Article

The Chemical Imbalance Explanation of Depression: Reducing Blame at What Cost?

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Abstract

Brain disease models of psychopathology, such as the popular chemical imbalance explanation of depression, have been widely disseminated in an attempt to reduce the stigma of mental illness. Ironically, such models appear to increase prejudicial attitudes among the general public toward persons with mental disorders. However, little is known about how biochemical causal explanations affect the perceptions of individuals seeking mental health treatment. Ninety undergraduate students participated in a thought experiment in which they were asked to imagine feeling depressed, seeking help from a doctor who diagnosed them with major depressive disorder, and receiving, in counterbalanced order, a chemical imbalance and biopsychosocial explanation for their symptoms. Ratings of each explanation's credibility and perceptions of self-stigma (e.g., blame), prognosis, and treatment expectancies were obtained. Compared to the biopsychosocial model, the chemical imbalance model was associated with signifi antly less self-stigma but also significantly lower credibility, a worse expected prognosis, and the perception that psychosocial interventions would be ineffective. The chemical imbalance explanation appears to reduce blame at the cost of fostering pessimism about recovery and the efficacy of nonbiological treatments. Research is needed on how the chemical imbalance model affects the clinical response of patients receiving mental health treatment.

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... However, longitudinal and meta-analytic data suggest stigma surrounding mental disorders has gone unchanged despite more of the public accepting a biological model of mental illness (Pescosolido et al., 2010;Schomerus et al., 2012). It has since been theorized that belief in bio-genetic causes may increase the perceived dangerousness and differentness of individuals labeled as experiencing a mental disorder (Schomerus, Matschinger, & Angermeyer, 2014), as well as increase beliefs about severity and persistence of symptoms (Deacon & Baird, 2009;Phelan, 2005;Phelan, Cruz-Rojas, & Reiff, 2002). Similar stigmatizing beliefs tied to biological attributions are held by people receiving a diagnosis of a mental disorder (Lebowitz, Ahn, & Nolen-Hoeksema, 2013;Lebowitz et al., 2014;Rüsch, Todd, Bodenhausen, & Corrigan, 2010). ...
... Biological etiological attributions generally relate to deterministic views of illness, including beliefs that symptoms are uncontrollable. Alternatively, psychological attributions tend to be associated with personal responsibility, blame, and invalidating beliefs about difficulties (e.g., Corrigan & Watson, 2004;Deacon & Baird, 2009;Lebowitz et al., 2013;Lebowitz et al., 2014;Phelan, 2005;Phelan et al., 2002;Rüsch et al., 2010;Weiner, Perry, & Magnusson, 1988). In both cases, etiological attributions can relate to negative, stigmatizing beliefs about the received label and experienced symptoms. ...
... In the pre-treatment data, we predicted that there would be positive correlations among the self-stigma, etiological attributions, and symptoms. We further predicted that biological attributions would less strongly relate to self-stigma and symptom severity than psychological attributions, potentially due to lessened self-blame associated with biological causes (Deacon & Baird, 2009). We then utilized multivariate analyses in the pre-treatment data to explore the unique variance accounted for by self-stigma and etiological attributions in relation to symptom severity at pre-treatment. ...
Article
Nearly one-third of individuals in the U.S. will be diagnosed with an anxiety disorder during their lifetime. Receiving that label can evoke self-stigma, with self-stigma relating to greater symptom severity and negatively impacting treatment outcomes. A lesser-studied variable related to self-stigma is etiological attributions about symptoms, including biological and psychological attributions. The current study examined interrelations among self-stigma, etiological attributions, and symptom severity among 213 individuals diagnosed with an anxiety disorder who completed a cognitive-behavioral treatment (CBT) program. How self-stigma and etiological attributions related to symptom improvement following the program was examined in a subset of participants. Etiological attributions and self-stigma shared positive associations with symptom severity. Regression analyses indicated that, when controlling for overlap among self-stigma and etiological attributions, psychological attributions emerged as particularly relevant for understanding symptom severity. Changes in self-stigma and attributions were positively associated with changes in symptom severity following the CBT program. Study implications are discussed.
... For people experiencing mental illness, biological causal accounts can help reduce self-blame (Lee et al., 2016). However, they can also promote fatalistic attitudes towards recovery prospects (Deacon and Baird, 2009;Lam and Salkovskis, 2007), which are likely to impede help-seeking and treatment engagement. Research also suggests causal attributions predict the treatment approach that is favoured (Hagmeyer and Englemann, 2014). ...
... Experimental studies are required to establish the directionality of effects, i.e. that causal attributions influence treatment attitudes rather than vice versa. Two experimental studies by Phelan et al. (2006) and Deacon and Baird (2009) report that biological explanations of depression, such as genetic or chemical explanations, increased endorsement of hospitalisation and pharmacological interventions (Phelan et al., 2006) and reduced perceived efficacy of psychosocial interventions such as psychotherapy or lifestyle changes (Deacon and Baird, 2009). While these studies confirm causal attributions are important in determining treatment preference, they show some limitations. ...
... Experimental studies are required to establish the directionality of effects, i.e. that causal attributions influence treatment attitudes rather than vice versa. Two experimental studies by Phelan et al. (2006) and Deacon and Baird (2009) report that biological explanations of depression, such as genetic or chemical explanations, increased endorsement of hospitalisation and pharmacological interventions (Phelan et al., 2006) and reduced perceived efficacy of psychosocial interventions such as psychotherapy or lifestyle changes (Deacon and Baird, 2009). While these studies confirm causal attributions are important in determining treatment preference, they show some limitations. ...
Article
Background: Depression is a leading cause of ill-health and disability globally and encouraging help-seeking and treatment engagement is a key priority of health authorities worldwide. Causal attributions for mental illness have numerous attitudinal and behavioural consequences; however, limited research has explored their implications for attitudes to treatment. This study experimentally investigates the impact of causal attributions for depression on attitudes to specific help-seeking and treatment options. Methods: In an online study, 196 participants read a vignette that emphasised either biological, social or biopsychosocial causes of a character's depression. Participants rated several help-seeking and treatment options on how helpful or harmful they would be for the individual described in the vignette and for themselves personally. Results: The causal attribution manipulation significantly affected treatment attitudes. Relative to social attributions, emphasising biological causes of depression significantly decreased the perceived helpfulness of lifestyle-based treatments, but did not affect attitudes to psychotherapeutic or medical treatment options. Participants rated most help-seeking and treatment options as less helpful for themselves compared to the vignette character. Participants with personal experience of depression had lower confidence in informal sources of help-seeking and greater confidence in medical treatment. Limitations: Limitations include reliance on self-report measures and low reliability of certain sub-scales. Conclusions: These findings suggest emphasising the biological underpinnings of depression could deter people from engaging with lifestyle-based treatment options. Promoting biopsychosocial theories of depression could increase awareness about the multifactorial causes of depression without negatively impacting the perceived efficacy of any help-seeking or intervention options.
... Disseminating information that emphasises the efficacy of particular treatment approaches (for example, in media reports or popular entertainment narratives) may influence public beliefs about the relevant mental illness. Previous general population studies show that emphasising different causes of mental illness affects people's treatment preferences; for example, reading endorsements of biological causes of depression increases preference for biomedical and reduces preference for psychotherapeutic or lifestyle interventions (Deacon and Baird, 2009;Nolan and O'Connor, 2019;Phelan et al., 2006). No research has tested the reverse direction of this treatment-attribution relationshipthat is, whether endorsing the efficacy of particular treatment approaches affects lay beliefs about the causes of mental illness. ...
... Aetiological beliefs about the origins (‗causal attributions') of mental illness represent one dimension of the Self-Regulation Model, which has been particularly intensively studied. Research shows that attributing mental illness to biological causes can reduce self-blame (Lee et al., 2016), but also impede treatment engagement by promoting fatalistic attitudes regarding recovery (Deacon and Baird, 2009;Lam and Salkovskis, 2007;Schroder et al., 2020). ...
... This research suggests that promoting psychological treatment of mood disorders, and social treatment of anxiety disorders, may risk inadvertently implying an individual is to blame for their symptoms. Yet endorsing biological treatment may also carry a risk: namely, fostering fatalistic attitudes about a person's ability to control the course of their illness (Deacon and Baird, 2009;Lam and Salkovskis, 2007;Schroder et al., 2020). The paradox of positioning individuals as active agents in the trajectory of mental illness is that implicating individual volition in the origin of illness encourages stigma, but endorsing individual volition in the course of illness is necessary for help-seeking and treatment engagement (Baines and Wittkowski, 2013). ...
Article
Full-text available
The current paper reports three experimental studies that investigate how selectively emphasising different treatment approaches (biological, psychological or social) for mental health difficulties affects lay beliefs about those illnesses. Online experimental vignettes exposed participants to different treatment narratives for a clinical case of Major Depressive Disorder (Study 1; n=164), Generalized Anxiety Disorder (Study 2; n=173) and Schizophrenia (Study 3, n=170). Measures of causal attributions and illness perceptions assessed effects on beliefs about the causes and course of the illness. Emphasising psychological treatment of Major Depressive Disorder promoted more causal attributions to personal weakness, while endorsing biological treatment weakened confidence in individual control over the course of their illness. For Generalized Anxiety Disorder, stressing social treatment encouraged more causal attributions to personal weakness and lifestyle factors. Causal attributions for Schizophrenia did not shift across treatment modality, but highlighting biological treatment made the symptoms appear more treatable, while emphasising psychological treatment made the illness seem more personally controllable. As lay understandings of the causes and course of mental illness have implications for help-seeking, treatment engagement and stigma, effects on illness beliefs may be an important consideration when endorsing a particular treatment approach in public discourse or clinical communication.
... The biomedical model can increase feelings of powerlessness as it can create the idea that individuals have no control over their emotions and cognitions (Karp, 2006). Moreover, it can lead to prognostic pessimism: the belief that mental health problems are relatively permanent and unlikely to remit (Deacon & Baird, 2009;Lebowitz, 2014;Kemp et al., 2014). ...
... Moreover, the conceptualization of mental illnesses as biological diseases may also induce essentialist thinking, thereby reinforcing views about the chronic and untreatable nature of mental disorders and increasing certain forms of stigma (Deacon & Baird, 2009;Kvaale, Haslam, & Gottdiener, 2013). ...
... The role of the biomedical model in mental illness stigma in children should also be explored further. In studies with adults, biological explanations of mental illness have shown to reduce blame, but they can increase other forms of stigma such as desire for social distance (Deacon & Baird, 2009;Kvaale et al., 2013). For healthcare professionals, this knowledge is essential, as the causal explanation they give to their patients can have an influence on self-stigma and coping behaviour. ...
Thesis
This paper describes a qualitative study designed to explore the lived experiences of children diagnosed with Autism Spectrum Disorder (ASD). The voices of these children have often been missing in bioethical arguments about potential threats of psychiatric diagnosis and treatment to children’s sense of identity and moral self-understanding. This study aimed to examine the suitability of activity-based interviews to elicit these children’s perspectives, and to empirically evaluate the social and moral dimensions of an ASD diagnosis. Participants included six children diagnosed with ASD ranging in age from 8 to 14. Methods used include photo elicitation, drawing, sentence starters, and the making of a collage. Through thematic analysis, four main themes were identified: anger and losing control of the self; brain, power, and responsibility; identity and authenticity; and friendship, bullying, and stigma. The use of multiple qualitative strategies proved to be valuable in engaging children in the study and eliciting their perspectives. Children’s self-understandings appear to be structured by their ASD diagnosis and treatment; however, these effects are in part positive. Nonetheless, children also describe frequently encountering stigma and bullying about their diagnosis. Implications of these results and suggestions for further research are discussed.
... Proponents of the biomedical model suggest that it has value for reducing stigma for depressed persons by reducing personal blame by framing depression as an uncontrollable illness, no different than cancer. Evidence, however, suggests that on the contrary, framing depression as biologically caused may in fact increase stigma (Deacon & Baird, 2009) and prognostic pessimism, or the length of time an individual believes that depression will last (Lebowitz, Ahn, & Nolen-Hoeksema, 2013). ...
... Correlational evidence suggests that individuals who attribute their depression to neurobiological problems prefer pharmacological treatment, while those who attribute their depression to psychosocial aetiology report a greater preference for psychotherapy (Beshai, Watson, Meadows, & Soucy, 2019;Jorm et al., 1997;Schomerus et al., 2012;Schroder, Dawood, Yalch, Donnellan, & Moser, 2015). Experimental studies have found that participants presented with biochemical explanations of depression were less likely to report willingness to seek psychotherapy, less likely to find causes or solutions for emotional problems, and to agree that the cure to mental health problems was outside the individual's control (Deacon & Baird, 2009;Fisher & Farina, 1979;Iselin & Addis, 2003). ...
... Our results show that presenting psychoeducation based on a biological causal model of depression increases the credibility of pharmacological treatment for depression, but not of psychotherapy. This result is consistent with past work that has suggested a relationship between belief in a causal model of depression and treatment preference (Beshai et al., 2019;Deacon & Baird, 2009;Fisher & Farina, 1979;Iselin & Addis, 2003;Jorm et al., 1997;Nieuwsma & Pepper, 2010;Schomerus et al., 2012;Schroder et al., 2015). Furthermore, causal explanations had an effect on some but not all aspects of stigma and prognostic pessimism, with individuals in the biomedical condition endorsing greater belief in depression as a lifelong disorder, more likely to view depression as 'feeling sorry for oneself' and view depression as more likely to elicit perceptions of dangerousness from others. ...
Article
Objectives: Understanding depression as biologically caused has been shown to impact both treatment preferences and prognostic pessimism. Attribution theory has been posited as an explanation for this relationship. Given that evidence-based psychotherapy is effective yet often not delivered to individuals with depression, the present study sought to determine factors that impact treatment credibility. Design: Non-treatment-seeking, depressed individuals (n = 229) were randomly assigned to read a psychoeducation article about depression that consisted of a biological causal explanation, psychosocial causal explanation, or a non-causal control. Methods: Attributional dimensions of locus, stability, and control were examined as mediating the relationship between causal explanation and treatment credibility and prognostic pessimism. Results: Individuals in the biological condition were more likely to find antidepressant medication a credible treatment for depression. The manipulation had no direct effect on preference for psychotherapy or prognostic pessimism. Attributional dimensions of locus, stability, and control did not mediate the relationship between causal explanation and treatment credibility. To the extent that the psychosocial article increased perceived instability of the depression cause, however, prognostic pessimism was reduced. Conclusions: The present study has implications for framing education about depression in mental health literacy programs and public awareness campaigns. Practitioner points: This study found that conceptualizing depression as biologically caused increased the credibility of medication but not psychotherapy Participants reading a biological explanation of depression demonstrated an increase on some aspects of stigma and prognostic pessimism Emphasizing the person-environment interaction rather than biological causes decreased the perceived stability of depression which was associated with a decrease in prognostic pessimism.
... Indeed, biogenetic beliefs have been shown to have direct effects on treatment expectancy. Studies of college students (Deacon and Baird, 2009;Kemp et al., 2014), community members with depressive symptoms (Zimmermann and Papa, 2019), and outpatient psychotherapy clients (Tompkins et al., 2016) find that participants exposed to or espousing the biological model of depression expect less benefit from psychotherapy and more benefit from medication (but see Salem et al., 2019, who found no effects of induced beliefs on expectancies for medication or psychotherapy). Although these studies are suggestive, they have almost exclusively evaluated etiological beliefs in relation to hypothetical treatment scenarios (i.e., thought experiments). ...
... In fact, one study (Klein et al., 2017) found that individuals with depression were more likely to ascribe their first depressive episode to stressful external circumstances but attributed subsequent episodes to internal biological factors. It is possible that these beliefs then become self-reinforcing in that they may reduce self-blame for the experience of depression (Deacon and Baird, 2009). In this way, they may act as an emotion regulation strategy -when someone is distressed, they can recall that their problems are partly due to biological abnormalities and therefore not feel as upset. ...
... Some alternative messages have been proposed to minimize the effects of biogenetic beliefs. For instance, some have suggested invoking the biopsychosocial model of mental distress, which equally emphasizes biological, psychological, and social circumstances that contribute to the onset and maintenance of depression (Deacon and Baird, 2009). However, some have pointed out that even biopsychosocial models inadvertently favor biological explanations of psychological distress (Read, 2005). ...
... Further, research indicates that hopelessness is associated with lower treatment expectancies (Goldfarb 2002). Although Lebowitz et al. did not find a significant link between biological explanations and scores on a general hopelessness measure (2013), biological explanations have been linked to hopelessness regarding perceived likelihood of recovery from depression (Deacon and Baird 2009;Kemp et al. 2014;Kvaale et al. 2013a, b;Lebowitz et al. 2013), which is arguably more relevant than general hopelessness in shaping treatment expectancies. ...
... Among clinicians and in the general public, causal attributions for depression have been linked to beliefs about treatment and preferences for specific treatment modalities (Ahn et al. 2009;Goldstein and Rosselli 2003;Lebowitz and Ahn 2014;Lebowitz and Applebaum 2017). Consistent with this idea, when causal explanations for depression were experimentally manipulated in participants instructed to imagine that they were depressed, biological explanations led to significantly lower perceived helpfulness ratings for psychotherapy, but higher perceived helpfulness for antidepressants (Deacon and Baird 2009). After participants read a biopsychosocial explanation these effects were reversed, however, with psychotherapy rated as more helpful and antidepressants as less helpful (Deacon and Baird 2009). ...
... Consistent with this idea, when causal explanations for depression were experimentally manipulated in participants instructed to imagine that they were depressed, biological explanations led to significantly lower perceived helpfulness ratings for psychotherapy, but higher perceived helpfulness for antidepressants (Deacon and Baird 2009). After participants read a biopsychosocial explanation these effects were reversed, however, with psychotherapy rated as more helpful and antidepressants as less helpful (Deacon and Baird 2009). These findings represent initial experimental evidence suggesting that causal explanations for depression might shape treatment expectancies. ...
Article
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In the current literature there is a general lack of research examining the impact of causal explanations on beliefs about psychotherapy, willingness to accept treatment, and treatment expectancies. The present study was aimed at experimentally investigating effects of causal explanations for depression on treatment-seeking behavior and beliefs. Participants at a large Southern university (N = 139; 78% female; average age 19.77) received bogus screening results indicating high depression risk, then viewed an explanation of depression etiology (fixed biological vs. malleable biopsychosocial) before receiving a treatment referral (antidepressant vs. psychotherapy). Participants accepted the cover story at face value, but some expressed doubts about the screening task’s ability to properly assess their individual depression. Within the skeptics, those given a fixed biological explanation for depression were relatively unwilling to accept either treatment, but those given a malleable biopsychosocial explanation were much more willing to accept psychotherapy. Importantly, differences in skepticism were not due to levels of actual depressive symptoms. Information about the malleability of depression may have a protective effect for persons who otherwise would not accept treatment.
... people with mental disorder, we may expect that biological explanations would foster rather than mitigate negative social attitudes towards patients (Haslam, 2011). In fact, previous work has found evidence for such negative consequences, such as greater pessimism about illness prognosis (Deacon & Baird, 2009;Phelan et al., 2002) and harsher behavioral responses (Mehta & Farina, 1997). The implication that biomedical framing conveys both advantages and disadvantages has been incorporated into the "Mixed Blessings Model" which proposes that biomedical explanations simultaneously promote essentialist thinking as well as perceptions of symptoms as outside patient control (Haslam & Kvaale, 2015). ...
... Given the compatibility between biological explanations for symptoms and pharmacological treatment, it is unsurprising that previous studies have provided evidence that biological framing may promote more positive perceptions of pharmacological interventions for oneself (Deacon & Baird, 2009;Kemp, Lickel, & Deacon, 2014) and for a distressed other person (Phelan et al., 2006), as well as potentially more negative perceptions of psychotherapeutic interventions for oneself (Deacon & Baird, 2009 medication, and combination treatment), and perceptions of prognosis. We hypothesized that: 1) Similar to depression research, the biological explanation would be rated as less credible than psychosocial accounts. ...
... Given the compatibility between biological explanations for symptoms and pharmacological treatment, it is unsurprising that previous studies have provided evidence that biological framing may promote more positive perceptions of pharmacological interventions for oneself (Deacon & Baird, 2009;Kemp, Lickel, & Deacon, 2014) and for a distressed other person (Phelan et al., 2006), as well as potentially more negative perceptions of psychotherapeutic interventions for oneself (Deacon & Baird, 2009 medication, and combination treatment), and perceptions of prognosis. We hypothesized that: 1) Similar to depression research, the biological explanation would be rated as less credible than psychosocial accounts. ...
Article
Full-text available
Background and aims: There is evidence to suggest that biogenetic explanations for symptoms of mental disorders have become increasingly popular. Research suggests that such explanations provokes mixed blessings: biological explanations may reduce blame but also encourage prognostic pessimism and promote perceptions of pharmacological treatment over psychotherapy. The goal of this study was to evaluate the impact of different causal explanations on social anxiety disorder. Method: About 205 adults completed an experiment where they read a vignette describing an individual with social anxiety disorder and were randomly assigned to a symptom explanation that was: (1) biological, (2) biopsychosocial, (3) psychosocial, or (4) no explanation. Results: The psychosocial condition yielded the highest perceived credibility and lowest attributions of blame. The biological condition promoted positive expectations for medication effectiveness compared to other conditions. Conditions did not differ on prognostic expectations. Conclusions: Calls attention to the risk of generalizing from previous research to mental disorders as a whole.
... Nor was there evidence that Anglo-Australians see people with clinical diagnoses of depression as biologically inferior or mentally unstable (see e.g. Barney, Griffiths, Jorm, & Christensen, 2006;Deacon & Baird, 2009). Rather, they raised concerns about the negative side effects antidepressants have on people, describing medication as a cheap and convenient replacement for more far-reaching efforts to shift dispositions, lifestyles, and socio-structural situations. ...
... However, these comments from participants echo critical perspectives from academia, which have recommended psychosocial and biopsychosocial approaches over narrow biomedical understandings of depression (see esp. Brijnath & Antoniades, 2016;Deacon & Baird, 2009;Dowrick, 2013;Pilgrim, 2007). It could indicate that Anglo-Australians' criticisms of the Australian health system involve a 'double hermeneutic' (Giddens, 1987), where critical scholarship is influencing lay-participants' views and re-entering social research. ...
Article
This article deploys a legitimacy framework to explore how Anglo-Australian and Indian-Australian community members living in Melbourne, Australia, interpret the diagnosis and treatment of depression. Examining community beliefs about depression illuminates the lay-discourses that people living with depression encounter when they disclose their experiences to others. Based on 10 focus groups with 77 community members from Indian-Australian and Anglo-Australian backgrounds, we deploy three frames of legitimacy through which depression is described: biomedical, situational, and moral. Indian-Australian participants were less likely to see depression as a legitimate biomedical condition, describing it primarily in situational terms often connected to migration experiences. Additionally, Indian-Australians often described succumbing to depression as a sign of individual weakness, suggesting that disclosing depression within their community risks loss of moral legitimacy. Anglo-Australians more readily recognised the biomedical legitimacy of depression but offered lay-critiques of medical diagnoses and treatment with antidepressants. In cases of long-term depression, there was a potential loss of moral legitimacy within both communities. The findings illustrate variation in the ways and degrees to which depression and its treatment are socially legitimised across two communities, which manifests in a continuum of diverse approaches to help-seeking.
... However, few studies so far have investigated how specific explanatory models influence the way individuals think about their pathology and even less is known about how explanatory models influence illness perceptions in individuals with EDs. Most research has focused on investigating the influence of purely genetic or biological explanations, (i.e., explanations that characterize mental illnesses as "brain diseases"; Deacon and Baird 2009;Kemp et al. 2014;Lebowitz et al. 2013), as such explanations have recently been put forward to call for recognition of EDs as biologically-based serious mental illnesses (Klump et al. 2009). However, genetic essentialism (i.e., the notion that mental illnesses have immutable essence; Dar-Nimrod and Heine 2011; Haslam 2011) introduces certain biases (e.g., an illness's course is determined and barely influenceable) that, in line with attribution theory (Weiner et al. 1988), may reduce feelings of self-blame but foster feelings of diminished control and chronic timeline (for a review see Lebowitz and Appelbaum 2019). ...
... In line with previous studies on depression (Deacon and Baird 2009;Kemp et al. 2014;Lebowitz et al. 2013) and EDs (Farrell et al. 2015), participants in the BG condition reported greater prognostic pessimism (i.e., a more chronic timeline) than participants in the CB condition after watching the video. This is plausible given that BG explanations focus on latent and stable conditions (e.g., genes) whereas the CB and NT rationale mention factors that are more transient and influenceable (e.g., behaviors). ...
Article
Full-text available
Background Negative illness representations such as self-blame impede treatment-seeking behavior and therapy motivation in individuals with eating disorders (EDs). However, only one study so far has investigated how different explanatory models influence these beliefs in EDs. We aimed to expand these findings by introducing an explanatory model based on network theory (NT). Methods We presented three explanatory models to a diverse web-recruited sample (n = 290, 141 females, 149 males) with clinically elevated ED symptomatology. Participants either watched a video with a biological-genetic (BG), cognitive-behavioral (CB) or an NT explanatory model and were asked about illness representations before and after watching the video. Results The BG group showed significantly greater reductions in self-blame but a significant decrease in personal control and less optimistic expectation regarding timeline compared to the CB and NT groups. There were no group differences regarding the perception of the clinician, comprehensibility of the explanatory model and credibility of a CBT intervention. Conclusions Given the increasing popularity of biological-genetic explanatory models of EDs, it is important to note the disadvantages we found to be associated with these models. Our findings indicate that explanatory models emphasizing cognitive-behavioral (CB) principles and/or network theoretical (NT) underpinnings of EDs may serve to promote optimism and greater perceptions of personal agency in affected populations. This trial's registration number is 316.
... They must navigate information about MDD and antidepressant treatment that may conflict with the conventional wisdom held by the general public. Despite the influence of causal beliefs about depression impacting clients' prognostic expectations (e.g., Deacon & Baird, 2009;Lebowitz, Ahn, & Nolen-Hoeksema, 2013), there remains scant social science/medical data on what is discussed in therapy with clients. ...
... While clinicians aimed to reduce client blame and self-stigma with the CIT, there is limited empirical support for this position (e.g., Deacon & Baird, 2009;Lebowitz & Appelbaum, 2019). These findings provide crucial evidence of the disconnect between the scientific literature and clinical practice best practices for treating depression. ...
Article
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Major Depressive Disorder (MDD) is poorly understood and frequently diagnosed in mental health practice. Qualitative thematic analysis from interviews with 20 licensed clinical social workers (LCSWs) was conducted to evaluate clinicians’ perceptions, sources of information, and use of the chemical imbalance theory (CIT) during interactions with clients. Findings revealed that clinicians held nuanced and often critical perceptions of the CIT. When clinicians did incorporate CIT, they did so in highly specific and nuanced ways, often to justify antidepressant treatment. Social workers highlighted a gap in psychopharmacology education and training. Implications for social work education and practice are addressed.
... A better understanding of lay intuitive theories about the mind and the brain is important not only for insights into human cognition, but also because intuitive theories contain causal beliefs, and causal beliefs affect behavior. Dualistic biases about the mind and the body have been shown to affect, for example, health-related behaviors (Forstmann, Burgmer & Mussweiler, 2012), expectations of mental-health treatment outcomes (Ahn, Kim, & Lebowitz, 2017;Deacon & Baird, 2009;Kemp, Lickel, & Deacon, 2014;Lebowitz & Ahn, 2015), mental illness stigma (Haslam & Kvaale, 2015), clinical judgments of mental health professionals (Miresco & Kirmayer, 2006), and, some authors argue, implicitly even ways in which entire societal institutions such as health care and the criminal justice system are structured (Greene, 2011). Both lay people and mental health professionals believe, for example, that a biological treatment is more effective for mental health problems with a biological basis, a belief that encourages increased use of psychiatric drugs and decreased utilization of psychotherapy as the neuroscience of mental disorders progresses (Ahn, Proctor, & Flanagan, 2009;Ahn et al., 2017). ...
... When people think that the source of a mental health issue such as depression is in the brain, they perceive psychological interventions as less likely to be helpful (Ahn et al., 2017;Deacon & Baird, 2009;Kemp et al., 2014). The belief that a psychological treatment cannot be effective if the problem is reflected in brain processes is at odds with both a physicalist view of the mind and 48 with the empirical evidence (e.g., Linden, 2006;Lozano, 2011;Deacon, 2013). ...
Article
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People commonly think of the mind and the brain as distinct entities that interact, a view known as dualism. At the same time, the public widely acknowledges that science attributes all mental phenomena to the workings of a material brain, a view at odds with dualism. How do people reconcile these conflicting perspectives? We propose that people distort claims about the brain from the wider culture to fit their dualist belief that minds and brains are distinct, interacting entities: Exposure to cultural discourse about the brain as the physical basis for the mind prompts people to posit that mind–brain interactions are asymmetric, such that the brain is able to affect the mind more than vice versa. We term this hybrid intuitive theory neurodualism. Five studies involving both thought experiments and naturalistic scenarios provided evidence of neurodualism among laypeople and, to some extent, even practicing psychotherapists. For example, lay participants reported that “a change in a person’s brain” is accompanied by “a change in the person’s mind” more often than vice versa. Similarly, when asked to imagine that “future scientists were able to alter exactly 25% of a person’s brain,” participants reported larger corresponding changes in the person’s mind than in the opposite direction. Participants also showed a similarly asymmetric pattern favoring the brain over the mind in naturalistic scenarios. By uncovering people’s intuitive theories of the mind–brain relation, the results provide insights into societal phenomena such as the allure of neuroscience and common misperceptions of mental health treatments.
... Like public stigma, most research has explored the effects of different causal presentations on depression self-stigma. Namely, biological presentations have been found to increase prognostic pessimism and decrease self-efficacy (Deacon & Baird, 2009;Kemp, Lickel, & Deacon, 2014;Lebowitz & Ahn, 2014). Meanwhile, biopsychosocial causal presentations (depression is caused by the interplay of biological, psychological and social causes) may increase feelings of self-blame (Lee, Farrell, McKibbin, & Deacon, 2016). ...
... Findings are also mixed on whether a biopsychosocial presentation always improves stigma. Some studies show that biopsychosocial presentations, compared to biological explanations, improve perceptions that people with depression can recover (Deacon & Baird, 2009). Other work found that combined biological and cognitive-behavioral presentations increase prognostic pessimism (Lee et al., 2016). ...
Preprint
We review knowledge concerning public presentations for depression. These presentations impact illness beliefs and may influence public stigma, self-stigma, and depression literacy. We provide a critical review of messages, images, and information concerning depression’s causes, continuum conceptualization, timeline, curability, coping/treatment regimen, and strengths. To provide data regarding the prevalence of particular presentations, we conducted a content analysis of 327 videos about depression representative of material on the YouTube social media platform. YouTube presentations of depression indicate that depression: 1) is caused by either biological (49.5%) or environmental (41.3%) factors; 2) is a categorical construct (71%); 3) is treatable, with 61% of relevant videos (n=249) presenting recovery as “likely”; 4) is chronic, found in 76% of videos mentioning timeline; 5) is recurrent (32.5%); 6) is mostly treated via medication (48.6%) or therapy (42.8%), although diet/exercise (29.4%) and alternative treatments (22.6%) are commonly endorsed; and 7) is rarely associated with strength (15.3%). We discuss how these presentations may influence stigmatizing attitudes and depression literacy among people with and without depression and suggest future research directions to better understand how to optimize public presentations. Ultimately this work may help to decrease stigma, increase depression literacy, and improve social support and treatment seeking behaviors.
... Providing basic neuroeducation in a therapeutic setting can offer profound benefits to our patients, among them reducing stigma, appreciating the spectrum of individual variability, and promoting an understanding for how treatments work, which can in turn spur improved motivation for change. Research suggests that presenting biological explanations to patients about their disorder reduces the self-stigmatizing attitudes they may hold about their mental health struggles (Deacon & Baird, 2009;Lebowitz et al., 2014). For example, learning that environmental factors combined with genetic propensities impact how the brain develops, and generates patterns of thinking, behaving, and feeling (Miguel et al., 2019), may reduce selfblame and help challenge long-held assumptions that any shortcomings are intrinsic and fixed features of the self. ...
... Learning about brain-based mechanisms can reduce stigma in patients, but there is also a risk of patients being left with faulty assumptions or misconceptions of having a fixed, permanent problem, thus generating prognostic pessimism (Deacon & Baird, 2009;Lebowitz et al., 2014). Given evidence that an emphasis on the malleability of biological mechanisms can reduce prognostic pessimism and increase patients' belief in their ability to change (Lebowitz & Ahn, 2015), we believe that it is imperative to balance explanations of brain-based mechanisms of psychological difficulties with information about how psychotherapy changes the brain. ...
Article
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As clinicians we have numerous tools at our disposal when working with patients in the therapeutic context, ranging from rapport building to empirically validated psychotherapy manuals. Psychoeducation is another invaluable clinical tool that can help patients make sense of the causes and consequences of their symptoms and how psychotherapy tools work to facilitate change. Psychoeducation furthermore provides an opportunity to define terms and arrive at a common language for speaking about psychological processes throughout the course of psychotherapy. One specific aspect of psychoeducation that many clinicians may not be leveraging to full effect is neuroscience-informed psychoeducation, or “neuroeducation.” Neuroeducation in the context of clinical practice refers to communication with our patients about the brain’s role in mental health, learning and memory, and brain-based explanations for how and why psychosocial interventions work. Although our understanding of the complex brain mechanisms underlying psychological disorders is still in its infancy, an ever-growing body of clinical neuroscience research is laying a strong foundation for the utility of neuroeducation in psychotherapy. The present article describes the benefits and challenges surrounding the use of neuroeducation in the clinic and proposes four basic components of neuroeducation, along with sample language to use with patients.
... (18) This athlete expresses certainty toward a singular explanation for the origin of depression which has absolved him of blame for the development of his mental illness. Although such a construction can absolve the athlete of blame, acceptance of this singular explanation can create ineffective recovery outcomes by failing to look more deeply at other personal or sociocultural influences which may have impacted mental illness (Deacon & Baird, 2009). ...
... The dominance of a diagnostic perspective was evident within athlete accounts, as many athletes' mental illness and recovery stories were shaped through medical conceptualizations. Research has indicated that recovery experiences for individuals whose stories align to medical understandings of illness may not be as fulfilling given the promises the medical model makes about 'curing' illness (Deacon & Baird, 2009). We encourage future research to explore further narratives which focus on athlete experiences of living with mental illness, which deviate from biomedical understandings of illness. ...
Article
This meta-study systematically appraises and synthesizes research into athletes’ experiences of mental illness. Our critical review of 37 studies conformed to the meta-study structure of meta-theory, meta-method, and meta-data analysis. We also produced a meta-synthesis of findings to deliver new insights into athlete mental illness. Athlete accounts of mental illness pertained to experience of the following: depression, eating disorders, gambling addiction and substance-related disorders (alcohol and drugs). Following a critical interrogation of original articles’ theory, method, and findings, we noted a general lack of methodological coherence (congruence between philosophical stance, theoretical position, and methodology). Through the process of a thematic synthesis, we developed 4 new themes: origins of certainty and ambiguity, a gradual sense of decline, mental illness as a threat to identity, and constructing recovery stories. Athletes drew upon dominant illness discourses to construct mental illness and recovery experiences. Our results provide us with an understanding of how mental illness and recovery were experienced within an elite sport involvement. We recommend future research embraces more diverse methodologies and authors ensure a strong alignment between guiding philosophies and methodological approach.
... A large literature has explored the role of Dualism and Essentialism in laypeople's reasoning about mental disorders. Dualism has been invoked to explain the curious finding that, when psychiatric symptoms are linked to a biological source, laypeople's attitudes towards the symptoms and patients are generally more negative: people consider biological symptoms as less controllable by the patient [48,49] and as less likely to benefit from psychotherapy [48,50,51]. ...
... A large literature has explored the role of Dualism and Essentialism in laypeople's reasoning about mental disorders. Dualism has been invoked to explain the curious finding that, when psychiatric symptoms are linked to a biological source, laypeople's attitudes towards the symptoms and patients are generally more negative: people consider biological symptoms as less controllable by the patient [48,49] and as less likely to benefit from psychotherapy [48,50,51]. ...
Article
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Despite advances in its scientific understanding, dyslexia is still associated with rampant public misconceptions. Here, we trace these misconceptions to the interaction between two intuitive psychological principles: Dualism and Essentialism. We hypothesize that people essentialize dyslexia symptoms that they anchor in the body. Experiment 1 shows that, when dyslexia is associated with visual confusions ( b / d reversals)—symptoms that are naturally viewed as embodied (in the eyes), laypeople consider dyslexia as more severe, immutable, biological, and heritable, compared to when dyslexia is linked to difficulties with phonological decoding (a symptom seen as less strongly embodied). Experiments 2–3 show that the embodiment of symptoms plays a causal role in promoting essentialist thinking. Experiment 2 shows that, when participants are provided evidence that the symptoms of dyslexia are embodied (i.e., they “show up” in a brain scan), people are more likely to consider dyslexia as heritable compared to when the same symptoms are diagnosed behaviorally (without any explicit evidence for the body). Finally, Experiment 3 shows that reasoning about the severity of dyslexia symptoms can be modulated by manipulating people’s attitudes about the mind/body links, generally. These results show how public attitudes towards psychological disorders arise from the very principles that make the mind tick.
... First, language can be used with different goals in mind, such as accuracy or self-understanding and it is not clear whether person-first language is always beneficial for achieving those goals (Sass 2007;Tekin 2015b). Second, there has been some discussion as to whether person-first language reduces stigma, or perhaps even increases -some parts ofstigma (Deacon & Baird 2009;Thibodeau et al. 2015). Third, and perhaps most importantly, some argue that person-first language is itself stigmatizing. ...
Article
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In this paper, we argue that a crucial component of ‘self-management’ as management of the self consists of reducing what John Sadler has called ‘self-illness ambiguity’ (Sadler 2007). The paper seeks to supplement Sadler’s view on self-illness ambiguity in two ways. First, we zoom out of self-illness ambiguity and provide a philosophical analysis of self-ambiguity more generally. We will argue that ambiguity may arise both on the level of (unreflective) self-experience as well as on the level of (reflective) self-understanding. Acknowledging these levels and their interplay enables us to see how self-ambiguity might arise and how it might be reduced or even resolved. Second, we zoom in on self-illness ambiguity and elucidate some of the contextual, conceptual and epistemological obstacles that may arise when trying to reduce self-ambiguities in a psychiatric context (such as self-illness ambiguity).
... A long-standing and prominent argument in favor of the widespread adoption of biomedical explanations of mental disorders has been that they lead people with mental disorders to be blamed less for their own symptoms. Indeed, there is empirical support for the claim that biomedical explanations reduce perceptions of blame and personal responsibility (Crisafulli et al. 2008, Deacon & Baird 2009. For example, Crisafulli et al. (2008) conducted a study of undergraduate nursing students in which participants read one of two singlepage information sheets about anorexia nervosa, one of which emphasized the role of genes in the disorder's etiology and one of which focused instead on the causal role of sociocultural factors. ...
Article
Mental disorders are increasingly conceptualized as biomedical diseases, explained as manifestations of genetic and neurobiological abnormalities. Here, we discuss changes in the dominant explanatory accounts of psychopathology that have occurred over time and the driving forces behind these shifts, lay out some real-world evidence for the increasing ascendancy of biomedical explanations, and provide an overview of the types of attitudes and beliefs that may be affected by them. We examine theoretical and conceptual models that are relevant to understanding how biomedical conceptualizations might affect attitudes and beliefs about mental disorders, and we review some empirical evidence that bears on this question. Finally, we examine possible strategies for combatting potential negative effects of biomedical explanations and discuss important conclusions and directions for future research.
... First, language can be used with different goals in mind, such as accuracy or self-understanding and it is not clear whether person-first language is always beneficial for achieving those goals (Sass 2007;Tekin 2015). Second, there has been some discussion as to whether person-first language reduces stigma, or perhaps even increases -some parts of-stigma (Phelan, Yang & Cruz-Rojas 2006;Read 2007;Deacon & Baird 2009;Pescolido et al. 2010;Lebowitz & Ahn 2014;Thibodeau et al. 2015). Third, and perhaps most importantly, some argue that person-first language is itself stigmatizing. ...
... Whereas ET focuses on biological attributions, often construed as a single biological cause construct (e.g. Deacon & Baird, 2009;Lam & Salkovskis, 2007;Lebowitz, 2014;Phelan, 2005), the CSM's open framework encourages examining individual, precisely specified causal beliefs (e.g. "neurobiological" versus "genetic"). ...
Article
Background: Essentialist theory (ET) links biological attributions for mental illnesses to pessimistic prognostic beliefs and stigma. The commonsense model (CSM) provides a nuanced framework for studying illness beliefs as shaped by experience. Aims: ET-informed hypotheses linking causal and prognostic beliefs and stigmatizing attitudes concerning depression were tested using CSM constructs with a focus on the moderating effects of self-reported experience with this disorder. Methods: U.S. adults (N = 319) completed online questionnaires assessing depression-related beliefs, attitudes and experience. Multiple regression analysis focused on predictive effects of neurobiological and genetic attributions. Potential mediators (prognosis) and moderators (experience) of the biological attribution-stigma link also were tested. Results: Neurobiological attributions predicted viewing depression as more consequential, longer lasting, and unexpectedly, more treatable. Neurobiological attributions were inversely related to stigma, a link partially mediated by beliefs about depression’s consequences and duration. However, both biological attributions’ relationships to stigma were moderated by experience. Stronger biological attributions predicted less stigma specifically among participants reporting first- or second-hand experience with depression. Conclusion: Experience with depression may shape the relationships of specific causal and prognostic beliefs with depression stigma. Psychoeducation in clinical and public health contexts may be informed by further research using CSM constructs.
... Several studies have found that biological explanations lead to more pessimistic beliefs regarding recovery than psychological explanations for a range of different psychiatric problems (Lam & Salkovskis, 2007;Lam, Salkovskis, & Warwick, 2005). Some studies have also found associations between prognostic pessimism and biogenetic beliefs in depression (Deacon & Baird, 2009;Lebowitz, Ahn, & Nolen-Hoeksema, 2013;Lebowitz, 2014), and eating disorders (Easter, 2012). A rare study on bipolar disorder by Meiser et al. (2007) also demonstrated a correlation between genetic causal attributions and a reduced willingness to have children (in family members of those diagnosed with bipolar disorder), suggesting a pessimism that extended into future generations. ...
Thesis
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Psychiatric diagnosis has become a pervasive aspect of modern culture, exerting an increasing influence on forms of personhood, identity practices, and modes of selfgoverning. Debates surrounding the classification of psychiatric disorders are also prevalent, with particular disputes surrounding the relative merits of ‘biomedical’ vs ‘psychosocial’ understandings of mental health difficulties. There is arguably a need for further empirical exploration into the social and cultural implications of psychiatric classification and categorising practices within mental health service interactions. Drawing on ethnographic research conducted within several UK mental health settings, this thesis considers the role of diagnosis in constituting patient identities and in shaping professional categorisation practices, with a particular focus on bipolar disorder. Observations were conducted within sites where diagnostic identities are particularly salient: Psychiatric diagnostic and screening assessments, and a psychoeducation programme for bipolar disorder. Focusing on the formal and informal categorisation practices of service users and professionals, this study highlights the way in which psychiatric classifications can be negotiated, ascribed, and withheld in order to legitimate and contest particular kinds of suffering; in particular, it explores the way in which diagnostic categories – in particular bipolar disorder - can be used to interpret and medicalise morally problematic forms of experience and behaviour. Whilst diagnosis itself can function to medicalise aspects of moral life, its ability to perform this function is also shown to depend upon its conceptualisation as a biomedical disease entity. Findings suggest that bipolar disorder gives rise to particularly somatic concepts of personhood; its conceptualisation as an essentialised and reified illness category, with its cause located within the brain, enables a legitimisation of psychiatric ‘symptoms’ for both patients and professionals. In seeking access to more specialised mental health services with limited resources, potential patients can face trivialisation and deligitimisation of their problems by professionals, which at times manifests in the withholding of diagnosis. This is particularly the case within a mental health policy context which has increasingly moved towards the prioritisation of those with ‘severe mental illness’. As such, the study shows how the legitimising function of diagnoses such as bipolar disorder, can lead to a tendency for it to be both sought after by patients, but contested by professionals and amongst patients. In light of the apparent advantages conferred by this diagnosis, the moral and personal consequences of diagnostic membership, exclusion, and uncertainty are considered; in particular, the potential for this essentialised category to create divides between those considered to ‘have’ the disorder and those who are not, is contemplated.
... Though medicalizing problems-in-living as "illnesses like any other" (Angermeyer & Matschinger, 2005) should decrease stigma, it actually can increase it (e.g., Mehta & Farina, 1997). Biological explanations can evoke negative attitudes (e.g., Deacon & Grayson, 2009) whereas psychosocial explanations promote positive ones (e.g., Bennett, Thirlaway & Murray, 2008). Sometimes merely being associated with the patient can evoke stigma, a phenomenon called associative stigma (Goffman, 1963). ...
Article
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What happens when we, as a profession, forget our past, whether it is what history and research have taught or the values that motivated us to become healers? Here, I explore this question. First, I remember several experiences I have had that illustrate what can go wrong when we “forget.” Then I review some of our history and research, critically examining it, to remind us of those lessons. Finally, I share examples from my own practice to show how remembering the past can guide us in the present.
... depressive, schizophrenic, or substance abuse disorders) have suggested that neurobiological explanations of those mental conditions may increase the belief that these symptoms lay in factors outside of their control (Prins et al., 2008). Some studies have also found associations between causal beliefs and increased levels of selfstigma (Moses, 2010), lower levels of self-blame (Deacon & Baird, 2009), or personal responsibility among affected individuals. It may be possible that similar effects occur in people with high psychopathic traits. ...
Article
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Research on how neurobiological evidence influences jurors’ decision-making in adjudications of criminal responsibility is growing. Mock trial studies on this topic have almost entirely considered purposeful violent crimes, but the results of these studies are inconsistent. The present study tests the effects of neurobiological evidence (neuroimaging, clinical psychology, and genetics) on outcomes related to criminal responsibility for psychopathic defendants by using a unique and novel crime paradigm: involuntary manslaughter, committed either through recklessness or negligence. Dependent variables were guilt, legal insanity, and beliefs about the defendant’s free will at the time of the crime. We found no evidence that neurobiological evidence affected mock jurors’ verdicts of guilt or legal insanity, but, interestingly, we found that neuroimaging evidence significantly influenced mock jurors’ perceptions of the defendant’s free will. Additionally, mock jurors with higher self-reported psychopathy scores rated defendants as significantly guiltier when presented with reckless conduct and as having significantly less free will when presented with neuroimaging evidence on psychopathy. Our findings add to a growing body of research suggesting that neurobiological evidence appears to have only minor influences on jurors’ decision-making.
... As we gather data about the prevalence of HFAD and the factors that influence it, it is critical to disseminate this information widely. Public perceptions of depression are currently bleak, dominated by the disease model of depression, which presents the condition as biology based and frequently lifelong and sees the clinical goal as mitigating vulnerability (i.e., by taking medications; Deacon & Baird, 2009;Kemp, Lickel, & Deacon, 2014). Findings about HFAD are important to add to this public conversation, not merely as inspirational anecdotes but to ground realistic hope in systematic scientific research. ...
Article
We address a key issue at the intersection of emotion, psychopathology, and public health—the startling lack of attention to people who experience benign outcomes, and even flourish, after recovering from depression. A rereading of the epidemiological literature suggests that the orthodox view of depression as chronic, recurrent, and lifelong is overstated. A significant subset of people recover and thrive after depression, yet research on such individuals has been rare. To facilitate work on this topic, we present a generative research framework. This framework includes (a) a proposed definition of healthy end-state functioning that goes beyond a reduction in clinical symptoms, (b) recommendations for specific measures to assess high functioning, and (c) a road map for a research agenda aimed at discovering how and why people flourish after emotional disturbance. Given that depression remains the most burdensome health condition worldwide, focus on what makes these excellent outcomes possible has enormous significance for the public health.
... Individuals who endorse a biological causal explanation for depression are more likely to prefer medication, whereas individuals who endorse a more psychosocial causal belief about depression are more likely to prefer psychotherapy (Schomerus et al. 2012). This relationship has also been demonstrated experimentally (Deacon and Baird 2009;Fisher and Farina 1979;Lebowitz 2014), although in one study this association was found for biological but not psychosocial causal explanations (Zimmermann and Papa 2019). This relationship may be due to the belief that biological factors are fixed, as individuals provided with a biopsychosocial description of depression emphasizing malleability report greater willingness to accept a psychotherapy referral than do their counterparts receiving information that depression was fixed and biological (Salem et al. 2019). ...
Article
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Background: Implicit theories (beliefs about the malleability of self-relevant traits) of emotion are associated with various motivational and emotional responses. Less is known about implicit theories of depression. The present study examined the effects of a manipulation of implicit theories of depression on depression symptom severity, engagement in a self-help task, and treatment-relevant attitudes. Methods: Participants experiencing clinically significant levels of depression (N = 142) were randomly assigned to receive education about depression emphasizing either the malleability of depression (incremental condition) or depression as a chronic condition (entity condition). Participants subsequently completed a self-help task for depression. Symptom severity, stigma, prognostic pessimism, psychotherapy and antidepressant credibility, psychological flexibility, and time spent on the self-help task were assessed. Results: Participants in the incremental condition endorsed a greater incremental theory of depression than did those in the entity condition. To the extent that the experimental condition was associated with the adoption of an incremental theory of depression, depression symptom severity and stigma decreased, and treatment-relevant attitudes were more favorable. The experimental condition had no effect on self-help task persistence. Conclusions: Presenting depression as malleable may be associated with more positive attitudes towards treatment, although the impact on actual treatment engagement warrants future investigation.
... According to the rule of unanticipated consequences, however, an increasing acceptance of the chemical imbalance theory has often had the opposite effect (Kvaale, Haslam, & Gottdiener, 2013). While these efforts do appear to lessen blaming dynamics (Deacon & Baird, 2009;Kvaale et al., 2013), they promote a sense of biological otherness that actually reduces the social acceptance of people of mental illness and increases overall stigma and perceived dangerousness (Kvaale et al., 2013;Pescosolido et al., 2010), burdening rather than relieving children and adults with psychiatric diagnoses. ...
Article
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Medications exert effects not only through biological mechanisms but also through the meanings that they carry. While positive effects (e.g., the placebo effect) are broadly recognized, psychiatry is often less attuned to the negative effects that are mediated through the meaning of medications. These negative effects may be especially pronounced when noxious meanings and countertherapeutic aspects of medications are incorporated into the unfolding development of a child and not countered by psychotherapeutic experiences that allow iatrogenic meanings to be placed in context. In this paper, psychosocial mechanisms, by which medications may cause harm, are explored. These include adverse effects on identity, impaired agency, impaired affective competence, and negative effects on the patient's relationship with care. When such harm has occurred at the level of meaning, it is best addressed at the level of meaning. Examples of psychotherapeutic work with young adults is offered to demonstrate the process of reworking developmental harm related to the meaning of medications.
... A few alternative messages have been proposed. One approach to combating purely neurobiological explanations of mental illness and their unintended consequences on motivation is to discuss the "biopsychosocial model" of illness, which emphasizes equally the biological, psychological, and social circumstances surrounding the onset of mental illness (e. g., Deacon & Baird, 2009). This framework is explained in many treatment protocols. ...
Article
Beliefs about the malleability of attributes, also known as mindsets, have been studied for decades in social-personality psychology and education. Here, I review the many applications of mindset theory to clinical psychology and psychotherapy. First, I review social psychological and cognitive neuroscience evidence that mindsets and mindset-related messages are, to a large extent, focused on emotional tolerance. Specifically, the growth mindset, or the belief that attributes are malleable, encourages confronting and tolerating anxiety, frustration, and disappointment in healthy and adaptive ways that promote resilience, whereas the fixed mindset and related messages discourage the experience of these emotions and often leads to helplessness. Second, I review the emerging research on the anxiety mindset and discuss its relevance to clinical work. A model is proposed illustrating connections between mindsets, emotion regulation strategies, treatment preferences, and outcomes. Case examples are used to illustrate practical applications. I conclude that mindsets can inform psychotherapy, research, and public policy.
... This has social ramifications, as people tend to avoid unpredictable people. Such mechanisms have been found with regard to people who suffer from depression (Deacon & Baird 2009) and ADHD (Singh 2013) and it may also be the case for autism. Thus, to what extent may the data found in this study be understood as being the result of the participants' understanding of the self-illness relation in autism (or self-illness relations more generally)? ...
Article
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I argue that the importance of self–illness ambiguity for the social perception of autism is not sufficiently acknowledged, and offer some suggestions for follow-up research.
... We need much more information on long-term consequences before we deem it safe to continue prescribing these techniques Furthermore, believing you have a brain disease requiring medical intervention can be profoundly disempowering. It encourages people to view themselves as the victims of their biology, to adopt pessimistic views about recovery, increases self-stigma and discourages people from taking active steps to improve their situation (Deacon & Baird, 2009;Kemp, Lickell, & Deacon, 2014;Read, Haslam, & Magliano, 2013). Amongst the general population and mental health professionals biological causal beliefs (genetic, biochemical imbalance etc.) about 'mental health problems' have been consistently linked to negative attitudes (Kvaale, Haslam, & Gottdiener, 2013;Lebowitz & Ahn, 2014;. ...
Article
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The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for one another when we are suffering in this way. This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization and service users who have suffered negative consequences of physical treatments that modify brain functions in ways that are not well-understood.
... For instance, research indicates that attributing mental illness to biological causes reduces blame of people with mental illness, but increases perceptions of dangerousness, social ostracism and fatalism about their prospects of recovery [2,27]. Moreover, at a societal level, public underestimation of the social determinants of distress may dampen support for mental health policies that focus on environmental interventions (e.g., community-level supports) rather than biomedical treatments (e.g., medication) [28][29][30]. This is likely to disadvantage populations who experience mental illness, given evidence of the effectiveness of sociallytargeted interventions in promoting mental health and wellbeing [31]. ...
Article
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COVID-19 and its countermeasures have negatively impacted the mental health of populations worldwide. The current paper considers whether the rising incidence of psychiatric symptoms during the pandemic may affect lay beliefs about the cause and course of mental illness. Laypeople’s causal attributions and expectations regarding the trajectory of mental illness have important implications for societal stigma and therapeutic orientations. Two online experimental studies investigated whether reading about fictional cases of mental illness that were explicitly situated during the COVID-19 pandemic, compared with reading about the same cases without any pandemic-related contextualisation, affected attributions and expectations about Generalised Anxiety Disorder (Study 1) and Major Depressive Disorder (Study 2). Study 1 (n = 137) results showed that highlighting the onset of anxiety symptoms during the COVID-19 pandemic weakened attributions to biological causes and reduced the anticipated duration of symptoms. However, Study 2 (n = 129) revealed no effects of COVID-19 contextualisation on beliefs about the cause or course of depression. The research provides preliminary evidence that the increased incidence of mental illness during the pandemic may reshape public beliefs about certain mental illnesses. Given the importance of public understandings for the lived experience of mentally unwell persons in society, further evidence of the range and extent of the pandemic’s effects on lay beliefs is important to inform clinical, public health and stigma-reduction initiatives.
... Other interviewees noted the general influence of popular media and pharmaceutical advertising. All of these sources have been noted in the research literature (Deacon and Baird 2009;Fosgerau and Davidsen 2014;Lacasse and Leo 2005;Leo and Lacasse 2008). They convey, I will argue, very similar ontological and moral presuppositions. ...
Article
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The biomedical aspiration of psychiatry has fundamentally reoriented clinical practice since the DSM-III in 1980 and reverberated in the public sphere. Over time, lay public understanding of the causes of mental suffering has increasingly endorsed biological conceptions. In this paper, I explore the sources from which a neurobiological model for mental suffering reaches ordinary people, and investigate its rhetorical appeal, personal appropriation, and consequences. Drawing on interviews and other data, I show that these sources—physicians, popular media, and advertising—share common ontological and moral assumptions. These assumptions, in turn, influence how people take up neurobiological explanation to account for their suffering, and how, paradoxically, they join it to their projects of self-determination. I conclude by considering how, from a phenomenological perspective, a neurobiological account fails to enhance self-knowledge or determination but leads to a hermeneutic dead end.
... The notion that psychotherapy can change the brain is intuitive to neuroscientists; neuroscience conceptualizes therapy as a learning experience that confers long-term benefits precisely via alteration of brain structure and function. However, members of the general public are likely to believe that psychotherapy alone is insufficient for treating "biological" mental disorders (Deacon & Baird, 2009). We aimed to counter this assumption by harnessing the persuasive power of neuroscience information, which appeals to and is considered highly credible by lay audiences (Fernandez-Duque, Evans, Christian, & Hodges, 2015;McCabe & Castel, 2008;Weisberg, Keil, Goodstein, Rawson, & Gray, 2008). ...
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To benefit from cognitive behavioral therapy (CBT), individuals must not only learn new skills but also strategically implement them outside the session. Here, we tested a novel technique for personalizing CBT skills and facilitating their generalization to daily life. We hypothesized that showing participants the impact of specific CBT strategies on their own brain function using real-time functional magnetic imaging (rt-fMRI) neurofeedback would increase their metacognitive awareness, help them identify effective strategies, and motivate real-world use. In a within-subjects design, participants who had completed a clinical trial of a standardized course of CBT created a personal repertoire of negative autobiographical stimuli and mood regulation strategies. From each participant’s repertoire, a set of experimental and control strategies were identified; only experimental strategies were practiced in the scanner. During the rt-fMRI neurofeedback session, participants used negative stimuli and strategies from their repertoire to manipulate activation in the anterior cingulate cortex, a region implicated in emotional distress. The primary outcome measures were changes in participant ratings of strategy difficulty, efficacy, and frequency of use. As predicted, ratings for unscanned control strategies were stable across observations, whereas ratings for experimental strategies changed after neurofeedback. At follow-up one month after the session, efficacy and frequency ratings for scanned strategies were predicted by neurofeedback during the rt-fMRI session. These results suggest that rt-fMRI neurofeedback created a salient and durable learning experience for patients, extending beyond the clinic to guide and motivate CBT skill use weeks later. This metacognitive approach to neurofeedback offers a promising model for increasing clinical benefits from cognitive-behavioral therapy by personalizing skills and facilitating generalization.
... is has social ramifications, as people tend to avoid unpredictable people. Such mechanisms have been found with regard to people who suffer from depression (Deacon & Baird 2009) and ADHD (Singh 2013) and it may also be the case for autism. us, to what extent may the data found in this study be understood as being the result of the participants' understanding of the self-illness relation in autism (or self-illness relations more generally)? ...
Article
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Context • Numerous analyses emphasize the historical variability and social construction of the autism category. As a result, many beliefs and stereotypes about autism function unconsciously in social awareness as background knowledge. > Problem • We present the results of a survey concerning the social perception of autism and we draw attention to the possible impact of the specific ways in which people with autism spectrum disorder (ASD) are perceived, as revealed in the survey, on how this social identity might be created. > Method • A questionnaire consisting of two parts-closed-ended questions and free associations-was used in the survey. 355 participants answered the questions concerning the nature of autism, its causes, sources of information and experiences in contact with people on the spectrum. > Results • The results shows that there exists a cognitively interesting divergence between the level of knowledge declared by the respondents, based on credible sources, which is indicative of a positive attitude toward people with ASD, and the more negative attitude seen in the free associations. > Implications • Despite the level of social reflective knowledge, relations between people with ASD and neurotypical people seem to be lined with feelings such as fear, anxiety or uncertainty. This should draw attention to the need for a deeper and more conscious analysis of societal beliefs about autism. > Constructivist content • The theoretical framework for this survey is social representations theory (SRT), which derives from the constructivist paradigm. By showing the important role of individu-als' background knowledge in the construction of autism social representation, the results of the survey confirm the usefulness of the constructivist approach to the analysis of the autism phenomenon. > Keywords • Autism spectrum, constructivism, social perception of autism, reflective knowledge, background knowledge, identity.
Article
Escalating numbers of depressed, anxious, and suicidal persons in the United States have led to increased demands for clinical practice guidelines. These guidelines are designed by and for medical professionals to locate and promote the best evidence-based treatments. Clinicians suggest that a widespread application of substantiated treatments will curtail trends of increased despair, but there are a wider range of ethical and socio-political limitations that are not always immediately addressed in these assessments. Issues regarding social stigma, control and normalization, diverse life stressors, and disproportionate access to resources are often diluted in depictions of treatment efficacy. Consistent interpretations of the concepts illness, disorder, health, recovery, and need are also lacking. In this paper, I unravel the limitations of several leading evidence-based treatments and propose principles of care as preconditional commitments for future practice. This analysis specifically assesses treatment options for depression and anxiety. In response, I argue that clinical practice guidelines require a deeper engagement with the theoretical foundations of prominent therapeutic models and must consider the effects of those premises beyond controlled treatment sessions. I recommend more substantial collaborations with mental health sociology and bioethics, with a particular emphasis on care ethics.
Article
Purpose The purpose of this study is to determine the antecedents of obesity among the younger generation of Indians (Generation Y) from a psychological and lifestyle consumer perspective. The study also investigates the moderating role of demography on the body mass index (BMI) of Indian youths. Design/methodology/approach The study initially develops a conceptual model, stemming from an extensive theoretical research, and subsequently validates this using structural equation modeling (SEM) technique with a sample size of 1,242 Indian youths. Findings The study concludes that consumers' food habits (FH) and physical activity (PA) positively impact consumers' physical health (PH), which influences their BMI levels (BLs). Anxiety (AX), depression (DE), stress (ST), peer pressure (PP) and work pressure (WP) impact individuals' mental health (MH), which also influences their BLs. Finally, there is a significant moderating impact of demographic factors, such as age (AG), gender (GE) and income levels (ILs) on the relationship between individuals' physical and MH and individuals' BLs. Research limitations/implications This study proposes a new model which highlights the issue of youth consumer obesity from the psychological and lifestyle perspectives. The model is effective as it has a high explanative power of 73%. The study investigates consumer obesity from emerging market like India perspective, but the study does not examine consumer food consumption behavior and obesity from developed market perspective. Practical implications Youth obesity could be considered a global pandemic, and obesity rates among the Indian youth are also increasing. This study provides valuable inputs and understanding of consumer markets to policy makers, consumer protection institutions, organizations related to the food and beverage industry, healthcare workers and consumers themselves regarding the antecedents of youth obesity (BL) in developing and emerging markets. Originality/value The study adds value to the body of literature related to consumer obesity, FH, consumer psychology and lifestyle through findings that are new in terms of findings' specificity, contextual focus and explication. Moreover, the study extends the cognitive theory of DE and the theory of planned behavior (TPB). The research effectively offers significant theoretical and practicable market knowledge to both scholars and marketing practitioners, as well as policy makers and institutions dealing with youth obesity, particularly in emerging markets.
Article
CHILD SEXUAL ABUSE (CSA) occurs frequently, with one recent review suggesting that approximately 1 in 10 children will experience sexual abuse before age 18 (Townsend&Rheingold, 2013). Victims of CSA are at risk for developing a range of psychological and behavioral problems, including depression, anxiety, posttraumatic stress disorder (PTSD), suicidal thoughts and behavior, substance abuse, high-risk and inappropriate sexual behavior, and other conduct problems (Maniglio, 2009; Tyler, 2002). However, not all children experience these short- and long-term effects and many factors influence the heterogeneity of response to CSA (Kendall-Tackett, Williams, & Finkelhor, 1993; Putnam, 2003). Stigma, defined as “a mark of disgrace associated with a particular circumstance, quality, or person” (Oxford English Dictionary, 2017), can play an important role in victims’ recovery (Coffey, Leitenberg, Henning, Turner, & Bennett, 1996).As such, the purpose of this paper is to critically review the literature on how survivors of CSA are currently stigmatized, identify the consequences of such stigma, and make suggestions for clinicians working with CSA victims and their families.
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Genetic and other biological explanations appear to have mixed blessings for the stigma of mental disorder. Meta-analytic evidence shows that these “biogenetic” explanations reduce the blame attached to sufferers, but they also increase aversion, perceptions of dangerousness, and pessimism about recovery. These relationships may arise because biogenetic explanations recruit essentialist intuitions, which have known associations with prejudice and the endorsement of stereotypes. However, the adverse implications of biogenetic explanations as a set may not hold true for the subset of those explanations that invoke neurobiological causes. Neurobiological explanations might have less adverse implications for stigma than genetic explanations, for example, because they are arguably less essentialist. Although this possibility is important for evaluating the social implications of neuroscientific explanations of mental health problems, it has yet to be tested meta-analytically. We present meta-analyses of links between neurobiological explanations and multiple dimensions of stigma in 26 correlational and experimental studies. In correlational studies, neurobiological explanations were marginally associated with greater desire for social distance from people with mental health problems. In experimental studies, these explanations were associated with greater desire for social distance, greater perceived dangerousness, and greater prognostic pessimism. Neurobiological explanations were not linked to reduced blame in either set of studies. By implication, neurobiological explanations have the same adverse links to stigma as other forms of biogenetic explanation. These findings raise troubling implications about the public impact of psychiatric neuroscience research findings. Although such findings are not intrinsically stigmatizing, they may become so when viewed through the lens of neuroessentialism.
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Background and objectives: Biomedical explanations of psychiatric problems, compared to psychosocial explanations, may amplify psychiatric stigma. One limitation of existing research is the measurement of almost exclusively self-reported stigma. This study evaluated the stigma-related effects of biomedical versus psychosocial explanations of schizophrenia using conventional self-report and two other measurement approaches that may tap more deeply held attitudes. Methods: One hundred three undergraduates listened to a vignette describing a man with (1) schizophrenia of biomedical origin, (2) schizophrenia of psychosocial origin, or (3) diabetes. They then completed an Implicit Association Test, conventional self-report stigma measures, and projected other measures that captured perceptions of most other people's likely impressions. Results: Participants were more likely to attribute stigmatizing views to others compared to themselves. The projected other measurement, but not the conventional self-report measurement, predicted implicit attitudes. We obtained no evidence that the psychosocial causal explanation of schizophrenia led to decreased stigma compared to the biomedical causal explanation. In fact, the psychosocial causal explanation increased stereotyped attitudes. Limitations: The absence of a schizophrenia control group complicates interpretation of biomedical versus psychosocial group comparisons. Conclusions: Further research is needed to evaluate discrepancies between the present findings and other published evidence pertaining to psychosocial causal explanations of psychiatric problems.
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De entre todas las palabras nacidas de las luchas emancipatorias que han acabado siendo coaptadas y mercantilizadas quizás la más evidente sea la del concepto de Estigma. Veamos brevemente su recorrido, la situación actual y un posible camino a seguir.
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Background Depression raises a double challenge: besides the negative mood and the intrusive thoughts, the relation to the self also becomes difficult. Online forums are analysed as communicative platforms enabling the interactive reconstruction of the self. Aims The discourses of online depression forums are explored. Firstly, narrative patterns are identified according to their thematic focus (e.g. dysfunctional body, challenges of intimacy) and discursive logic (e.g. information exchange, support). Secondly, narratives are analysed in order to describe various ways of grounding a depressed self. Methods ∼70.000 depression-related posts from the biggest English-speaking online forums (e.g. www.reddit.com/r/depression, www.healthunlocked.com) were analysed. Quantitative (LDA topic modelling) and qualitative (deep reading) approaches were used simultaneously to determine the optimal number of topics and their interpretation. Results 13 topics were identified and interpreted according to their content and communicative function. Based on the inter-topic distances four clusters were identified (medicalized, intimacy-oriented, critical and uninhabitable self-narratives). Conclusions The clusters of the 13 topics highlight various ways of narrating depression and the depressed self. Based on a comparison with a systematic review of mental illness recovery narratives, depression forums cover most narrative genres and emotional tones, thus create a unique opportunity for integrating the depressing experiences in the self.
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In 1997, thirty-nine members of a religious cult from California, US, committed mass suicide to gain abnormal powers exchanging their present body form. This is popularly known as Heaven’s Gate. In 2021, in India, two young women were killed by their learned parents to get abnormal powers by giving-up their present body form. The paper connects such incidences and answers questions like why we feel that our present form of life is worth quitting? Ten eminent personalities from different fields were interviewed. Their responses are presented in a “belief-emotion-behavior,” a novel format, analyzing the relationship between the three.
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A large campaign has sought to destigmatize psychiatric disorders by disseminating the view that they are in fact brain disorders. But when psychiatric disorders are associated with neurobiological correlates, laypeople's attitudes toward patients are harsher, and the prognoses seem poorer. Here, we ask whether these misconceptions could result from the essentialist presumption that brain disorders are innate. To this end, we invited laypeople to reason about psychiatric disorders that are diagnosed by either a brain or a behavioral test that were strictly matched for their informative value. Participants viewed disorders as more likely to be innate and immutable when the diagnosis was supported by a brain test as compared to a behavioral test. These results show for the first time that people spontaneously essentialize psychiatric conditions that are linked to the brain, even when the brain probe offers no additional diagnostic or genetic information. This bias suggests that people consider the biological essence of living things as materially embodied.
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This study explored the stigma toward individuals with sexual addiction and how it compared to gambling addiction, alcohol addiction, and depression in both males and females. Undergraduate students (N = 241) were assigned to read one of eight vignettes (mental illness x gender) and completed quantitative stigma measures (e.g., social distance). Results showed that alcohol addiction was the most stigmatized, followed closely by gambling addiction. Sexual addiction and depression had similar levels of stigma. Participants were less stigmatizing toward females with sexual addiction, and no other gender differences emerged. Additional variables and measures (e.g., perceived causes) were also explored.
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Research
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This research work is done in fulfillment of the award of a master’s degree in psychology from the University of Liverpool. The work made some findings through a systematic review of previous investigations and predicted that multilateral factors are contributing factors in depression, and suggested that treatment should include a tripartite method such as pharmacotherapeutic (CBT, pharmacology, and Exercise). However, the outcome of this study is not a conclusive finding and is subject to review, hence further study is warranted.
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For people with serious mental illness (SMI) (schizophrenia, bipolar disorder, schizoaffective disorder), psychiatric genetic counseling (PGC) has been shown to significantly increase empowerment and illness management self-efficacy. While these outcomes are important, they are also theoretical precursors for behaviour changes (e.g. improved medication adherence), and improved mental health. Therefore, we conducted the first study (repeated-measures/within-subjects design) to test the hypothesis that PGC would reduce psychiatric symptoms due to increased medication adherence. Between 2013-2018, we recruited N=109 individuals (age 19- 72) with SMI and administered the short Positive and Negative Syndrome Scale (short-PANSS) and Brief Adherence Rating Scale (BARS) at four timepoints; twice Pre-PGC (T1: 1-month Pre-PGC and T2: immediately Pre-PGC), to assess change in adherence/symptoms without any intervention (internal control condition), and twice Post-PGC (T3: 1-month and T4: 2-months Post-PGC), to assess impact of PGC. A quantile regression model investigated the relationships between short-PANSS, timepoints, and BARS. There was a significant relationship between short-PANSS and timepoints at the 75th (T4 short-PANSS scores < T1 and T2) and 90th quantiles (T4 short-PANSS scores < T2), but these results were not explained by improved medication adherence. PGC for SMI may reduce psychiatric symptoms, but confirmatory work and studies to examine mechanism are needed.
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This experiment examined how two language features-linguistic agency and assignment of causality-of online support-seekers' messages regarding depression influenced viewers' perceived stigma and features of their support messages. Participants (N = 254) read and responded to an online support-seeking post about depression. Our results revealed that personal stigma toward a depressed individual was lower when the individual disclosed a biological cause for the depression and assigned agency to depression than agency to human. Additionally, when agency was assigned to depression with a biological rather than non-biological cause, more positive emotion words were utilized in participants' response posts. Cognitive process words were used more often in response to messages with non-biological causality than biological causality.
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This study examined the widely held belief that a disease view of mental disorder reduces stigma. Behavioral and self-report measures were used to assess 55 male students' treatment and attitudes toward another, whom they believed either to be a typical student or to have a history of mental disorder. The mental difficulties were characterized in either disease or psychosocial terms. The results indicate that the way in which mental disorder is represented does have an effect on behavior and on some aspects of evaluation. In general, the disease view did not improve attitudes, except in terms of blame. It did, however, tend to provoke harsher behavior. In contrast, the psychosocial view induced treatment no different from that toward normal others. The results provide little support for the claim that regarding the mentally disordered as sick or diseased will promote greater acceptance and more favorable treatment.
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Associations between exercise and mental well-being have been documented repeatedly over the last two decades. More recently, there has been application of exercise interventions to clinical populations diagnosed with depression, anxiety, and eating disorders with evidence of substantial benefit. Nonetheless, attention to the efficacy of exercise interventions in clinical settings has been notably absent in the psychosocial treatment literature, as have been calls for the integration of these methods within the clinical practice of psychologists. In this article, we provide a quantitative and qualitative review of these efficacy studies in clinical samples and discuss the potential mechanism of action of exercise interventions, with attention to both biological and psychosocial processes. The meta-analysis of 11 treatment outcome studies of individuals with depression yielded a very large combined effect size for the advantage of exercise over control conditions: g = 1.39 (95% CI: .89–1.88), corresponding to a d = 1.42 (95% CI: .92–1.93). Based on these findings, we encourage clinicians to consider the role of adjunctive exercise interventions in their clinical practice and we discuss issues concerning this integration.
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Research indicates that the ‘mental illness is an illness like any other’ approach to destigmatisation has failed to improve attitudes. This study replicated, with 469 New Zealanders, previous findings that the public tends to reject biological and genetic explanations of mental health problems in favour of psychosocial explanations focused on negative life events. It also confirmed previous findings (contrary to the assumption on which most destigmatisation programmes are based) that biological and genetic causal beliefs are related to negative attitudes, including perceptions that ‘mental patients’ are dangerous, antisocial and unpredictable, and reluctance to become romantically involved with them. The amount of reported personal contact with people who had received psychiatric treatment was correlated with positive attitudes. It is recommended that destigmatisation programmes consider abandoning efforts to promulgate illness-based explanations and focus instead on increasing contact with and exposure to users of mental health services.
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The cause of mental disorders such as depression remains unknown. However, the idea that neurotransmitter imbalances cause depression is vigorously promoted by pharmaceutical companies and the psychiatric profession at large. We examine media reports referring to this chemical imbalance theory and ask reporters for evidence supporting their claims. We then report and critique the scientific papers and other confirming evidence offered in response to our questions. Responses were received from multiple sources, including practicing psychiatrists, clients, and a major pharmaceutical company. The evidence offered was not compelling, and several of the cited sources flatly stated that the proposed theory of serotonin imbalance was known to be incorrect. The media can play a positive role in mental health reporting by ensuring that the information reported is congruent with the peer-reviewed scientific literature.
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The major focus of the three studies reported was the consequences of changing public conceptions of mental illness for the sufferer and his family. In two identically performed studies with a total of 405 subjects, two messages (one describing mental illness as a disease and the other as a.- product of social learning) were effective in changing beliefs. More important, the subjects receiving the disease message thought that a victim of mental illness could do less to help himself than did the subjects receiving the social learning message. In a third study, the subjects received similar messages and were given a therapy session. They were then asked to keep a journal for a week and to make an entry in the journal every time a problem similar to one discussed in therapy arose. It was expected that the disease message subjects would feel less able to master the problems and, consequently, would think about them less frequently. The findings confirmed the expectation.
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Although considerable research has been conducted on women who are depressed, the actual experiences and voices of women have not been central to this research. Therefore little is known about how women make sense of depression as they live with and manage it in their daily lives. Our purposes in doing this study were to (1) examine how women experience and manage depression and treatment, and (2) investigate the core components of women's explanatory models of depression (including beliefs about etiology, onset of symptoms, pathophysiology, course of illness, and treatment needs). We interviewed 43 women living in a small city in Western Canada who had sought treatment within the previous five years. Data were analyzed using the constant comparison method of grounded theory. In this paper we will focus on the core concept, Keeping it Together, and its three supporting categories, (1) Taking Up a Biomedical Explanation for Depression, (2) Using the Biomedical Explanatory Model (BEM) to Manage the Stigma of Depression, and (3) The Inadvertent Effects of Adopting a BEM.
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Direct-to-consumer advertising (DTCA) of prescription drugs has increased rapidly in the United States during the last decade, yet little is known about its effects on prescribing decisions in primary care. We compared prescribing decisions in a US setting with legal DTCA and a Canadian setting where DTCA of prescription drugs is illegal, but some cross-border exposure occurs. We recruited primary care physicians working in Sacramento, California, and Vancouver, British Columbia, and their group practice partners to participate in the study. On pre- selected days, patients aged 18 years or more completed a questionnaire before seeing their physician. We asked these patients' physicians to complete a brief questionnaire immediately following the selected patient visit. By pairing individual patient and physician responses, we determined how many patients had been exposed to some form of DTCA, the frequency of patients' requests for prescriptions for advertised medicines and the frequency of prescriptions that were stimulated by the patients' requests. We measured physicians' confidence in treatment choice for each new prescription by asking them whether they would prescribe this drug to a patient with the same condition. Seventy-eight physicians (Sacramento n = 38, Vancouver n = 40) and 1431 adult patients (Sacramento n = 683, Vancouver n = 748), or 61% of patients who consulted participating physicians on pre-set days, participated in the survey. Exposure to DTCA was higher in Sacramento, although 87.4% of Vancouver patients had seen prescription drug advertisements. Of the Sacramento patients, 7.2% requested advertised drugs as opposed to 3.3% in Vancouver (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-4.1). Patients with higher self- reported exposure to advertising, conditions that were potentially treatable by advertised drugs, and/or greater reliance on advertising requested more advertised medicines. Physicians fulfilled most requests for DTCA drugs (for 72% of patients in Vancouver and 78% in Sacramento); this difference was not statistically significant. Patients who requested DTCA drugs were much more likely to receive 1 or more new prescriptions (for requested drugs or alternatives) than those who did not request DTCA drugs (OR 16.9, 95% CI 7.5-38.2). Physicians judged 50.0% of new prescriptions for requested DTCA drugs to be only "possible" or "unlikely" choices for other similar patients, as compared with 12.4% of new prescriptions not requested by patients (p < 0.001). Our results suggest that more advertising leads to more requests for advertised medicines, and more prescriptions. If DTCA opens a conversation between patients and physicians, that conversation is highly likely to end with a prescription, often despite physician ambivalence about treatment choice.
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Dysthymia and minor depression are common problems in primary care, but it is not known how patient health beliefs shape response to antidepressant treatment of these less severe forms of depression. Three hundred thirty-three primary care patients with dysthymia or minor depression received at least 4 weeks of paroxetine or placebo in a multicenter, randomized controlled 11-week trial. Patient health beliefs and other characteristics were examined as predictors of treatment adherence and depression remission. Patient beliefs were not predictive of adherence to paroxetine or placebo. Patients with less endorsement of biological beliefs about their condition (odds ratio [OR] = 3.40), higher perceived general health (OR = 3.38), meeting criteria for dysthymia (OR = 2.37), and age younger than 60 years (OR = 2.68) were more likely to achieve remission on paroxetine. Patient beliefs did not predict remission on placebo. Those with lower severity of depression symptoms at baseline (OR = 2.70) and women (OR = 2.18) were most likely to achieve remission on placebo. Our results suggest that patients with dysthymia or minor depression are more likely to respond to antidepressant medication if they do not see their depression as a biological illness and see themselves as generally healthy. It is clearly not necessary for patients to believe that their dysthymia or minor depression is biological to respond to antidepressant medication.
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There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy's effects in this population. To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise.
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Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that it leads to overprescribing, while proponents counter that it helps avert underuse of effective treatments, especially for conditions that are poorly recognized or stigmatized. To ascertain the effects of patients' DTC-related requests on physicians' initial treatment decisions in patients with depressive symptoms. Randomized trial using standardized patients (SPs). Six SP roles were created by crossing 2 conditions (major depression or adjustment disorder with depressed mood) with 3 request types (brand-specific, general, or none). Offices of primary care physicians in Sacramento, Calif; San Francisco, Calif; and Rochester, NY, between May 2003 and May 2004. One hundred fifty-two family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%. The SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. The SPs made a brand-specific drug request, a general drug request, or no request (control condition) in approximately one third of visits. Data on prescribing, mental health referral, and primary care follow-up obtained from SP written reports, visit audiorecordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics. Standardized patient role fidelity was excellent, and the suspicion rate that physicians had seen an SP was 13%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests, respectively (P<.001). In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and 10%, respectively (P<.001). The results were confirmed in multivariate models. Minimally acceptable initial care (any combination of an antidepressant, mental health referral, or follow-up within 2 weeks) was offered to 98% of SPs in the major depression role making a general request, 90% of those making a brand-specific request, and 56% of those making no request (P<.001). Patients' requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse.
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Many ads for SSRI antidepressants claim that the drugs boost brain serotonin levels. Lacasse and Leo argue there is little scientific evidence to support this claim.
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Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.
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Research indicates that the 'mental illness is an illness like any other' approach to destigmatisation has failed to improve attitudes. This study replicated, with 469 New Zealanders, previous findings that the public tends to reject biological and genetic explanations of mental health problems in favour of psychosocial explanations focused on negative life events. It also confirmed previous findings (contrary to the assumption on which most destigmatisation programmes are based)that biological and genetic causal beliefs are related to negative attitudes, including perceptions that 'mental patients' are dangerous, antisocial and unpredictable, and reluctance to become romantically involved with them. The amount of reported personal contact with people who had received psychiatric treatment was correlated with positive attitudes. It is recommended that destigmatisation programmes consider abandoning efforts to promulgate illness-based explanations and focus instead on increasing contact with and exposure t...
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Context Recent advances in pharmacotherapy and changing health care environments have focused increased attention on trends in outpatient treatment of depression.Objective To compare trends in outpatient treatment of depressive disorders in the United States in 1987 and 1997.Design and Setting Analysis of service utilization data from 2 nationally representative surveys of the US general population, the 1987 National Medical Expenditure Survey (N = 34 459) and the 1997 Medical Expenditure Panel Survey (N = 32 636).Participants Respondents who reported making 1 or more outpatient visits for treatment of depression during that calendar year.Main Outcome Measures Rate of treatment, psychotropic medication use, psychotherapy, number of outpatient treatment visits, type of health care professional, and source of payment.Results The rate of outpatient treatment for depression increased from 0.73 per 100 persons in 1987 to 2.33 in 1997 (P<.001). The proportion of treated individuals who used antidepressant medications increased from 37.3% to 74.5% (P<.001), whereas the proportion who received psychotherapy declined (71.1% vs 60.2%, P = .006). The mean number of depression treatment visits per user declined from 12.6 to 8.7 per year (P = .05). An increasingly large proportion of patients were treated by physicians for their condition (68.9% vs 87.3%, P<.001), and treatment costs were more often covered by third-party payers (39.3% to 55.2%, P<.001).Conclusions Between 1987 and 1997, there was a marked increase in the proportion of the population who received outpatient treatment for depression. Treatment became characterized by greater involvement of physicians, greater use of psychotropic medications, and expanding availability of third-party payment, but fewer outpatient visits and less use of psychotherapy. These changes coincided with the advent of better-tolerated antidepressants, increased penetration of managed care, and the development of rapid and efficient procedures for diagnosing depression in clinical practice.
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An increased emphasis on biological causes of mental illness has been viewed as having the potential to significantly reduce stigma. From this perspective, the current genetics revolution can be seen as a source of hope with regard to reducing stigma. However, theory and empirical research suggest that biological attributions may have complex effects for stigma, reducing it along some dimensions while magnifying it along others. In a sample of 56 residents of New York City and Los Angeles, we assess the relationship between respondents' belief that schizophrenia (as described in a vignette) is influenced by genetic factors and several stigma-related beliefs and attitudes about the vignette subject. We find that respondents who believe the problem may be influenced by genetics are less likely to think the person did anything to cause the problem but also less likely to think the person can improve with appropriate help and more likely to think other family members may develop the same problem. These results suggest that the genetics revolution may have both positive and negative effects for the stigma of mental illness as it affects both ill individuals and their families. We suggest that it is important to attend to these effects because, at the present time, when genetic knowledge is accruing rapidly and the cultural response to these advances is evolving in turn, we may have an unusual opportunity to influence the public interpretation of and reaction to this knowledge in a way that will reduce rather than exacerbate the stigma of mental illness.
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Background: There is a growing trend to view depression as a biological illness rather than a psychosocial condition, even though there is no consensus as to what causes depression. Furthermore, there are mixed data on the impact of advocating the biological model. Aims: This study examined public perceptions concerning the etiology of depression as well as the relationship between such perceptions and treatment preferences, empowerment, and stigma. Method: Survey techniques were used to assess how 66 college students view the etiology of depression. Etiology beliefs, as well as demographic data, were regressed upon measures of treatment preference, empowerment, and stigma. Results: Factor analysis produced three distinct models of etiology: biological, psychological, and environmental. Regression analyses showed that endorsement of the biological model was associated with increased empowerment, preference for psychotherapy, and decreased stigma. Endorsing the psychological model was associated with an increased belief that people can help themselves and increased stigma. Endorsing the environmental model was associated with a mixture of positive and negative beliefs concerning depression. Conclusions: Endorsement of each etiological model is associated with both positive and negative consequences. The current public emphasis on viewing depression as biologically based should thus be viewed with some caution. Declaration of interest: None.
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Although the public understands that many factors influence who ends up crazy, terrified or miserable, studies consistently find that they place much more emphasis on adverse life events than on chemical imbalances or genetics. Biological psychiatry, enthusiastically supported by the pharmaceutical industry, insists on trying to educate the public that they are wrong. This ‘‘mental illness is an illness like any other’’ approach to destigmatisation ignores the large body of research evidence that biogenetic explanations actually fuel fear and prejudice. If future destigmatisation programs are to be evidence based and therefore effective, they will need to avoid illness-type explanations and labels and focus instead on increasing contact with the people against whom the prejudice is targeted and on highlighting the social causes of their difficulties. This might create funding challenges for programs dependent on drug company money.
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When a client asks whether her or his depression is caused by a chemical imbalance, how do you respond? Depression is regularly depicted in popular media as resulting from a "chemical imbalance" and this depiction raises a number of interesting questions for practicing clinicians. How accurate is the chemical imbalance explanation for depression? How widely do laypersons agree with the explanation, and how do they interpret the explanation? We discuss the origins, accuracy, and transmittal (e.g., via direct-to-consumer advertising) of the chemical imbalance explanation for depression. We next present results from a group case study examining lay endorsement and interpretation of the explanation. Finally, we discuss clinical implications and present a short script for educating clients concerning "chemical imbalances" in depression.
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Perceptions of the credibility and helpfulness of various treatments for depression can affect the success of different treatment options. While previous research has demonstrated individual differences in credibility ratings, no studies have evaluated the impact of different etiological theories on the perceptions of various treatment options. In this study, 36 mental health clients and 36 undergraduates rated 7 depression treatments presented first alone, then with 6 different etiological vignettes. All participants considered treatments more helpful when cause and treatment focus were congruent (i.e., both psychological or both physical). Students regarded treatments as less helpful than did clients. We discuss implications for treatment credibility and acceptability research, and suggest ways of presenting to clients etiological information in relation to treatments.
Article
Cognitive-behavioral therapy (CBT) and pharmacotherapy are the most well-established treatments for anxiety disorders. This study examined how treatment-seeking anxiety disorder patients (N = 103) perceive the acceptability, believability, and effectiveness of these treatments. While both treatments were perceived favorably, CBT was rated as more acceptable and more likely to be effective in the long-term. Most patients also rated CBT as their treatment of choice. Patients taking medication reported equally favorable views of both treatments, whereas unmedicated patients rated CBT more favorably than medication. Psychotherapy history was less strongly related to treatment perceptions. Our results suggest that despite their favorable views of both treatments, patients tend to prefer CBT to medication for the treatment of anxiety disorders. Directions for future research are discussed.
Article
Background: There is a tension between psychological and biological accounts of the cause of “mental illness”; this tension is evident in theoretical work, in research and professionals' dissemination of information to both patients and the public. It has been suggested that biological accounts de-stigmatize psychiatric problems and are to be preferred over potentially stigmatizing psychological accounts; others suggest the exact opposite pattern. Aims: The present study used an experimental manipulation to evaluate the impact of causal labels on the perception of a range of psychiatric problems. Methods: One-hundred-and-ten community volunteers were asked to rate a range of these problems, having been randomly allocated to three conditions in which the cause of such disorders were described as psychological or biological; the third (control) group were told that the causes were unclear. Results: Participants in the psychological condition rated patients with mental health problems as significantly more likely to be curable and significantly less likely to harm themselves, require professional help and frequent hospitalization; the problems were also rated as significantly less disabling. Conclusion: A psychological account of psychiatric problems may be relatively de-stigmatizing. It is unclear from these results whether biological accounts are stigmatizing or neutral in their impact. Declaration of interest: None known to the authors.
Article
Examined the attitudinal and behavioral effects of changing Ss' conceptualizations of mental disorders, along a social-learning/biosocial continuum, for their related attitudes and behaviors. 81 undergraduates in a field setting were exposed to communications that described mental disorders as almost exclusively a result of social learning, or to communications that also assigned a role to genetic and somatic factors. Several differences were observed between Ss in the 2 conditions. For example, those exposed to a biosocial orientation placed less value than those in a social-learning condition did on thinking about the cause and solution to emotional problems, and they felt they could do less on a personal level to control their problems. Also, they were more likely to use alcohol and/or drugs to relieve emotional distress in the 4 mo following the experimental manipulation. (17 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A study was conducted to assess the belief systems of the general public concerning the appropriate treatments for mental disorders and correlates of these belief systems. The study was based on the results of a household survey of the general public in Australia, using a national random sample of 2,031 adults aged 18-74 years. Respondents were given a vignette describing either a person with depression or one with schizophrenia, and were asked for their opinions about the helpfulness of various professional and non-professional treatments for the person described. A principal components analysis of the helpfulness ratings gave three factors: a Medical factor with high loadings on all drug treatments (except Vitamins) and on Psychiatric ward and ECT; a Psychological factor with high loadings on Counsellor, Social Worker, Phone counselling, Psychiatrist, Psychologist, Psychotherapy and Hypnosis; and a Lifestyle factor with high loadings on Close family, Close friends, Naturopath, Vitamins, Physical activity and Get out more. The same factors emerged from ratings of the two vignettes. Mean scores on scales constructed from the items with high loadings showed that the public tend to have a negative view of medical treatments and a positive view of psychological and lifestyle ones. However, medical treatments were rated more negatively for depression than for schizophrenia, psychological treatments were rated more positively for schizophrenia, and lifestyle treatments more positively for depression. Age, sex and education of respondents showed few associations with scores on the scales, although the better educated were more in favour of psychological treatments for both depression and schizophrenia and were less opposed to medical treatments for schizophrenia. Respondents who had suffered from the symptoms described in the schizophrenia vignette were more negative towards medical treatments. These findings about public belief systems could have implications for the provision of treatment: where there is a discrepancy in belief system between the patient and the clinician there may be poor adherence to treatment.
Article
Programmes to destigmatise 'mental illness' have traditionally been based on the 'mental illness is an illness like any other' metaphor and have been largely unsuccessful. By measuring attitudes towards, and etiology beliefs about, 'mental illness' before and after a series of four undergraduate lectures presenting the psychosocial causes of, and solutions to, severe mental health problems, this study (a) replicated previous studies demonstrating a relationship between biogenetic causal beliefs and negative attitudes towards 'mental patients'; (b) found that following the lectures attitudes improved, particularly around the key variables of dangerousness and unpredictability; and (c) demonstrated that amount of contact with people who had received psychiatric treatment was an even stronger predictor of positive attitudes than acceptance of a psychosocial perspective.
Article
Given the apparent failure of the "mental illness is an illness like any other" approach to reducing negative stereotypes of people with mental health problems, the differential effects of biogenetic and psychosocial explanations of psychiatric symptoms were evaluated. Attitude measures were administered to young New Zealand adults before and after a video portraying a young man with psychotic symptoms followed by either biogenetic or psychosocial explanations. Consistent with previous studies, the "medical model" approach significantly increased perceptions of dangerousness and unpredictability. Following the psychosocial explanation there was a slight but statistically insignificant improvement in attitudes. Participants who knew users of psychiatric services, or who had used services themselves, had more positive attitudes than other participants. It is recommended that destigmatization programs minimize efforts to persuade the public that mental health problems are biogenetic illnesses, and focus instead on increasing exposure to users of mental health services. Further research is required to determine whether such exposure should include life histories, so as to highlight the psychosocial causes of mental health problems.
Article
Antidepressant medication prevents the return of depressive symptoms, but only as long as treatment is continued. To determine whether cognitive therapy (CT) has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication. Patients who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up. Outpatient clinics at the University of Pennsylvania and Vanderbilt University. A total of 104 patients responded to treatment (57.8% of those initially assigned) and were enrolled in the subsequent continuation phase; patients were initially selected to represent those with moderate to severe depression. Patients withdrawn from CT were allowed no more than 3 booster sessions during continuation; patients assigned to continuation medication were kept at full dosage levels. Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression or Hamilton Depression Rating Scale scores of 14 or higher during the continuation phase. Recurrence was defined in a comparable fashion during the subsequent naturalistic follow-up. Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20). There were also indications that the effect of CT extends to the prevention of recurrence. Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.
Article
Using Link and Phelan's concept of the stigma process, public attitudes towards people with schizophrenia are examined. In the spring of 2001, a representative population survey was conducted in Germany (n=5025). A fully structured personal interview was carried out, beginning with the presentation of a case vignette. Labeling as mental illness increased the likelihood that someone suffering from schizophrenia was considered as being unpredictable and dangerous. This, in turn, led to an increase of the preference for social distance. Although much weaker, labeling also had a positive effect on public attitudes insofar as it was associated with a decrease of the tendency to attribute the responsibility for the occurrence of the disorder to the afflicted person. However, this had no significant impact on the desire for social distance. There was no significant association between labeling and the anticipation of poor prognosis. There were some differences between respondents who are familiar with mental illness and those who are not. Our findings have some implications for the planning of interventions aimed at reducing stigma and discrimination because of schizophrenia. These interventions should primarily address the stereotypes of unpredictability and dangerousness since they are most likely to have a negative impact on the public's willingness to engage in social relationships with those suffering from this disorder. The interventions should also be tailored according to whether the target population is familiar with mental illness or not.
Article
Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Article
Persons with mental illness frequently encounter public stigma and may suffer from self-stigma. This review aims to clarify the concept of mental illness stigma and discuss consequences for individuals with mental illness. After a conceptual overview of stigma we discuss two leading concepts of mental illness stigma and consequences of stigma, focussing on self-stigma/empowerment and fear of stigma as a barrier to using health services. Finally, we discuss three main strategies to reduce stigma -- protest, education, and contact -- and give examples of current anti-stigma campaigns. Well-designed anti-stigma initiatives will help to diminish negative consequences of mental illness stigma.
Article
Professional services for persons with serious mental illnesses are underutilized. The genetics revolution has the potential to increase professional help seeking by increasing biomedical interpretations of mental illness among the public. The objective of this study was to assess whether genetic attributions for serious mental illnesses are associated with more positive orientations to professional treatment among members of the general public. Data from two nationally representative surveys were analyzed. First, associations between perceptions of genetic causes of both schizophrenia and depression and treatment recommendations and perceived treatment effectiveness were assessed in a vignette study that was part of the 1996 General Social Survey (GSS). Second, the effect of various descriptions of the role of genetic factors in schizophrenia and depression on perceived treatment effectiveness was assessed in a vignette experiment conducted in 2002-2003. Perception of genetic causes was associated with more recommendations for mental hospitalization and prescription medication but not with more recommendations to see a psychiatrist, a therapist, or a general medical practitioner. Perception of genetic causes was not related to perceived treatment effectiveness in the GSS, and genetic causes as described in the vignette were associated with lower perceived effectiveness of treatment. Increasing emphasis on genetic causes of mental illnesses may have multifaceted effects on orientations to professional treatment. Genetic attributions appear to direct people's help seeking toward the most extreme or biological forms of intervention, possibly because people view genetically influenced disorders as more serious and chronic. At the same time, such attributions lead to pessimism that intervention will be effective.
Article
It is often suggested that biological accounts of the cause of mental health problems are beneficial in health education initiatives. However, an alternative view is that the idea of a diseased brain may result in stigma and therapeutic pessimism in sufferers, professionals and the public with implications for the perception of unpredictability and risk. Anxious and depressed patients (n=49) were randomly allocated to three experimental conditions. Prior to watching a video of a person suffering from panic disorder, participants were told either that research indicated that panic was caused by biological factors, by psychological factors or the cause was unclear (control condition). Those in the biological condition were significantly more pessimistic about the patient's prospects for recovery and rated risks as higher compared to those in the psychological condition. The results call into question the widely accepted practice of promoting biological/disease explanations of mental health problems.
Article
Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia. The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes. The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.
how does direct-to-consumer advertising (DTCa) affect prescribing? a survey in primary care environments with and without legal DTCa About mental illness national institute of mental health The invisible disease: Depression national trends in the outpatient treatment of depression
  • S Mehta
  • J Lexchin
mehta, s., & farina, a. (1997). is being " sick " really better? effect of the disease view of mental disorder on stigma. Journal of Social & Clinical Psychology, 16, 405-419. mintzes, b., barer, m. l., kravitz, r. l., bassett, k., lexchin, J., kazanjian, a., et al. (2003). how does direct-to-consumer advertising (DTCa) affect prescribing? a survey in primary care environments with and without legal DTCa. Canadian Medical Association Journal, 169, 405-412. national alliance on mental illness (2006). About mental illness. retrieved september 8, 2006, from http://www.nami.org/Content/navigationmenu/inform_yourself/about_mental_illness/about_mental_illness.htm. national institute of mental health (2001). The invisible disease: Depression. retrieved september 8, 2006, from http://www.nimh.nih.gov/publicat/invisible.cfm. olfson, m., marcus, s. C., Druss, b., elinson, l., Tanielian, T., & pincus, h. a. (2002). national trends in the outpatient treatment of depression. Journal of the American Medical Association, 287, 203-209.
lifetime prevalence and age-of-onset distributions of Dsm-iv disorders in the national comorbidity survey replication How expectancies shape experience influence of patients' requests for direct-toconsumer advertised antidepressants: a randomized controlled trial
  • R C Kessler
  • Demler
  • Jin
  • E E Walters
kessler, r. C., berglund, p., Demler, o., Jin, r., & Walters, e. e. (2005). lifetime prevalence and age-of-onset distributions of Dsm-iv disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593-602. kirsch, i. (ed.) (1999). How expectancies shape experience. Washington, DC: american psychological association. kravitz, r. l., epstein, r. m., feldman, m. D., fraz, C. e., azari, r., Wilkes, m. s, hinton, l., & franks, p. (2005). influence of patients' requests for direct-toconsumer advertised antidepressants: a randomized controlled trial. Journal of the American Medical Association, 293, 1995-2002.
belief systems of the general public concerning the appropriate treatments for mental disorders. Social Psychiatry and Psychiatric Epidemiology
  • F E Jorm
  • Jacomb
  • H Christensen
  • Z Jiao
Jorm, a. f., korten, a. e., rodgers, b., pollitt, p., Jacomb, p. a., Christensen, h., & Jiao, Z. (1997). belief systems of the general public concerning the appropriate treatments for mental disorders. Social Psychiatry and Psychiatric Epidemiology, 32, 468-473.