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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
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.
References
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.64.6.1417
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.2017.08.021
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.x
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.12970
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.
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/10.1080/00223891.1990.9674019
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.20754
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.2014.06.109
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/a0021860
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.2012.09.007
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)00012-4
Gelman, S. A. (2004). Psychological essentialism in children. Trends in Cognitive Sciences, 8(9), 404–409. https://doi.org/10.1016/j.tics.2004.07.001
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.0038176
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/a0022386
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.2020.101908
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.2018.10.005
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/10.1177/2167702618772296
Iselin, M. G., & Addis, M. E. (2003). Effects of etiology on perceived helpfulness of treatments for depression. Cognitive Therapy and Research, 27, 205–222.
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.2006.07.014
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.
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.x
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.2014.02.009
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.2013.07.017
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.1020
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.1414058111
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.2015.06.005
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/s10897-017-0140-5
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/a0031730
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/bul0000057
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/10.1177/2381468316669361
Miller, G. A. (2010). Mistreating psychology in the decades of the brain. Perspectives on Psychological Science, 5(6), 716–743. https://doi.org/10.1177/1745691610388774
Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy (chicago, Ill.), 48(1), 4–8. https://doi.org/10.1037/a0022180
Pearl, J. (2009). Causality. Cambridge University Press.
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/10.1080/08870446.2014.916807
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/s10608-023-10392-7
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.2010.09121743
Peterson, C., Maier, S. F., & Seligman, M. E. P. (1993). Learned helplessness: A theory for the age of personal control. Oxford University Press.
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.2013.04.019
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.
Satel, S., & Lilienfeld, S. O. (2013). Addiction and the brain-disease fallacy. Front Psychiatry, 4, 141. https://doi.org/10.3389/fpsyt.2013.00141
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.2020.07.061
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.2021.21040338
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/10.1348/1476083041839367
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.22532
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/10.1080/10503307.2017.1373205
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.
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.20238
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.12247
Funding
An internal grant from Yale University supported this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Annalise M. Perricone and Woo-kyoung Ahn declare that they have no conflict of interest.
Research Involving Human and Animal Rights
No animal studies were carried out by the authors for this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Perricone, A.M., Ahn, Wk. Emphasizing Controllability over Biological Processes Underlying Depression: Effects on the Perceived Credibility of Psychotherapy. Cogn Ther Res 48, 242–253 (2024). https://doi.org/10.1007/s10608-023-10444-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-023-10444-y