Traditionally, medical adherence has been viewed as the extent to which a patient follows a prescriber's instructions. Adherence to treatment is a relevant factor able to influence results obtained by clinical trials and clinical practice. The components of adherence can be considered by the actions of patients, professionals, family and social support programs. Concerning mental health disorders, nonadherence is related to poorer treatment outcomes, such as lack of symptom stabilization, homelessness, lower quality of life and hospitalization. This book discusses clinical treatment outcomes, along with the clinical implications adherence has on patients with social anxiety, and chronic pain. It also provides several theoretical models of adherence.
Chapter 1 - The literature that examines adherence to treatment is represented in this chapter. Adherence to medical regimens and medication has been predominantly represented in this literature base. However, Behavioral interventions are described in terms of mental health treatments and psychoeducational approaches have also been included in this literature. The methodology predominantly, in a majority of the investigations, was survey based with random treatment control used for outcome measures of medication adherence. Treatment adherence is commonly referenced to these medication adherence studies. Some conclusions are presented for the reader. It is concluded from the findings in this area, that mild levels of adherence to treatment exists.
Chapter 2 - In this chapter theoretical models of adherence to medical treatment are reviewed. The chapter begins by describing the traditional biomedical approach and then moves on to explain the broader psychological approaches including: the health belief model, health locus of control theory, self efficacy theory, the theory of planned behaviour, the self-regulatory model and the transtheroetical stages of change model. The limitations of these psychological models are discussed and a more contemporary view of adherence using the accident causation framework is described. Finally, a move away from only focussing on adherence to incorporating other concepts such as shared decision making is described. For each model, the effects of the theoretical approach on the types of interventions that are employed to monitor and reduce non -adherence to treatment are discussed.
Chapter 3 - Background: Adherence to treatment is a relevant factor able to influence results obtained by clinical trials and clinical practice. The components of adherence can be considered by the actions of patients, professionals, family and social support programs. Concerning mental health disorders, nonadherence is related to poorer treatment outcomes, such as: lack of symptom stabilization, homelessness, lower quality of life and hospitalization.
Purpose: This chapter aims to discuss adherence to treatment to social anxiety disorder and possible interventions to increase adherence.
Results: It was found that some patients on a social phobia research had a poor adherence to group psychotherapy, some of them having abandoned therapy at different stages. The results showed that those patients had a history of poor adherence to other treatments, a misunderstanding of their treatment outcomes and clinical status, lack of motivation and attribution of their symptoms to personality features instead of the disease. Yet, a correlation between depression and active treatment was found (SSRI, CBT or combined). The patients with dependent personality trait adhered less to treatment. The antisocial and borderline disorders were correlated with low adherence in CBT. The presence or absence of social abilities before treatment was not related to adherence, different from what we found in the literature. Besides, social phobic patients adherence to treatment is likely to increase when family members also participate in the intervention.
Conclusion: Therapists should be concerned to patient's motivation and with his/her continuous evaluation of adherence in order to detect those who most likely would abandon the treatment in order to prevent patients, initially motivated, discouraged with the treatment and consequently leaving. The findings of personality disorders indicate the need to deal with these disorders before or concomitant the treatment of social phobia. A possible solution to increase adherence to mental disorders patients, particularly anxiety illnesses, is to consider the family as an active and central figure in the patient's treatment. Therefore, adherence interventions that include family as an important variable are likely to succeed.
Chapter 4 - Because acute pain is unpleasant sensory associated with fear and worries it is common reason that somebody seek a medical help. In some cases, even after it has been appropriate treated, it may persist and develop from acute into chronic form. In this article the authors pay attention to this, to the traditional biomedical treatment generally difficult accessible pain, which significant worse the individual's quality of life. The adherence to treatment, usually combination of pharmacological and physical therapies, they highlighted through individual's changed life position, ways of coping, as well as from the viewpoint of theoretical models, which could predict and explain health behaviour and adherence in medical treatment.
After a torment of diagnostic procedures and testing the effects of various available medical options, chronic pain patients could be completely frustrated and deep rooted in a passive, "sick role". Therefore primary goal in psychological treatment as a part of multidimensional, multidisciplinary, and multimodal approach to pain management must be shifting toward interventions emphasizing a proactive and self-management capacity of the patients. But this raises the questions of their motivation. The solutions can be seen in integrative therapeutic approach including the models of provider-patients interactions such as the Motivating Interviewing, MI, and Patient-Centred Model with the principles of Self management concept.

Preface vii

Chapter 1 Clinical Treatment Outcomes 1

Kathy Sexton-Radek

Chapter 2 Theoretical Models of Adherence 19

Sara Garfield

Chapter 3 Clinical Implications of Adherence to Treatment of Patients with Social Anxiety 31

Mariangela Gentil Savoia and Silvia Sztamfater

Chapter 4 Motivation and Adherence in Management of Chronic Pain 49

Zlatka Rakovec-Felser

Index 85

中国医科院医学信息研究所