Treatment of First Resort in Depression

Treatment of First Resort

As one would expect from the heterogeneity of the class

"depression" having no covering laws, and as is evidenced from

numerous postings on this NET, some people benefit from cognitive

therapy and some do not. Some benefit from drug therapy and some

do not.

So we must approach the problem of treatment on an individual

case-to-case basis. What rationally coherent procedure might

an individual coherently adopt to weigh the merits and

drawbacks of a treatment for HIM NOW in his present circumstances?

(Note the dual indexicals in capital letters).

I suggest that he construct for himself the following

Evaluation Table of non-zero values important to him multiplied

by his subjective probabilities (degree of belief), the product

of which will yield the expected values of the compared treatments

for depression.

The VALUES in the leftmost column represent the desireability

of a treatment consequence. Each VALUE is given a WEIGHT of

1 - 5, 5 meaning a high value and 1 a low value. The PROBABILITIES

(Pr .1 - Pr .9) represent the individual's estimate that the

treatment will realize the desired VALUE. Multiply the WEIGHT

times the PROBABILITY and then sum the products to get the method's

expected value. For example, in the following table I represent

MY personal assessments NOW comparing three treatment options -

cognitive therapy mediated by a computer program, (CMT), cognitive

therapy mediated by a human therapist (HCT), and antidepressant

medication ({*filter*}).

Evaluation Table

VALUE WEIGHT Pr(CMT) Pr(HCT) Pr({*filter*})

Effectiveness 5 5 x .7 = 3.5 5 x .7 = 3.5 5 x .7 = 3.5

Safety 5 5 x .9 = 4.5 5 x .6 = 3.0 5 x .6 = 3.0

Economy 3 3 x .9 = 2.7 3 x .2 = 0.6 3 x .8 = 2.4

Prevention 5 5 x .8 = 4.0 5 x .3 = 1.5 5 x .1 = 0.5

Availability 3 3 x .9 = 2.7 3 x .5 = 1.5 3 x .7 = 2.1

Ease 3 3 x .2 = 0.6 3 x .3 = 0.9 3 x .9 = 2.7

Nonstigma 3 3 x .9 = 2.7 3 x .7 = 2.1 3 x .8 = 2.4

Learning 5 5 x .8 = 4.0 5 x .8 = 4.0 5 x .2 = 1.0

Convenience 2 3 x .9 = 2.7 2 x .5 = 1.0 2 x .9 = 1.8

Records 3 3 x .9 = 2.7 3 x .1 = 0.3 3 x .1 = 0.3

Catharsis 5 5 x .9 = 4.5 5 x .9 = 4.5 5 x .1 = 0.5

Human contact 3 3 x .1 = 0.3 3 x .9 = 2.7 3 x .3 = 0.9

SUMS OF PRODUCTS (CMT) = 34.9 (HCT) = 24.6 ({*filter*}) = 21.1

The expected value of computer-mediated cognitive therapy is 34.9,

that of human-mediated cognitive therapy is 24.6, and that of {*filter*}

is 21.1.

Hence I would conclude, based on my personal values and

probabilities, that (to no surprise to my critics ) computer-

mediated cognitive therapy is, overall, the treatment of first

resort for ME NOW.

Each individual makes up his own table comparing treatments

and decides which method is of greatest expected value for HIM NOW.

Again note the important indices in capital letters. A different

individual will have different values, weights, and probabilities

and the same individual may have different entries at a later time.

(To be continued)

Ken Colby