Treatment of First Resort in Depression
Author Message 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

Sun, 04 Aug 1996 05:01:49 GMT

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