A recent article, published in the journal Psychiatric Services, reviewed the literature on mental health professionals’ causal beliefs about psychosis and examined the differences between their causal beliefs and those of people diagnosed with psychotic disorders. The results showed that mental health professionals are more likely to endorse biogenetic beliefs while people with psychosis are more likely to endorse psychosocial beliefs.
“The purpose of this review was to describe the scope of literature and to map the existing evidence on causal beliefs about psychosis among mental health professionals and people with psychosis,” Rosenthal Oren and her coauthors write.
“Less attention has focused on causal beliefs about psychosis held by mental health professionals, and little is known about possible disagreements between mental health professionals and people with psychosis regarding causal beliefs.”
The modern psy-disciplines have proposed several different understandings of the causes and treatment protocols for psychosis. However, there have been at least six common types of causal beliefs identified in the literature. Causal beliefs are the beliefs regarding the cause of a condition, and they are often understood as part of active attempts to cope with health threats. In fact, a recent systematic review found that the health outcomes of people with psychosis were related to the type of causal beliefs they held.
“Causal beliefs influence emotional responses, coping strategies, and treatment choices,” the authors note. “Among individuals with psychosis, a growing body of literature highlights the potential impact of causal beliefs on adherence behavior and service engagement.”
The six common causal beliefs are as follows:
- Biogenetic beliefs emphasize the genetics or heritability of psychosis and primarily focus on pharmacological treatments to address biological abnormalities. Previous studies found this type of belief is associated with higher rates of stigma and medication adherence among people with psychosis.
- Psychosocial beliefs take psychological, social, and environmental influences into account for the development of psychosis and utilize more psychosocial interventions to produce changes in cognition, emotions, and behaviors. Previous studies found this type of belief is associated with greater psychotherapy engagement among people with psychosis.
- Spiritual-religious beliefs focus on spiritual explanations of psychosis and seek to understand how spirituality and religion are adapted as coping strategies. Previous studies found this type of belief is associated with a longer duration of untreated psychosis.
- Substance-related beliefs link the onset of psychosis with substance use and sees drugs and/or alcohol as the reasons for triggering psychosis.
- Personal characteristics related to beliefs consider personality and other individual characteristics as contributing factors for the development of psychosis. Previous studies found this type of belief is associated with higher rates of stigma among people with psychosis.
- “Psychosis as a part of human experience” refers to beliefs that embrace the idea that the experience of psychosis could be a part of reality—whereby people can have special power beyond current scientific explanations.
This study screened and reviewed 17,029 studies and presented their results based on the final 42 sample articles. They found a clear preference for biogenetic beliefs about psychosis among mental health professionals, whereas the most endorsed causal beliefs for people with psychosis were psychosocial beliefs. However, they also suggested that both mental health professionals and people with psychosis often hold several causal beliefs simultaneously.
“Results suggest that both mental health professionals and people with psychosis often hold complex causal models composed of different types of causal beliefs and that a gap exists in the different sets of causal beliefs held by mental health professionals and by people with psychosis,” the authors write.
Their results showed that different mental health professionals seemed to have different tendencies in endorsing causal beliefs. Among all mental health professionals, including psychiatrists, psychiatric nurses, psychologists, social workers, case managers, occupational therapists, and support workers, psychiatrists were the only group with a higher endorsement of biogenetic belief.
“Those from medical professions were found to hold mostly biogenetic beliefs, whereas those from nonmedical professions, such as psychologists and social workers, were found to hold psychosocial beliefs more often than they held other types of causal beliefs,” the authors note.
“Social-environmental causal beliefs may be associated with positive outcomes, such as higher self-esteem, whereas beliefs related to personal characteristics were found to be frequently associated with negative consequences, such as self-blame, poorer emotional state, and higher levels of anxiety.”
Lastly, the study found that causal beliefs about psychosis varied by nationality for both mental health professionals and people with psychosis. It seemed that people from Western cultures were more likely to endorse biogenetic and psychosocial causal beliefs than people from non-Western cultures, who were more likely to endorse spiritual-religious beliefs than other types of beliefs.
The authors conclude:
“These possible differences can harm the therapeutic alliance, which is closely linked to treatment adherence and outcomes. Overcoming gaps in causal beliefs requires that mental health professionals become aware of their own causal beliefs and potential gaps so that they can discuss them openly and respectfully with people with psychosis.”
“Such discussion may help people with psychosis integrate their current experiences with their life history, which can facilitate the process of constructing a personally meaningful narrative of self and illness, an important part of the recovery process.”
Rosenthal Oren, R., Roe, D., Hasson-Ohayon, I., Roth, S., Thomas, E. C., & Zisman-Ilani, Y. (2021). Beliefs about the causes of psychosis among persons with psychosis and mental health professionals: a scoping review. Psychiatric services, appi-ps. https://doi.org/10.1176/appi.ps.202000460 (Link)