The effect of abstract versus concrete framing on judgments of biological and psychological bases of behavior

Human behavior is frequently described both in abstract, general terms and in concrete, specific terms. We asked whether these two ways of framing equivalent behaviors shift the inferences people make about the biological and psychological bases of those behaviors. In five experiments, we manipulated whether behaviors are presented concretely (i.e. with reference to a specific person, instantiated in the particular context of that person’s life) or abstractly (i.e. with reference to a category of people or behaviors across generalized contexts). People judged concretely framed behaviors to be less biologically based and, on some dimensions, more psychologically based than the same behaviors framed in the abstract. These findings held true for both mental disorders (Experiments 1 and 2) and everyday behaviors (Experiments 4 and 5) and yielded downstream consequences for the perceived efficacy of disorder treatments (Experiment 3). Implications for science educators, students of science, and members of the lay public are discussed

Causal explanations of mental illness and perceived credibility of psychological therapy

Aim Biological explanations of mental health difficulties have remained dominant in recent decades, particularly in the case of psychosis. Research has shown that these explanations can lead to reduced empathy and a bias towards offering pharmacological rather than psychological intervention. This study aimed to explore whether this bias can be reduced by presenting evidence that CBT for psychosis (CBTp) also brings about neurobiological changes (i.e. neuroplasticity). This was examined both in samples from the general population (Study 1) and mental health clinicians (Study 2). Method An experimental design was employed in which participants read a vignette of a person with psychosis. Participants were asked to report which treatment they would recommend (i.e. medication versus psychological therapy) and how effective they perceived each to be. These ratings were elicited before and after reading information about the effects of CBTp: either control information about its clinical effectiveness or evidence of CBTp-led neuroplasticity. Results In Study 1, the predominantly biological description of psychosis elicited lower therapy effectiveness and higher medication effectiveness ratings compared to the predominantly psychosocial description, replicating previous work. Therapy effectiveness ratings were higher and medication effectiveness ratings were lower after either type of CBTp effectiveness evidence was presented. In Study 2, evidence of CBTp-led neuroplasticity had a greater impact than the control information on treatment recommendation ratings amongst psychologists, but not psychiatrists. Conclusions We replicate a previous finding that when biological factors are emphasised in patient information, it biases people to choose medication rather than psychological therapy as a treatment option. When the general population are presented with any type of evidence that CBTp is an effective treatment, they are likely to rate psychological therapy as a more effective treatment method. The impact amongst clinicians is more varied, depending on their training background

Beyond the DSM-IV: Assumptions, Alternatives, and Alterations

Current diagnostic processes reflect the limitations and utility of the framework of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Clinical information in the DSM-IV\u27s 5-axis system almost exclusively focuses on weaknesses and pathology and is summarized in a flawed categorical system. Hence, the authors describe 3 adjunctive, or alternative, means of conceptualizing behavior; several means of altering the current DSM-IV system; and 2 future directions in the diagnosis of strengths

How do we conceptualize depression?: A mixed methods study

Despite being extensively discussed, the concepts of mental disorder in general and depression in particular remain unclear and no consensual definitions are yet established. Empirical research on how professionals and laypeople think about depression also points to tensions and lack of consensus. However, there still remains much work to be done in order to more effectively and clearly elucidate how depression is conceptualized. Specifically, there has not been an in-depth analysis of the beliefs, values, and justification that guide practitioners in their everyday work regarding mental disorders in general and depression in particular. The purpose of the current mixed methods convergent study was to fill this gap. Specifically, this study utilized the Behavioral Shutdown Model as a conceptual framework to develop the Understanding Depression Interview for exploring mental health professionals and laypeople’s conceptualizations of depression in terms of its nature, diagnosis, etiology, and treatment. Utilizing qualitative and quantitative research methodology, this investigation found that in certain aspects mental health professionals and non-experts conceptualized depression differently (e.g., psychiatrists tended to confer more importance to the biological aspect of depression than the other groups). The investigation also found that participants shared many beliefs about depression across groups. For instance, mental health professionals differentiated between a disease and a non-disease type of depression. Also, some participants from different groups struggled diagnosing cases where there was a clear psychosocial stressor because they recognized that the symptoms met the criteria for diagnosis with a depression disorder but did not want to pathologize a normal reaction to a stressor. Implications and limitations are discussed

An investigation into the effect of causal beliefs about depression on attitudes and clinical judgements

Biological explanations of depression have been found to increase professional perceptions of the effectiveness of medical treatments and reduce the perceptions of the effectiveness of psychological therapy. Studies in lay populations have shown that biological explanations reduce perceptions of self-efficacy and control over depression symptoms. There is a lack of research examining the impact of causal models on clinicians’ attitudes. The current study aimed to explore whether clinicians’ causal models of a client’s depression can be biased by aetiological labelling and, in turn, whether clinicians’ causal models impact clinical judgements and attitudes. An experimental design was utilised, with one independent variable (labelling of the client’s depression) with three levels (biological, psychosocial and neutral). Outcomes measured causal beliefs, treatment effectiveness, control, clinical attitudes and perceived stigma in relation to a client vignette. Observational data were analysed to explore the effects of clinicians’ primary causal models on the outcome variables. Over 200 trainee clinical psychologists, across England, Scotland and Wales, took part in an online survey, presented using surveymonkey®. Where appropriate data were analysed using ANOVA. There was a small effect of the manipulation; labelling the depression as biological increased biological causal attributions and increased perceptions of the effectiveness of medical treatments. The exploratory analysis demonstrated substantial effects of strongly endorsing biological causal beliefs on judgements of medical treatments and client engagement. The results suggest that clinicians’ causal models of a client’s depression may bias clinical judgements. These findings are preliminary and further research is needed

Views of addiction neuroscientists and clinicians on the clinical impact of a ‘Brain Disease Model of Addiction’

Addiction is increasingly described as a "chronic and relapsing brain disease". The potential impact of the brain disease model on the treatment of addiction or addicted individuals' treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals' beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals' recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about "diseased brains" will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons

The Beliefs of Non-Psychiatric Doctors about the Causes, Treatments and Prognosis of Schizophrenia

Objectives To examine the causal beliefs about schizophrenia of non‐psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors’ views about treatments and prognosis. Design and methods Three hundred and five non‐psychiatric doctors working in outpatient community centres completed the ‘Opinions on mental disorders Questionnaire’ after reading a clinical description of people with schizophrenia. Results The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy‐five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty‐two per cent of respondents thought it ‘completely true’ that drugs are useful in schizophrenia, and 33.9% thought it ‘completely true’ that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia. Conclusions These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed

The words of the body: psychophysiological patterns in dissociative narratives

Trauma has severe consequences on both psychological and somatic levels, even affecting the genetic expression and the cell\u2019s DNA repair ability. A key mechanism in the understanding of clinical disorders deriving from trauma is identified in dissociation, as a primitive defense against the fragmentation of the self originated by overwhelming experiences. The dysregulation of the interpersonal patterns due to the traumatic experience and its detrimental effects on the body are supported by influent neuroscientific models such as Damasio\u2019s somatic markers and Porges\u2019 polyvagal theory. On the basis of these premises, and supported by our previous empirical observations on 40 simulated clinical sessions, we will discuss the longitudinal process of a brief psychodynamic psychotherapy (16 sessions, weekly frequency) with a patient who suffered a relational trauma. The research design consists of the collection of self-report and projective tests, pre-post therapy and after each clinical session, in order to assess personality, empathy, clinical alliance and clinical progress, along with the verbatim analysis of the transcripts trough the Psychotherapy Process Q-Set and the Collaborative Interactions Scale. Furthermore, we collected simultaneous psychophysiological measures of the therapeutic dyad: skin conductance and hearth rate. Lastly, we employed a computerized analysis of non-verbal behaviors to assess synchrony in posture and gestures. These automated measures are able to highlight moments of affective concordance and discordance, allowing for a deep understanding of the mutual regulations between the patient and the therapist. Preliminary results showed that psychophysiological changes in dyadic synchrony, observed in body movements, skin conductance and hearth rate, occurred within sessions during the discussion of traumatic experiences, with levels of attunement that changed in both therapist and the patient depending on the quality of the emotional representation of the experience. These results go in the direction of understanding the relational process in trauma therapy, using an integrative language in which both clinical and neurophysiological knowledge may take advantage of each other

Psychiatry beyond the brain: externalism, mental health, and autistic spectrum disorder

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply a strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy

How does the British public understand mental health? A qualitative analysis of open-text responses

BACKGROUND: An individual's understanding of mental health can influence their attitudes towards those experiencing mental health problems, and also impact their response to any mental health problems they experience. However, what the lay public understand about mental health is not well explored in existing research. AIMS: This study aims to gain a deeper insight into what the general public understand by the term 'mental health problem'. METHODS: Data were taken from a large-scale representative sample of adults from Great Britain (n = 2,708). A thematic analysis was carried out on an open-text question which asked people what they understood by the term 'mental health problem'. RESULTS: Six themes were identified in the thematic analysis, which included understanding mental health through thinking about cause and effect, thinking about the location of mental health problems in the body, the universality and variation of mental health problems, reflections on lived experience and identifying a specific mental health problem. CONCLUSION: The analysis suggests that there are many diverse ways the public conceptualises mental health. The themes identified may be useful for future quantitative analyses, and also may suggest how information about mental health can be best communicated to the public