Understanding Our Own Biology: The Relevance of Auto-Biological Attributions for Mental Health

Causal explanations of depression and treatment credibility in adults with untreated depression: Examining attribution theory

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.

Explaining Symptoms in Systemic Therapy. Does Triadic Thinking Come Into Play?

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they propose? The coding system “1 to 3: from the monad to the triad” was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows coding of the inference field of symptom explanations according to three categories: monadic, dyadic, and triadic. These three broad categories are also used to analyze the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields – a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapies – is proven, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients’ feelings, without disconfirming their emotions.

Attitudes Towards Seeking Psychological Help: An Integrative Model Based on Contact, Essentialist Beliefs About Mental Illness, and Stigma

Based on intergroup contact theory, a proposed comprehensive model of attitudes towards seeking professional psychological help was tested, including both potential barriers to mental health help-seeking (i.e., public stigma and self-stigma of seeking help, prejudicial and essentialist beliefs about mental illness, intergroup anxiety) and potential facilitators (i.e., direct and extended contact with persons with mental illness). Relevant measures were completed by 119 community-dwelling participants. Path analysis showed that direct (but not extended) contact with mental illness, by reducing intergroup anxiety, led to less negative beliefs about mental illness and weaker essentialist beliefs about mental illness (the latter being directly and positively associated with negative beliefs about mental illness). Moreover, less negative beliefs about mental illness, by reducing perceptions of self (but not public) stigma of seeking psychological help, were related to more positive attitudes towards help-seeking. Results are discussed in the context of the (unintentional) adverse effects of biogenetic (essentialist) explanations of mental disorders, and the clinical implications regarding interventions that aim at improving help-seeking attitudes.

Biological causal beliefs and depression stigma: the moderating effects of first- and second-hand experience with depression

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.

Future Directions in Single-Session Youth Mental Health Interventions

The United States spends more money on mental health services than any other country, yet access to effective psychological services remains strikingly low. The need-to-access gap is especially wide among children and adolescents, with up to 80% of youths with mental health needs going without services, and the remainder often receiving insufficient or untested care. Single-session interventions (SSIs) may offer a promising path toward improving accessibility, cost-effectiveness, and completion rates for youth mental health services. SSIs are structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program; they may serve as stand-alone or adjunctive clinical services. A growing body of evidence supports the capacity of SSIs to reduce and prevent youth psychopathology of multiple types. Here, we provide a working definition of SSIs for use in future research and practice; summarize the literature to date on SSIs for child and adolescent mental health; and propose recommendations for the future design, evaluation, and implementation of SSIs across a variety of settings and contexts. We hope that this paper will serve as an actionable research agenda for gauging the full potential of SSIs as a force for youth mental health.

Nutritional Status Affects Cortical Folding: Lessons Learned From Anorexia Nervosa

BACKGROUND

Cortical folding is thought to remain relatively invariant after birth. Therefore, differences seen in psychiatric disorders have been proposed as early biomarkers or used as intermediate phenotypes in imaging genetics studies. Anorexia nervosa (AN) is associated with drastic and rapid structural brain alterations and thus may be an ideal model disorder to study environmental influences on cortical folding.

METHODS

To date, the only two studies in AN applied different methods (local gyrification index and mean curvature) and found seemingly discordant results. We computed both vertexwise measures in a sizable sample of acutely underweight female AN patients (n = 87, mean age 16.5 years), long-term recovered patients (n = 58, mean age 22 years), and healthy control participants (n = 141, mean age 19.5 years). The majority of acutely ill patients were scanned longitudinally (n = 57) again after partial weight normalization (>14% body mass index increase).

RESULTS

While gyrification was broadly reduced in acutely ill patients, normal values were restored in most brain regions after partial weight restoration (≈3 months), and after full recovery no significant differences were evident relative to control participants. Increased gyrification was largely predicted by weight restoration alone. Results for absolute mean curvature analyses complemented those obtained using the local gyrification index.

CONCLUSIONS

Together, these findings indicate that nutritional status affects cortical folding and suggest that gyrification studies may need to better control for environmental factors. Moreover, they provide novel support for the likelihood that macroscopic changes in the cortical organization in AN are more reflective of nutritional state than premorbid trait markers or permanent scars.