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Fellin LC, Zizevskaia E, Galbusera L. Is the mainstream construction of mood disorders resistant to systemic thinking? Front Psychiatry 2024; 14:1270027. [PMID: 38323024 PMCID: PMC10846429 DOI: 10.3389/fpsyt.2023.1270027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction In this study we explore how the diagnostic category of mood disorders is constructed in two handbooks of Psychopathology as an example of the mainstream construction of psychopathology. Despite the increasing criticism and lack of evidence, the debunked chemical imbalance theory of the etiology of depression still dominates the professional and pop/folk understanding and interventions. Methods We analysed the breadth of the inference field and the type of etiopathogenetic contents of the explanations of mood disorders using the "1to3" Coding System. Results Our findings show that the dominant explanations draw almost exclusively onto monadic explanations, followed by limited dyadic ones. Intrapersonal etiopathogenetic contents prevailed, and biomedical explanations were dominant in both textbooks. Discussion We critically discuss the underpinnings of these results and address the clinical implications of these biased representations, as well as potential alternative approaches to psychopathology.
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Affiliation(s)
- Lisa C. Fellin
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Laura Galbusera
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Brandenburg, Germany
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Gonzalez AR, Strunk DR. Impact of messaging on views of depression treatment options: Examining credibility and expectations. J Clin Psychol 2023; 79:2288-2303. [PMID: 37259690 DOI: 10.1002/jclp.23548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Understanding how people respond to information about treatment options is important for informing efforts that promote treatment initiation and adherence. We examined the impact of informational treatment videos on treatment naive participants' views regarding the credibility of and their expectations for three treatment options. MATERIALS AND METHODS Adults (N = 300) who had experienced elevated depressive symptoms but had not participated in a treatment for depression were randomly assigned to one of four conditions. Three of the conditions were shown videos, providing information about (1) cognitive behavioral therapy (CBT), (2) antidepressant medication (ADM), or (3) the combination of CBT and ADM. The fourth condition was not shown a video. Participants' self-reported views of the credibility of and expectations for treatment served as primary outcome variables. RESULTS Compared with the control condition, videos about active treatments enhanced credibility and expectations for those treatments. When comparing CBT and ADM alone, messaging about either treatment enhanced credibility of and expectations for that treatment. The CBT only video produced the most positive expectations and highest credibility for CBT. Likewise, the ADM only video led to the most positive expectations and credibility for ADM. The video focused on combined treatment did not lead to particularly positive views of the combined treatment option. CONCLUSION These findings demonstrate the importance of providing focused messaging to enhance the credibility of and expectations for treatment. Future research is needed to examine the impact of messaging in different contexts, as well as the impact of such messaging on treatment seeking, adherence, and outcomes.
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Affiliation(s)
- August R Gonzalez
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Daniel R Strunk
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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Schroder HS, Devendorf A, Zikmund-Fisher BJ. Framing depression as a functional signal, not a disease: Rationale and initial randomized controlled trial. Soc Sci Med 2023; 328:115995. [PMID: 37301109 DOI: 10.1016/j.socscimed.2023.115995] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
Depression is often framed as a disease or dysfunctional syndrome, yet this framing has unintended negative consequences including increased stigma. Here, we consider an alternative messaging framework - that depression serves an adaptive function. We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a "signal" that serves a purpose. We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a "disease like any other" with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition). In the entire sample (N = 877), three of the six hypotheses were supported: The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression. Exploratory analyses revealed these Signal effects were stronger among females (N = 553), who also showed a greater growth mindset of depression after the Signal explanation. Results suggest that framing depression as an adaptive signal can benefit patients and avoid harmful consequences of popular etiological presentations. We conclude that alternative framings of depression are worthy of further study.
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Affiliation(s)
- Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, United States.
| | - Andrew Devendorf
- Department of Psychology, University of South Florida, United States
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, United States; Department of Internal Medicine, University of Michigan, United States; Center for Bioethics and Social Sciences in Medicine, University of Michigan, United States
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Lamontagne SJ, Duda JM, Madarasmi S, Rogers VA, Yu E, Pizzagalli DA, Schroder HS. Limited impacts of biogenetic messaging on neural correlates of cognitive control and beliefs about depression. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:383-399. [PMID: 36869258 PMCID: PMC9984246 DOI: 10.3758/s13415-023-01073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/05/2023]
Abstract
During the past 60 years, perceptions about the origins of mental illness have shifted toward a biomedical model, depicting depression as a biological disorder caused by genetic abnormalities and/or chemical imbalances. Despite benevolent intentions to reduce stigma, biogenetic messages promote prognostic pessimism, reduce feelings of agency, and alter treatment preferences, motivations, and expectations. However, no research has examined how these messages influence neural markers of ruminative activity or decision-making, a gap this study sought to fill. In this pre-registered, clinical trial (NCT03998748), 49 participants with current or past depressive experiences completed a sham saliva test and were randomly assigned to receive feedback that they either have (gene-present; n = 24) or do not have (gene-absent; n = 25) a genetic predisposition to depression. Before and after receiving the feedback, resting-state activity and neural correlates of cognitive control (error-related negativity [ERN] and error positivity [Pe]) were measured using high-density electroencephalogram (EEG). Participants also completed self-report measures of beliefs about the malleability and prognosis of depression and treatment motivation. Contrary to hypotheses, biogenetic feedback did not alter perceptions or beliefs about depression, nor did it alter EEG markers of self-directed rumination nor neurophysiological correlates of cognitive control. Explanations of these null findings are discussed in the context of prior studies.
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Affiliation(s)
| | | | | | | | - Esther Yu
- Harvard University, Cambridge, MA, USA
| | | | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Office 1752, Ann Arbor, MI, 48109, USA.
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Isbell LM, Kang S, Barysky G, Quinn G. Stigmatizing attitudes toward Disruptive Mood Dysregulation Disorder (DMDD) in parents vs. non-parents: Effects of medication and genetic etiology. PLoS One 2022; 17:e0274185. [PMID: 36084061 PMCID: PMC9462715 DOI: 10.1371/journal.pone.0274185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Stigmatizing attitudes toward children with psychopathology represent a barrier to treatment and well-being, yet almost no research has investigated what contributes to these attitudes. This study examines the effects of medication treatment and genetic etiology on stigmatizing attitudes toward a relatively new and controversial disorder–Disruptive Mood Dysregulation Disorder (DMDD). Participants (159 parents, 225 non-parents) completed a vignette study on Amazon’s Mechanical Turk (MTurk) in which a child displayed behaviors consistent with DMDD. The child was described as either taking psychiatric medication or not, and the vignette described the child’s condition as either genetic or did not mention etiology. Participants who were parents reported greater stigma when the etiology (genetic prime vs. no prime) matched the perceived appropriate treatment (medication vs. no medication). Among parents, a child treated with medication who had a genetic disorder, and a child who was not treated with medication and for whom genetic etiology was not primed, were most stigmatized. No differences emerged among non-parents. These findings highlight the importance of considering multiple factors (parental status, congruence between treatment and perceived disorder etiology) when investigating mental health stigma and underscore the need to further investigate such nuances to inform anti-stigma interventions.
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Affiliation(s)
- Linda M. Isbell
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- * E-mail:
| | - Sungha Kang
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Gregory Barysky
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Grace Quinn
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
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Schroder HS, Russman Block S, Moser JS. Chemical imbalance and etiological beliefs about depression among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-8. [PMID: 35834783 DOI: 10.1080/07448481.2022.2098037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Etiological beliefs of depression have differing impacts on motivation, hope, and treatment expectations. However, it is unclear where people are exposed to these beliefs. Objective: This study examined beliefs about depression and their relations to symptoms, attitudes about depression, and treatment preferences. Participants: 426 undergraduates attending a large midwestern university. Methods: Participants completed an online survey asking about causes of depression, if and where they had heard about the "chemical imbalance" explanation of depression, attitudes about depression, as well as measures of their symptoms, treatment history, and hypothetical treatment preferences. Results: Sixty-two percent of the sample had heard of the chemical imbalance explanation, most commonly from the classroom. Biochemical beliefs about depression were most strongly endorsed among participants with a family history of depression and who had had personal experience with treatment. The chemical imbalance belief was uniquely related to dysfunctional beliefs about depression. Etiological beliefs were largely unrelated to treatment preferences. Conclusion: College students are exposed to models of mental health that may not be ideal for treatment and recovery.
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Affiliation(s)
- Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Stefanie Russman Block
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Schroder HS, Duda JM, Christensen K, Beard C, Björgvinsson T. Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample. J Affect Disord 2020; 276:537-545. [PMID: 32807732 DOI: 10.1016/j.jad.2020.07.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/05/2020] [Accepted: 07/05/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public perceptions of mental illness are increasingly construed in neurobiological and genetic terms. Accumulating evidence suggests there are some unintended consequences of these explanations, including reduced optimism for recovery among individuals with depression. However, little is known about how these beliefs relate to treatment process and outcomes in a psychiatric treatment setting, a gap this study aimed to fill. METHODS We examined etiological beliefs about depression in a sample of patients (N = 279) seeking acute treatment in a behaviorally-based therapy program at a psychiatric hospital and examined relations with treatment expectations and outcomes. RESULTS We found that although psychosocial explanations of depression were most popular, biogenetic beliefs, particularly the belief that depression is caused by a chemical imbalance, were prevalent in this sample. Further, the chemical imbalance belief related to poorer treatment expectations. This relationship was moderated by symptoms of depression, with more depressed individuals showing a stronger relationship between chemical imbalance beliefs and lower treatment expectations. Finally, the chemical imbalance belief predicted more depressive symptoms after the treatment program ended for a 2-week measure of depression (but not for a 24-hour measure of depression), controlling for psychiatric symptoms at admission, inpatient hospitalizations, and treatment expectations. LIMITATIONS The sample was homogenous in terms of race and ethnicity and we did not assess how patients came to their beliefs. CONCLUSIONS Together, the results illustrate the correlates and possible impacts of etiological beliefs in a real-world clinical setting and invite a critical discussion about predominant messages about the etiology of depression.
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Affiliation(s)
| | - Jessica M Duda
- McLean Hospital and Harvard Medical School, United States
| | | | - Courtney Beard
- McLean Hospital and Harvard Medical School, United States
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Zimmermann M, Hmaidan R, Preiser B, Papa A. The Influence of Implicit Theories of Depression on Treatment-Relevant Attitudes. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10120-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Burnette JL, Babij AD, Oddo LE, Knouse LE. Self-Regulation Mindsets: Relationship to Coping, Executive Functioning, and ADHD. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2020. [DOI: 10.1521/jscp.2020.39.02.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: We examined if mindsets about the stability (fixed mindset) or malleability (growth mindset) of self-regulation predicted coping with setbacks. We also investigated relations with Executive Function (EF) deficits and ADHD status. Methods: In two correlational studies (Study 1, N = 204; Study 2, N = 184, ADHD, n = 34, Non-ADHD, n = 150), participants reported on their mindsets, self-regulatory abilities, and responded to assessments related to a setback about which they wrote. Results: Across both studies, growth mindsets predicted less negative affect, greater efficacy, and less avoidant coping. The relationship between mindsets and these responses did not depend on EF deficits (Study 1 and Study 2) nor ADHD diagnostic status (Study 2), but participants with greater EF deficits and an ADHD diagnosis reported weaker growth mindsets of self-regulation. Discussion: Findings support the evaluation and development of growth mindset interventions to help individuals with disorders of self-regulation to cope more effectively.
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