Skip to main content
SpringerLink
Log in

Reasons for the Belief that Psychotherapy is Less Effective for Biologically Attributed Mental Disorders

Cognitive Therapy and Research (2023)Cite this article

Abstract

Background

Upon learning that a mental disorder has a biological etiology (e.g., multiple gene interactions, brain abnormalities), people tend to doubt the effectiveness of psychotherapy even though psychotherapy combined with pharmacotherapy is often considered optimal. The aim of this study was to empirically identify reasons for this lessened perceived effectiveness of psychotherapy.

Methods

Participants (N = 278 U.S. adults) indicated their endorsement of three beliefs hypothesized to explain the reduced perceived effectiveness of psychotherapy for a mental disorder with a biological etiology; (1) the belief that mental activities affect the brain less than they affect the mind, (2) the belief that biological processes are less controllable than psychological processes, and (3) the belief that psychosocial causes are less likely to be present when biological causes are present. Additionally, participants judged the effectiveness of psychotherapy for a hypothetical case of depression before and after learning about its biological etiology.

Results

Participants endorsed each of the proposed beliefs. Furthermore, the extent of holding these beliefs correlated with the extent to which psychotherapy was undermined after learning that a hypothetical patient’s depression was biologically caused.

Conclusions

By identifying these beliefs, the current findings offer specific strategies to mitigate the lessened perceived effectiveness of psychotherapy for mental disorders with biological etiologies.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Availability of Data and Materials

Raw data generated and analyzed for this study are publicly available via the study’s OSF page: https://osf.io/4wdyu/?view_only=fbacd366f6844ccc841ed36e915a85a2.

Notes

  1. At points, the texts or the materials for participants refer to biological / brain / mental / psychological processes or causes. Although all mental and psychological processes are biological, the uses of these terms are for the sake of brevity and to reflect the typical usage of these terms, not to endorse dualistic reasoning. For instance, “biological causes of mental disorders” refer to genetic risks and brain abnormalities, as opposed to childhood trauma or environmental stressors.

  2. See Wallman and Melvin (2022) for evidence of an association between endorsing biological etiologies and preferring psychotherapy among parents of adolescents with depression when considering treatment for their children.

  3. It is also worth noting that in Iselin and Addis (2003), Lebowitz and Ahn (2014), and Ahn and colleagues (2009), medications were thought to be less effective for treating disorders attributed to psychosocial etiologies. While this is also worth investigating, the current study focuses solely on the effect of biological explanations on the perceived effectiveness of psychotherapy because the trend appears to be towards describing mental disorders in biological terms (again, Deacon 2013; Lebowitz, 2019; Pescosolido et al., 2010; Pilkington et al., 2013; Salm et al., 2014).

  4. Depression was chosen as a target disorder because it is among the most prevalent mental disorders, affecting more than 8% of the U.S. adult population (National Alliance on Mental Health). Partly due to its prevalence, depression is also familiar among lay people, making it easier for participants in this study to understand our reading materials and questions.

  5. Mturk Toolkit recruits and interfaces with Mturk workers, but independently collects demographic information over time, and provides more protections against poor-quality workers (i.e., by blocking workers with hidden locations, running VPN checks and creating anonymized CloudResearch IDs for respondents. Participants completing this survey did so in an average of 8.40 min and the survey was advertised as taking 10 min or less. To help ensure data quality we used two captchas at the start of the survey, one asked participants to select a box with the label, “I’m not a robot” and a second captcha asked participants to select “all statements that are true” with four options including 1) “the earth is flat”, 2) “the sun revolves around the Earth”, 3) 3 + 5 = 8 and 4) “plants need water to grow”. Respondents who failed either captcha did not proceed to the survey.

  6. Although the current study’s focus is on perceptions of psychotherapy, perceptions of medication were measured to ensure replicability of previous findings.

  7. Although the materials referred to chemical imbalances and amygdala activation, we recognize that these theories of depression have been scrutinized and sometimes discredited (e.g., respectively, Moncrieff et al., 2022; Grogans et al., 2022). The inclusion of these theories should not be seen as endorsement of them, but rather as a way of providing lay participants with accessible information, as such theories have been popularized over many years (e.g., Pescosolido et al., 2010), are still implied in practice (e.g., SSRI), and are still debated (again, Moncrieff et al., 2022). Future work should modify the materials using current theories of depression.

References

  • Ahn, W., & 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.

    Article  PubMed  Google Scholar 

  • Ahn, W., 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychiatric Association, D. S., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5 vol.). Washington, DC: American psychiatric association.

    Book  Google Scholar 

  • Angermeyer, M. C., Van der Auwera, S., Matschinger, H., et al. (2016). The public debate on psychotropic medication and changes in attitudes 1990–2011. European archives of psychiatry and clinical neuroscience, 266(2), 165–172. https://doi.org/10.1007/s00406-015-0660-7.

    Article  PubMed  Google Scholar 

  • Bear, A., & Knobe, J. (2015). What do people find incompatible with causal determinism? Cognitive Science, 40(8), 2025–2049. https://doi.org/10.1111/cogs.12314

    Article  PubMed  Google Scholar 

  • Beauregard, M. (2022). Functional neuroimaging studies of the effects of psychotherapy. Dialogues in Clinical Neuroscience.

  • 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.

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1037/12075-003.

  • Buchheim, A., Viviani, R., Kessler, H., Kächele, H., Cierpka, M., Roth, G., & Taubner, S. (2012). Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy. PloS one, 7(3), e33745.

  • Constantino, M. J., Arnkoff, D. B., Glass, C. R., et al. (2011). Expectations. Journal of clinical psychology, 67(2), 184–192. https://doi.org/10.1002/jclp.20754.

    Article  PubMed  Google Scholar 

  • Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T., A (2020). A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92–107. https://doi.org/10.1002/wps.20701.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dar-Nimrod, I., & Heine, S. J. (2011). Genetic essentialism: On the deceptive determinism of DNA. Psychological bulletin, 137(5), 800. https://doi.org/10.1037/a0021860.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dar-Nimrod, I., Zuckerman, M., & Duberstein, P. R. (2013). The effects of learning about one’s own Genetic susceptibility to alcoholism: A randomized experiment. Genetics in medicine, 15(2), 132–138. doi: https://doi.org/10.1038/gim.2012.111

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Deacon, B. J., & Baird, G. L. (2009). The chemical imbalance explanation of depression: Reducing blame at what cost? Journal of Social and Clinical Psychology, 28(4), 415–435.

    Article  Google Scholar 

  • Descartes, R. (2008). Meditations on first philosophy: With selections from the objections and replies. Oxford University Press.

  • Engel, G. L. (1978). The biopsychosocial model and the education of health professionals. Annals of the New York Academy of Sciences, 310(1), 169–181. https://doi.org/10.1111/j.1749-6632.1978.tb22070.x

  • 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.

    Article  PubMed  Google Scholar 

  • 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

  • Grogans, S. E., Fox, A. S., & Shackman, A. J. (2022). The amygdala and depression: A sober reconsideration. American Journal of Psychiatry, 179(7), 454–457. https://doi.org/10.1176/appi.ajp.20220412.

    Article  PubMed  Google Scholar 

  • Haslam, N. (2011). Genetic essentialism, neuroessentialism, and stigma: commentary on Dar-Nimrod and Heine (2011). DOI: https://doi.org/10.1037/a0022386

  • Haslam, N., & Kvaale, E. P. (2015). Biogenetic explanations of mental disorder: The mixed-blessings model. Current Directions in Psychological Science, 24(5), 399–404. https://doi.org/10.1177/0963721415588.

    Article  Google Scholar 

  • Heine, S. J., Cheung, B. Y., & Schmalor, A. (2019). Making sense of genetics: The problem of essentialism. Hastings Center Report, 49, S19–S26. https://doi.org/10.1002/hast.1013.

    Article  PubMed  Google Scholar 

  • Iselin, M. G., & Addis, M. E. (2003). Effects of etiology on perceived helpfulness of treatments for depression. Cognitive therapy and research, 27(2), 205–222. https://doi.org/10.1023/A:1023513310243.

    Article  Google Scholar 

  • Jones, E. E., Davis, K. E., & Gergen, K. J. (1961). Role playing variations and their informational value for person perception. The Journal of Abnormal and Social Psychology, 63(2), 302. https://doi.org/10.1037/h0048514.

    Article  CAS  PubMed  Google Scholar 

  • Kelley, H. H. (1972). Causal schemata and the attribution process. In E. E. Jones, D. E. Kanouse, H. H. Kelley, R. E. Nisbett, S. Valins, & B. Weiner (Eds.), Attribution: Perceiving the causes of behavior. Morristown, NJ: General Learning Press.

    Google Scholar 

  • Kelley, H. H., & Michela, J. L. (1980). Attribution theory and research. Annual review of psychology, 31(1), 457–501.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Kendler, K. S. (2001). A psychiatric dialogue on the mind-body problem. American Journal of Psychiatry, 158(7), 989–1000.

    Article  CAS  PubMed  Google Scholar 

  • Kupfer, D. J., Frank, E., & Phillips, M. L. (2016). Major depressive disorder: New clinical neurobiological, and Treatment perspectives. Focus, 14(2), 266–276. doi: https://doi.org/10.1016/S0140-6736(11)60602-8

  • Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The ‘side effects’ of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical psychology review, 33(6), 782–794.

    Article  PubMed  Google Scholar 

  • Lebowitz, M. S. (2019). The implications of genetic and other biological explanations for thinking about mental disorders. Hastings Center Report, 49, S82–S87.

    Article  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  • 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, 204-216.

  • 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.

    Article  Google Scholar 

  • Lucassen, P. J., Pruessner, J., Sousa, N., Almeida, O. F., Van Dam, A. M., Rajkowska, G., & Czéh, B. (2014). Neuropathology of stress. Acta neuropathologica, 127, 109–135.

    Article  CAS  PubMed  Google Scholar 

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

  • Miresco, M. J., & Kirmayer, L. J. (2006). The persistence of mind-brain dualism in psychiatric reasoning about clinical scenarios. American Journal of Psychiatry, 163(5), 913–918. https://doi.org/10.1176/ajp.2006.163.5.913.

    Article  PubMed  Google Scholar 

  • Moncrieff, J., Cooper, R. E., Stockmann, T., et al. (2022). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular psychiatry, 1–14. https://doi.org/10.1038/s41380-022-01661-0.

  • National Alliance on Mental Health. Mental health by the numbers. NAMI: https://www.nami.org/mhstats.

  • 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.

    Article  Google Scholar 

  • Pescosolido, B. A., Martin, J. K., Long, J. S., et al. (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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Robinson, H. (2017). Dualism, the Standard Encyclopedia of Philosophy (fall 2017 Edition), Edward N. i>URL = < https://plato.standard.edu/archives/fall2017/entries/dualism

  • Salm, M., Abbate, K., Appelbaum, P., Ottman, R., Chung, W., Marder, K., & Klitzman, R. (2014). Use of genetic tests among neurologists and psychiatrists: Knowledge, attitudes, behaviors, and needs for training. Journal of genetic counseling, 23(2), 156–163.

    Article  PubMed  Google Scholar 

  • Satel, S., & Lilienfeld, S. O. (2013). Brainwashed: The seductive appeal of mindless neuroscience. Basic Civitas Books.

  • Tadmon, D., & Olfson, M. (2022). Trends in outpatient psychotherapy provision by US psychiatrists: 1996–2016. American Journal of Psychiatry, 179(2), 110–121.

    Article  PubMed  Google Scholar 

  • July 6th Cover: “Pills for the Mind.” Time Magazine, Valtonen, J., Ahn, W. K., & Cimpian, A. (1992). (2021). Neurodualism: People Assume that the Brain Affects the Mind more than the Mind Affects the Brain. Cognitive Science, 45(9), e13034. DOI: https://doi.org/10.1111/cogs.13034

  • Valtonen, J., Ahn, W. K., & Cimpian, A. (2021). Neurodualism: People assume that the brain affects the mind more than the mind affects the brain. Cognitive science, 45(9), e13034.

  • 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 controllability. Psychotherapy Research, 29(3), 383–402. https://doi.org/10.1080/10503307.2017.1373205.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhang, Z., & Yuan, K. H. (2018). Practical statistical power analysis using webpower and R. Granger, IN: ISDSA Press. https://webpower.psychstat.org].

    Book  Google Scholar 

  • Zimmermann, M., & Papa, A. (2020). Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory. Psychology and Psychotherapy: Theory Research and Practice, 93(3), 537–535.

    Article  Google Scholar 

Download references

Funding

Research funding provided by the authors’ university supported this study.

Author information

Authors and Affiliations

  1. Department of Psychology, Yale University, New Haven, Connecticut, United States of America

    Annalise Perricone & Woo-kyoung Ahn

Authors
  1. Annalise Perricone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Woo-kyoung Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Author contributions are provided on the separate title page with author names.

Corresponding author

Correspondence to Annalise Perricone.

Ethics declarations

Conflict of Interest

The authors acknowledge no conflicts of interest.

Ethics Approval

All study measures were approved by the Institutional Review Board; all procedures were in accordance with the Helsinki Declaration.

Consent to Participate

All participants provided informed consent after the study procedures had been fully explained.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Supplementary Material 2

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.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perricone, A., Ahn, Wk. Reasons for the Belief that Psychotherapy is Less Effective for Biologically Attributed Mental Disorders. Cogn Ther Res (2023). https://doi.org/10.1007/s10608-023-10392-7

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10608-023-10392-7

Keywords

search

Navigation