Treatment-Based Assessment and The 4 Plus One Matrix

When pursuing any type of care with the goal of improving your health, it is important to have an ability to verify how well the chosen intervention or interventions worked. We see many people who have just continued to pile on the drugs, supplements, therapies, and many other changes while never taking a step back to ask the simple questions. What, if anything, has worked? And which of the therapies that have failed had some sort of effect even if it was insufficient? What am I doing that has no evidence of helping me?


When you examine how well a given therapy works, you gain powerful insight. The ability to understand how your body responded to an intervention can help guide your long-term treatment plan. We like to call this Treatment-Based Assessment. This form of assessment can provides just as much information, or more, than many initial diagnostic tests. You see, everyone’s body is a little bit different and unfortunately most symptom presentations are far from what textbooks teach, so determining the best approach or what is wrong is far more difficult than “this symptom equals that disease.”


One of the primary motivations for pursuing treatment-based assessment strategies is the high cost of laboratory testing.  Don’t get us wrong here, there is great value in lab testing, but this type of approach can provide similar insights as the laboratory results. It just requires more observation and brain-work. Laboratory testing isn’t the only way to figure out what is wrong and what will help.

The 4 Plus One Matrix

As part of the continuing assessment we provide for patients we developed the 4 Plus One Matrix. This matrix is composed of four categories of how you may respond to an intervention in two ways. One is the Effect Vector which is positive or negative. A positive Effect Vector means there were benefits to the therapy. The other is the Effect Magnitude which can be large or small. A large Effect Magnitude means the experiences were obvious or dramatic. There is a fifth category that falls outside of this Matrix that is independent of Effect Vector or Effect Magnitude. The four primary categories include:The 4 Plus One Matrix


Treatment Worked Great

This category is fairly self-explanatory. Treatment was recommended, you followed through as you were instructed, and you ultimately felt much better. When this is the response to the initial treatment recommendation, we deem it a “home run.” While this is completely attainable it is exponentially harder than some think as many types of headaches have high complexity and have multiple factors to address.


Treatment Worked a Little Bit

This is the response we see most commonly. We compare this to a “single” as with enough singles you still win in the end. While not 100% better you do feel positive benefits. This type of response points to the fact that treatment was appropriate but there are likely multiple other factors to consider and address in order to arrive at the preferred final destination.


Treatment Did Nothing

When nothing changes it can be quite frustrating. Even though you may not agree, there is benefit when you don’t respond to a recommended course of care. First you must ascertain the fact of whether or not you fully followed the recommendation, as generally speaking, following recommendations partially does not result in a proportional response. For example if you only follow 50% of the recommendation you’ll be lucky if you get 10% of the desired change. If you did follow the treatment plan properly then you have successfully ruled out a potential cause or contributing factor and can move onto the next highest priority for your unique concerns.


Treatment Made Me Worse

Exacerbations are never fun. When you feel worse from a recommended course of care several different things may be happening. It could be it was just the wrong recommendation, or it could have been the proper recommendation with the wrong intensity or dose. With the former, a new understanding is gained regarding your functional capacity and a more appropriate treatment plan can be developed.  With the later, it may be that your body needs very small doses or less frequent doses. When you feel worse it’s tough because you or whoever made the recommendation must estimate why you responded as you did. Was your initial assessment flawed? Did you need to start slower? Was it a completely unexpected change which occurred with some unrelated system in the body?

What are you getting out of Treatment?

Plus One: Treatment Helped for a While, but then Stopped

This bonus category is very common for us to see as people find the therapies that work for them to maintain their health at a level they’re happy with then all of a sudden, boom, right back to where they were before. When you have finally found the solution or solutions that adequately works and you’re happy with how you’re able to live your life and enjoy the things that are most dear to you at a cost you find acceptable, this sudden change is very disheartening. It is important to understand that when you are pursuing any type of therapy your body is changing which is, ultimately, the goal of any treatment that you pursue. At times the changes that occur necessitate a modification or complete change in the current treatment program. If you get to the point in which the therapies you have relied on no longer work you just need to understand the treatment or therapies provided the outcome you were looking for and you are just on to the next stage of your journey.


Having an effective filter to view your responses to a specific treatment is very important. Everyone has varying needs, even if they happen to experience the same symptoms, so you must honor your body and learn what your personal experience with a therapy means to your unique needs. If you listen to what your body is telling you, you will find the interventions which work the best for you far sooner.

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