Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Treatment
Introduction to Range of Treatments
Mental disorders are treatable, contrary to what many think.12
An armamentarium of efficacious treatments is available to ameliorate symptoms.
In fact, for most mental disorders, there is generally not just one but a range
of treatments of proven efficacy. Most treatments fall under two general
categories, psychosocial and pharmacological.13 Moreover, the combination of the
two—known as multimodal therapy—can sometimes be even more effective than each
individually (see Chapter 3).
The evidence for treatment being more effective than placebo is overwhelming, as
documented in the main chapters of this report (Chapters 3 through 5). The
degree of effectiveness tends to vary, depending on the disorder and the target
population (e.g., older adults with depression). What is optimal for one
disorder and/or age group may not be optimal for another. Further, treatments
generally need to be tailored to the client and to client preferences.
The inescapable point is that studies demonstrate conclusively that treatment is
more effective than placebo. Placebo (an inactive form of treatment) in both
pharmacological and psychotherapy studies has a powerful effect in its own
right, as this section later explains. Placebo is more effective than no
treatment. Therefore, to capitalize on the placebo response, people are
encouraged to seek treatment, even if the treatment is not as optimal as that
described in this report.
If treatment is so effective, then why are so few people receiving it? Studies
reveal that less than one-third of adults with a diagnosable mental disorder,
and even a smaller proportion of children, receive any mental health services in
a given year. This section of the chapter strives to explain why by examining
the types of barriers that prevent people from seeking help. But the chapter
first covers some general points about psychological and pharmacological
therapies. It also discusses why therapies that work so well in research
settings do not work as well in practice.
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