Writing the Discussion
The discussion section is a framing section, like the Introduction, which returns to the significance argument set up in your introduction. So reread your introduction carefully before writing the discussion; you will discuss how the hypothesis has been demonstrated by the new research and then show how the field's knowledge has been changed by the addition of this new data. While the introduction starts generally and narrows down to the specific hypothesis, the discussion starts with the interpretation of the results, then moves outwards to contextualize these findings in the general field.
The Discussion section is sort of an odd beast because it is here where you speculate, but must avoid rambling, guessing, or making logical leaps beyond what is reasonably supported for your data. The solution that has evolved over time is to set up the Discussion section as a "dialogue" between Results -- yours and everyone elses'. In other words, for every experimental result you want to talk about, you find results/models/conclusions from other publications bearing the relationship to your result that you want the reader to understand.
- Claim -- add new information to what is already known -- "we are the first to show"
- Corroborate -- support what is already known -- "similar/same as to X"
- Clarify -- extend or refine what is already known -- "because X, also Y" or "because X, not Y"
- Conflict -- counter or contradict what is already known -- "contrary to"
This is how the new data you've generated is "situated" in the field -- by your careful placement of what is new against that which is already known. Results can take the form of data, hypotheses, models, definitions, formulas, etc. (I imagine the Results section like a dance with swords -- sometimes you are engaging your partner with the pointy end and sometimes you are gliding alongside them).
Parts of the Discussion Section
Addressing the Hypothesis
* Did the data support your hypothesis?
* How do your findings relate to the previous research?
Problems and Limitations
* To what extent did your study provide an adequate test of your Hypothesis?
* What ethical issues were raised?
* What methodological flaws or problems did your encounter?
* Do the data support an alternative theory?
Closing the Closing
* To what other populations can your findings be generalized?
* What are the practical implications of your findings?
* What direction should further research on this topic take?
Opening Paragraph -- restate RQ, then provide major result
Overall, attitudes and perceptions of both urban and
rural primary care patients in this sample show that they are
generally receptive to the possibility of receiving medical and
psychiatric services via telehealth. Comfort and confidence in
consulting with a provider for a range of medical services and
comfort using telepsychiatry in different settings ranged from
“a little bit” to “moderately.”
Prolonged Exposure therapy via telehealth technology was associated
with large reductions in symptoms of PTSD and depression
for veterans diagnosed with combat-related PTSD. In the current
sample, telehealth PE treatment was safe and pragmatically viable.
Treatment noncompletion rates, although higher than average for
our clinic, were in the acceptable range. Overall, the results of this
study support the need for a large-scale randomized controlled
There is a substantial amount of research documenting
high rates of SUD and PTSD comorbidity.11,15,16 The veteran
described in this case summary is a representative example of
a large subset of patients with comorbid SUD and PTSD.
That is, the patient’s substance-related difficulties are linked
to his traumatic event exposure and development of PTSD.
To date, there is a growing body of literature
documenting the effectiveness of telehealth for a number of
medical and mental health difficulties.21 There is also preliminary
evidence to support the use of telehealth for PTSD
among combat veterans, including high patient satisfaction
and comparable clinical outcomes with traditional face-toface
care.22 The current case summary lends further support
for the use of telehealth as a means of delivering specialized
PTSD services without significant compromise to the therapeutic
alliance or outcomes.
Importantly, rural patients, who are more likely to benefit from telehealth
interventions as a means of improving access to care, are no
more reluctant to use such services than their urban counterparts.
These data are all the more encouraging in light of
extant data, which suggests that attitudes toward mental
health use are positively associated with actual service use
(e.g., Lin and Parikh, 1999; Mackenzie et al., 2004).
...Although the efficacy of exposure-based therapies in
the treatment of PTSD is well established, there has been
some reluctance to use these therapies in individuals with
co-occurring SUDs because of fear that evoking vivid memories
of trauma exposure would worsen substance use or lead
to relapse or both. However, there is little empirical evidence
to support this belief or to guide the treatment of PTSD in
individuals with co-occurring SUDs. Several preliminary
studies conducted in the past several years suggest that
exposure-based therapy can be used in individuals with cooccurring
SUDs and PTSD as long as careful attention is paid
to substance use.11
The study also shows only small
changes in symptoms for the young people placed on the
waiting list (cf. ), therefore confirming the chronic nature
of OCD in young people. This adds to the body of
evidence in favour of CBT for OCD in young people. In
view of the potential problems associated with medication,
the results of this study support the view that young people
with OCD should, therefore, be offered CBT as the firstline
treatment by child and adolescent mental health
Other trials of CBT with young people have tended to
concentrate on managing the anxiety or discomfort experienced
when undertaking exposure and response prevention,
e.g. [4, 6, 22]. The effect size observed in this trial is
somewhat less than those seen in previous trials of CBT for
young people with OCD (mean effect size 1.98, Table 3 in
), although the differences in the methods of effect size
calculation make the comparison somewhat problematic.
These results are inconsistent with prior research indicating that interruptions
negatively affect task performance.5 There may
be several explanations. First, because the participants were
highly experienced IM users, they may frequently converse
with more than one person while performing a concurrent
task. Conversing with one person may not have challenged
the participants’ multitasking abilities. Relatedly, reading
and IMing at the same time may also not have stretched their
abilities as multitaskers. However, our data contradict this
explanation. We found that average daily IM use was negatively
related to performance on the reading comprehension
test, indicating that expertise did not help participants successfully
complete the task. In fact, expertise with IM predicted
lower scores on the comprehension test.
Some study limitations merit comment. This was a
cross-sectional research design that relied on survey data.
Future research designs may benefit from the inclusion of a
qualitative approach to understanding patients’ perceptions
and concerns regarding telehealth, as well as their suggestions
for making it more user friendly. Additionally, our
sample was predominantly Caucasian, and thus, we do not
know how these results would generalize to ethnic minority
groups. Last, PTSD status in our study was derived from the
PSS-SR, which is not a structured PTSD diagnostic interview.
Thus, our diagnoses are tentative and additional research
using more formal diagnostic assessments of PTSD
and other psychiatric diagnoses may be warranted.
Future research efforts are needed to develop effective strategies for
improving the acceptability and ensuring the appropriate use
of telehealth care for those patients who may be positioned to
benefit from it.
It is likely that the current increasing demand for mental health
services in VA and Department of Defense settings will require
the implementation of treatments that have not been adequately
investigated or alternatively, as in the current study, that treatments
with adequate empirical support will be modified or otherwise
flexibly implemented in an attempt to meet the needs of
veterans. Although the scale of the current situation poses challenges
to both service providers and veterans, it also presents
unprecedented opportunities for scientific investigation and
the continued development of evidence-based interventions for