Foundations of Methodology in Integrative Mental Health Care

Abstract

Current research and clinical methodologies in mental health care are reviewed and critiqued. Randomized controlled trials and other quantitative research designs do not adequately address complex synergistic mechanisms involved in many Western medical and CAM interventions. Treatment planning in Western medicine generally overlooks evidence for CAM modalities, and treatment planning in non-Western systems of medicine generally excludes evidence for Western medical approaches. The limitations of evidence-based medicine are discussed. Practice-based evidence is an important concept in personalized medicine that is emerging in response to the limitations of EBM. Novel research methodologies and their potential applications to studies on CAM and integrative modalities are described. Different research questions pertaining to Western medicine, CAM, or integrative medicine call for a variety of research methodologies. The limitations and benefits of different research designs should always guide the choice of study design especially when complex, multilevel interventions are being investigated. Mixed methods research designs that combine quantitative and qualitative research methods may help elucidate complex dynamic interactions between synergistic factors that influence outcomes in response to integrative treatment regimens. Methods for determining outcomes in clinical integrative mental health care are described including measures of cost-effectiveness, cost–utility analysis, and cost–benefit analysis. Finally, recent innovations in expert panels and their implications for more effective, more cost-effective, and more individualized clinical guidelines are discussed.