mental disorders. Information regarding the early precursors of panic and agoraphobia (such as an initial, transient panic experience)
From page 319...
... Other examples of a primary disorder leading to a secondary one include cocaine, marijuana, and amphetamine abuse triggering schizophrenia, panic disorder predating agoraphobia, and dvsthvmia being followed bv major depression. , , ~ , , ~ This evidence on co-morbidity of mental disorders suggests several rationales for preventive intervention research (Kessler and Price, in press)
From page 320...
... In a similar manner, patterns of seeking attention and social validation and avoiding challenging or anxiety-provoking situations in childhood may establish behavioral trends that can escalate to a mental disorder at a later stage in life. Thus it would appear that preventive intervention research would need to separate normative from abnormal developmental patterns of behavior and focus on eliminating or reducing those elements in the social environment that reinforce abnormal modes of coping and adaptation.
From page 321...
... Because many intervention programs aim to enhance skills that confer protection against risk factors both enduring psychobiological vulnerabilities in the individual and stressful life events-monitoring the acquisition of skills in the targeted population can reveal the point at which incremental, modular intervention has achieved its objective in any one individual. In a like manner, preventive interventions that are flexible and tailored to individual needs may yield better results than a preventive intervention that attempts to change all targeted participants in much the same way with much the same type,
From page 322...
... Multimodal Interventions The complexity of mental disorders has led to the use of multimodal treatment interventions including pharmacological and psychosocialbehavioral approaches. These combined approaches have tended to be more effective than either alone (Kaplan and Sadock, 1989; Karasu, 1989~.
From page 323...
... The literature on treatment intervention research repeatedly shows that the impact of a time-limited treatment tends to be diluted and lost over time because of subsequent intervening biopsychosocial events, natural living environments, and other transactions between individuals and their social settings (Forehand, 1992~. Ideally, to sustain the progress derived from the initial intervention, prevention programs need a developmental perspective, with an integrated and comprehensive series of age-specific interventions timed to enhance and sustain healthy adaptation and skills and prevent dysfunction at multiple points over the life course.
From page 324...
... Preventive intervention programs also may have different levels of participation and effectiveness depending on where they are delivered. Treatment research has illustrated that behaviors and skills transfer to novel environments and demonstrate durability if programming for generalization is a part of the intervention (Liberman, McCann, and Wallace, 1976~.
From page 325...
... If the pharmacological treatment is withdrawn and the patient relapses, the treatment is viewed as efficacious; on the other hand, if the psychosocial treatment is withdrawn and the patient relapses, this is considered evidence that the treatment is ineffective. The importance of prolonged, maintenance, and booster treatments for serious and chronic mental disorders has recently received greater recognition, and it is likely that preventive interventions will also increasingly be designed with these attributes.
From page 326...
... Preventive intervention research should be hypothesisdriven, with specification of the linkages and intervening mechanisms through which the interventions are expected to affect identified risk and protective factors and mediate delay or prevention of disorders. Participants in prevention trials should be followed up for long enough periods to determine the full effects of the intervention on the diagnosable disorderly.
From page 327...
... Treatment research has shown many times that diagnostic classifications and treatment techniques must be modified and adapted to meet the special needs of culturally diverse population groups (Mezzich, K:leinman, Fabrega, Good, lohnson-Lowell, Lin et al., 1992~. Failure of prevention researchers to address these needs can increase the risks of inadvertent adverse effects of preventive interventions or lack of positive effects.
From page 328...
... · With the development of reliable and sensitive means of detecting prodromal phases of a disorder, treatment intervention techniques can be used in indicated preventive interventions for individuals at high risk for developing a disorder. · Preventive interventions should be tailored to take cognizance of individual differences in the degree to which participants are at risk, possess personal or environmental protective factors, and display readiness for intervention.
From page 329...
... · The usefulness of viewing treatment and prevention as part of a spectrum of interventions for mental disorders, instead of in opposition to each other, is apparent. Many principles that have emerged from research in one area can be borrowed, fully formed, for use in the other.
From page 330...
... II. A longitudinal study of the risk factors for a subsequent major depression.
From page 331...
... (1991) Mental disorders among alcoholics: Relationship to
From page 332...
... (1992) Effectiveness and replicability of modules for teaching social and instrumental skills to the severely mentally ill.


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