Symptom Reduction or Well-being: What Outcome should Matter Most in Psychotherapy

March 12, 2018 By scottdm 10 Comments

So, what contributes to a living a long, healthy life?

Clean Air? Being lean versus overweight? The absence of depression or anxiety? Exercising regularly? Getting a flu vaccine? Abstaining from smoking? Minimizing alcohol intake? Personal sense of meaning? Close interpersonal relationships? Social integration?

OK, I’ll come clean: all contribute–but not equally. Far from it. Some are more important than others.

So, what contributes most? Before reading on, try rank ordering the list from least to most influential.

Now watch the brief video (If you are one of those that don’t want to try, or can’t wait to know the answer, just scroll past video).

Answer: the items as written are presented in order from the least to most influential, the last three being far more important to living a long and healthy life. Distinct from the other items on the list, personal sense of meaning, close interpersonal relationships, and social integration form the core of “well-being.”

Given such findings, it is more than a bit curious that the field of mental health and majority of its supporting research are organized around reducing symptoms. Perhaps this is one reason why, as psychiatrist Robert Cloninger persuasively argues, the profession has, “failed to improve the average levels of happiness and well-being in the general population, despite vast expenditures on psychotropic drugs and psychotherapy manuals.” Indeed, by all measures, mental health is on the decline.

Could it be that our field has the formula for improving health and well-being backwards? Instead of focusing on reducing problems or eliminating symptoms maybe we should be working directly on improving people’s personal sense of meaning, close interpersonal relationships, and social integration.

The evidence is compelling. In addition to a longer, healthier life, improved well-being leads to:

Faster recovery from illness;
Positive health behaviours in adults and children;
Quicker return to and more preseentism on the job;
Greater wellbeing and mental health of others;
Can inform treatment decisions and reduce healthcare costs;
May ultimately reduce the healthcare burden.

Twenty years ago, my team and I developed a quick, simple-to-use measure of well-being. Numerous studies have shown the Outcome Rating Scale (ORS) to be valid and reliable as well as strongly predictive of psychological intervention. The tool is listed on SAMHSA’s National Registry of Evidence-based Programs and Practices, is available in 30 languages, and in wide use in countries around the world. Best of all: individual practitioners can download and begin using the tool for free.

Most exciting of all, use of the tool is serving as the impetus for many new innovations in mental health service delivery. I just spent a week with teams from Slagelse municipality in Denmark who are now using the data generated from routine use of the ORS to transform service delivery at every level. My Scandinavian co-teacher, psychologist Susanne Bargmann will be talking about these new and exciting developments at this summer’s FIT Implementation and Training of Trainers workshops. Is it any wonder that Denmark consistently LEADS the world in well-being?

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

Practice-Based Evidence in Norway: An Interview with Psychologist Mikael Aagard

January 19, 2010 By scottdm Leave a Comment

For those of you following me on Facebook–and if you’re not, click here to start–you know that I was traveling above the arctic circle in Norway last week. I always enjoy visiting the Scandinavian countries. My grandparents immigrated from nearby Sweden. I lived there myself for a number of years (and speak the language). And I am married to a Norwegian! So, I consider Scandinavia to be my second home.

In a prior post, I talked a bit about the group I worked with during my three day stay in Tromso. Here, I briefly interview psychologist Mikael Aagard, the organizer of the conference. Mikael works at KORUS Nord, an addiction technology transfer center, which sponsored the training. His mission? To help clinicians working in the trenches stay up-to-date with the research on “what works” in behavioral health. Judging by the tremendous response–people came from all over the disparate regions of far northern Norway to attend the conference–he is succeeding.

Listen as he describes the challenges facing practitioners in Norway and the need to balance the “evidence-based practice” movement with “practice-based evidence.” If you’d like any additional information regarding KORUS, feel free to connect with Mikael and his colleagues by visiting their website. Information about the activities of the International Center for Clinical Excellence in Scandinavia can be found at: www.centerforclinicalexcellence.org.

The Crown Jewel of Research on CDOI: Professor Jan Blomqvist receives 2.9 million crown grant for RCT on feedback in Sweden

October 20, 2009 By scottdm 2 Comments

If you’ve been following me on Twitter, then you know that last week I was touring and teaching in different spots around Europe. First, I presented two days in Copenhagen. Then I keynoted the British Association of Counseling and Psychotherapy Conference in Newcastle, England. Early Saturday morning, I flew from London to Stockholm. My long time friend and associate, Gunnar Lindfelt picked me up at Arlanda airport and drove me back to his lovely home in the city. There, we gorged on smoked salmon, “svensk godies” (small candies, my favorite of which is “skum bananer”–dark chocolate covered marshmellow in the shape of a banana) and Cider–a non-alcoholic fizzy apple drink that is an old time Swedish favorite.

It was Gunnar Lindfeldt, a gifted clinician and expert in the treatment of drug and alcohol problems, who first introduced me to the work of Swedish psychologist Jan Blomqvist. In 1998, Blomqvist published a book entitled, “Beyond Treatment? Widening the Approach to Alcohol Problems and Solutions“ in which he made the provocative argument that common rather than specific factors held the key to effective care. Since writing the book, Jan Blomqvist has continued his research and is currently a full professor at SORAD, the Centre for Social Research on Alcohol and Drugs at Stockholm University.

Anyway, I had the pleasure of meeting with Professor Blomqvist at his home in Uppsala, Sweden this last week. Over homemade spinach soup, freshly-baked bread and cheese, we chatted about the state of the field. The pièce de résistance, however, was hearing about the 2.9 million Swedish crown grant he had just been awarded for a 4 year long study of outcome-informed treatment of alcohol problems, called “Putting the Client in the Driver’s Seat.”

The study to be conducted by Professor Blomqvist will be the largest, most comprehensive, randomized clinical trial on client-directed outcome informed clinical work. A centerpience of the study will be the routine use of the ORS and SRS and provision of feedback in the delivery of treatment services. Importantly, unlike all other studies to date, this project completely avoids claims of “allegiance effects” as no developers of measures or supporters of CDOI are participating. Stay tuned to the “Top Performance” blog for additional updates! While you are waiting, take a moment and read Professor Blomqvist’s provocative take on “addiction” in slide viewer below.

J Blomqvist 3 from Scott Miller