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03-11-2023 | Original Article

Emphasizing Controllability over Biological Processes Underlying Depression: Effects on the Perceived Credibility of Psychotherapy

Auteurs: Annalise M. Perricone, Woo-kyoung Ahn

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 2/2024

Abstract

Background

Laypeople tend to misunderstand that biological processes underlying mental disorders are largely uncontrollable with human effort. In contrast, psychotherapy is believed to require individual effort and is therefore seen as incompatible with addressing biological processes. This study examined whether explaining how some biological processes are controllable and malleable can remove distrust of psychotherapy when depression is attributed to biological factors.

Methods

Participants from the general public (n = 898) and individuals with symptoms of depression (n = 672) rated the effectiveness of psychotherapy for depression before and after learning about biological causes of a depression case. In the biology-controllability condition, participants learned how psychotherapy helps people control biological processes underlying depression. In the psychotherapy-controllability condition, they learned how psychotherapy teaches control over depressive symptoms, rather than biological processes.

Results

Unlike the control condition, participants in the biology-controllability and psychotherapy-controllability conditions judged psychotherapy as significantly more effective, and this increase was greater in the biology-controllability condition than in the psychotherapy-controllability condition.

Conclusions

An intervention specifically counteracting the belief that biological processes are uncontrollable can best mitigate distrust of psychotherapy for biologically attributed depression.

vorige artikel Reduced Belief Updating in the Context of Depressive Symptoms: An Investigation of the Associations with Interpretation Biases and Self-Evaluation

volgende artikel Body, Breath, and Mind: Feasibility of an Internet Intervention for Depressive Symptoms Combining Qi Gong and Behavioral Activation

Alleen toegankelijk voor geautoriseerde gebruikers

See Wallman and Melvin (2022) who found an association between parents endorsing biological etiologies of their child’s depression and preferring psychotherapy for their child.

Of course, various barriers (notably insurance reimbursement policies) likely drive this trend; for further discussion see Tadmon and Olfson (2022). Yet increasing endorsement of biological explanations for mental disorders and the perception that psychotherapy is less effective for biologically based disorders, may also be contributing.

Mturk Toolkit is a platform developed by CloudResearch, which recruits Mturk workers, but independently vets workers (i.e., by blocking workers with hidden locations, running VPN checks and creating anonymized CloudResearch IDs for respondents). The platform also independently collects worker demographic information. In both Studies 1 and 2 we also used Captchas to avoid recruiting bots.

In order to average across all 6 items, we subsequently recoded items #4 and #6 to a 1-9-point scale by multiplying each score on items #4 or #6 by 9 and then dividing that score by 100.

Using the SPSS procedure for missing data, participants with any missing data on the collapsed dependent measures were not included in ANOVAs.

In the Supplement, we also report analyses involving BDI-II as an additional interaction term using regression analyses. BDI-II scores did not interact with condition effects.

Addis, M. E., & Jacobson, N. S. (1996). Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies. Journal of Consulting and Clinical Psychology, 64(6), 1417–1424. https://doi.org/10.1037/0022-006X.64.6.1417CrossRefPubMed

Ahn, W. K., & Lebowitz, M. S. (2018). An experiment assessing effects of personalized feedback about genetic susceptibility to obesity on attitudes towards diet and exercise. Appetite, 120, 23–31. https://doi.org/10.1016/j.appet.2017.08.021CrossRefPubMed

Ahn, W. K., Proctor, C. C., & Flanagan, E. H. (2009). Mental health clinicians’ beliefs about the biological, psychological, and environmental bases of mental disorders. Cognitive Science, 33(2), 147–182. https://doi.org/10.1111/j.1551-6709.2009.01008.xCrossRefPubMedPubMedCentral

Beck, A. T. (1979). Cognitive therapy of depression. Guilford Press.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II: Beck depression inventory manual (2nd ed.). Psychological Corporation.

Beck, J. S. (2005). Cognitive therapy for challenging problems: What to do when the basics don’t work. Guilford Press.

Berent, I., & Platt, M. (2021). Essentialist biases toward psychiatric disorders: Brain disorders are presumed innate. Cognitive Science, 45(4), e12970. https://doi.org/10.1111/cogs.12970CrossRefPubMed

Bohart, A. C., & Tallman, K. (2010). Clients: The neglected common factor in psychotherapy. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (pp. 83–111). American Psychological Association.CrossRef

Catanzaro, S. J., & Mearns, J. (1990). Measuring generalized expectancies for negative mood regulation: Initial scale development and implications. Journal of Personality Assessment, 54(3–4), 546–563. https://doi.org/10.1080/00223891.1990.9674019CrossRefPubMed

Constantino, M. J., Arnkoff, D. B., Glass, C. R., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. Journal of Clinical Psychology, 67(2), 184–192. https://doi.org/10.1002/jclp.20754CrossRefPubMed

Dar-Nimrod, I., Cheung, B. Y., Ruby, M. B., & Heine, S. J. (2014). Can merely learning about obesity genes affect eating behavior? Appetite, 81, 269–276. https://doi.org/10.1016/j.appet.2014.06.109CrossRefPubMed

Dar-Nimrod, I., & Heine, S. J. (2011). Genetic essentialism: On the deceptive determinism of DNA. Psychological Bulletin, 137(5), 800–818. https://doi.org/10.1037/a0021860CrossRefPubMedPubMedCentral

Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846–861. https://doi.org/10.1016/j.cpr.2012.09.007CrossRefPubMed

Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86. https://doi.org/10.1016/s0005-7916(00)00012-4CrossRefPubMed

Gelman, S. A. (2004). Psychological essentialism in children. Trends in Cognitive Sciences, 8(9), 404–409. https://doi.org/10.1016/j.tics.2004.07.001CrossRefPubMed

Gould, W. A., & Heine, S. J. (2012). Implicit essentialism: Genetic concepts are implicitly associated with fate concepts. PLoS ONE, 7(6), e38176. https://doi.org/10.1371/journal.pone.0038176CrossRefPubMedPubMedCentral

Haslam, N. (2011). Genetic essentialism, neuroessentialism, and stigma: Commentary on Dar-Nimrod and Heine (2011). Psychological Bulletin, 137(5), 819–824. https://doi.org/10.1037/a0022386CrossRefPubMed

Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications, Inc.

Hayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2020). A process-based approach to psychological diagnosis and treatment: The conceptual and treatment utility of an extended evolutionary Meta model. Clinical Psychology Review, 82, 101908. https://doi.org/10.1016/j.cpr.2020.101908CrossRefPubMedPubMedCentral

Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy, 117, 40–53. https://doi.org/10.1016/j.brat.2018.10.005CrossRefPubMed

Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science: A Journal of the Association for Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296CrossRefPubMed

Iselin, M. G., & Addis, M. E. (2003). Effects of etiology on perceived helpfulness of treatments for depression. Cognitive Therapy and Research, 27, 205–222.CrossRef

Kassel, J. D., Bornovalova, M., & Mehta, N. (2007). Generalized expectancies for negative mood regulation predict change in anxiety and depression among college students. Behaviour Research and Therapy, 45(5), 939–950. https://doi.org/10.1016/j.brat.2006.07.014CrossRefPubMed

Kazantzis, N., Beck, J. S., Dattilio, F. M., Dobson, K. S., & Rapee, R. M. (2013). collaborative empiricism as the central therapeutic relationship element in CBT: An expert panel discussion at the 7th International Congress of Cognitive Psychotherapy. International Journal of Cognitive Therapy, 6(4), 386–400.CrossRef

Kazantzis, N., Dattilio, F. M., & Dobson, K. S. (2017). The therapeutic relationship in cognitive-behavioral therapy: A clinician’s guide. The Guilford Press.

Kazantzis, N., Whittington, C., & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144–156. https://doi.org/10.1111/j.1468-2850.2010.01204.xCrossRef

Kemp, J. J., Lickel, J. J., & Deacon, B. J. (2014). Effects of a chemical imbalance causal explanation on individuals’ perceptions of their depressive symptoms. Behaviour Research and Therapy, 56, 47–52. https://doi.org/10.1016/j.brat.2014.02.009CrossRefPubMed

Kvaale, E. P., Gottdiener, W. H., & Haslam, N. (2013). Biogenetic explanations and stigma: A meta-analytic review of associations among laypeople. Social Science and Medicine, 96, 95–103. https://doi.org/10.1016/j.socscimed.2013.07.017CrossRefPubMed

Lebowitz, M. S. (2019). The implications of genetic and other biological explanations for thinking about mental disorders. Hastings Center Report, 49, S82–S87. https://doi.org/10.1002/hast.1020CrossRefPubMed

Lebowitz, M. S., & Ahn, W. K. (2014). Effects of biological explanations for mental disorders on clinicians’ empathy. Proceedings National Academy Sciences USA, 111(50), 17786–17790. https://doi.org/10.1073/pnas.1414058111CrossRef

Lebowitz, M. S., & Ahn, W. K. (2015). Emphasizing Malleability in the biology of depression: Durable effects on perceived agency and prognostic pessimism. Behaviour Research and Therapy, 71, 125–130. https://doi.org/10.1016/j.brat.2015.06.005CrossRefPubMedPubMedCentral

Lebowitz, M. S., & Ahn, W. K. (2018). Blue genes? Understanding and mitigating negative consequences of personalized information about genetic risk for depression. Journal of Genetic Counseling, 27(1), 204–216. https://doi.org/10.1007/s10897-017-0140-5CrossRefPubMed

Lebowitz, M. S., Ahn, W. K., & Nolen-Hoeksema, S. (2013). Fixable or fate? Perceptions of the biology of depression. Journal of Consulting and Clinical Psychology, 81(3), 518–527. https://doi.org/10.1037/a0031730CrossRefPubMedPubMedCentral

Levitt, H. M., Pomerville, A., & Surace, F. I. (2016). A qualitative meta-analysis examining clients’ experiences of psychotherapy: A new agenda. Psychological Bulletin, 142(8), 801–830. https://doi.org/10.1037/bul0000057CrossRefPubMed

Marsh, J. K., & Romano, A. L. (2016). Lay judgments of mental health treatment options: The mind versus body problem. MDM Policy & Practice, 1(1), 2381468316669361. https://doi.org/10.1177/2381468316669361CrossRef

Miller, G. A. (2010). Mistreating psychology in the decades of the brain. Perspectives on Psychological Science, 5(6), 716–743. https://doi.org/10.1177/1745691610388774CrossRefPubMedPubMedCentral

Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy (chicago, Ill.), 48(1), 4–8. https://doi.org/10.1037/a0022180CrossRefPubMed

Pearl, J. (2009). Causality. Cambridge University Press.CrossRef

Pearl, R. L., & Lebowitz, M. S. (2014). Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support. Psychology & Health, 29(10), 1176–1191. https://doi.org/10.1080/08870446.2014.916807CrossRef

Perricone, A., & Ahn, W. K. (2023). Reasons for the belief that psychotherapy is less effective for biologically attributed mental disorders. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-023-10392-7CrossRef

Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry, 167(11), 1321–1330. https://doi.org/10.1176/appi.ajp.2010.09121743CrossRefPubMed

Peterson, C., Maier, S. F., & Seligman, M. E. P. (1993). Learned helplessness: A theory for the age of personal control. Oxford University Press.CrossRef

Pilkington, P. D., Reavley, N. J., & Jorm, A. F. (2013). The Australian public’s beliefs about the causes of depression: Associated factors and changes over 16 years. Journal of Affective Disorders, 150(2), 356–362. https://doi.org/10.1016/j.jad.2013.04.019CrossRefPubMed

Rubenstein, L. M., Alloy, L. B., & Abramson, L. Y. (2016). Perceived control: Theory, research, and practice in the first 50 years. In J. W. Reich & F. J. Infurna (Eds.), Perceived control and depression: Forty years of research. Oxford University Press.CrossRef

Satel, S., & Lilienfeld, S. O. (2013). Addiction and the brain-disease fallacy. Front Psychiatry, 4, 141. https://doi.org/10.3389/fpsyt.2013.00141CrossRefPubMed

Schroder, H. S., Duda, J. M., Christensen, K., Beard, C., & Bjorgvinsson, T. (2020). Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample. Journal of Affective Disorders, 276, 537–545. https://doi.org/10.1016/j.jad.2020.07.061CrossRefPubMed

Tadmon, D., & Olfson, M. (2022). Trends in outpatient psychotherapy provision by U.S. psychiatrists: 1996–2016. American Journal of Psychiatry, 179(2), 110–121. https://doi.org/10.1176/appi.ajp.2021.21040338CrossRefPubMed

Thwaites, R., Dagnan, D., Huey, D., & Addis, M. E. (2004). The reasons for depression questionnaire (RFD): UK standardization for clinical and non-clinical populations. Psychology and Psychotherapy, 77(Pt 3), 363–374. https://doi.org/10.1348/1476083041839367CrossRefPubMed

Timulak, L., & Keogh, D. (2017). The client’s perspective on (experiences of) psychotherapy: A practice friendly review. Journal of Clinical Psychology, 73(11), 1556–1567. https://doi.org/10.1002/jclp.22532CrossRefPubMed

von der Lippe, A. L., Oddli, H. W., & Halvorsen, M. S. (2019). Therapist strategies early in therapy associated with good or poor outcomes among clients with low proactive agency. Psychotherapy Research, 29(3), 383–402. https://doi.org/10.1080/10503307.2017.1373205CrossRefPubMed

Wallman, E. J., & Melvin, G. A. (2022). Parent preferences for adolescent depression treatment: The role of past treatment experience and biological etiological beliefs. Journal of Affective Disorders, 316, 17–25.CrossRefPubMed

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238CrossRefPubMedPubMedCentral

WHO. (2017). Depression and other common mental disorders: Global health estimates. NY: WHO.

Zimmermann, M., & Papa, A. (2020). Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory. Psychology and Psychotherapy, 93(3), 537–554. https://doi.org/10.1111/papt.12247CrossRefPubMed

Titel: Emphasizing Controllability over Biological Processes Underlying Depression: Effects on the Perceived Credibility of Psychotherapy
Auteurs: Annalise M. Perricone
Woo-kyoung Ahn
Publicatiedatum: 03-11-2023
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 2/2024
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-023-10444-y

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