Mind Over Misconception: Challenging the Idea that Therapy Is Ineffective for ‘Biologically Based’ Mental Disorders

A new study explores why people think some 'mental disorders' are biologically based, and why this belief could be keeping people from therapy.

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Mainstream discourse about ‘mental illness’ often assumes that some ‘mental disorders’ are more ‘biologically caused’ than ‘psychologically caused.’ However, this common yet unsupported assumption might be steering many away from therapy. A new study from Yale University dives into this problematic belief, and the findings might change the way we approach mental health.

In the complex mental health landscape, the battle between biology and psychology is rife with misconceptions and misunderstandings. New research from Yale psychologists Annalise Perricone & Woo-kyoung Ahn explores why many people perceive psychotherapy to be less effective when mental disorders are assumed to be tied to biological factors. The results are as surprising as they are concerning.

“When mental disorders are attributed to biological factors, people appear to endorse psychotherapy’s effectiveness less strongly,” Perricone and Ahn explain. “Even mental health clinicians show this tendency. Given biological explanations for a hypothetical patient’s symptoms (e.g., genetic causes, brain abnormalities), clinicians judged psychotherapy to be less effective than when given psychosocial explanations for the same person’s symptoms (e.g., childhood trauma).”

The experiment conducted by Perricone & Ahn in the study sought to understand why people tend to perceive psychotherapy as less effective for mental disorders assumed to be more ‘biologically caused’ than ‘psychologically caused.’ The researchers focused on exploring three specific beliefs that might explain this perception:

  1. Neurodualism: The false idea that mental treatments can’t affect assumed ‘biologically caused’ disorders.
  2. Controllability: The incorrect notion that assumed ‘biologically caused’ processes are beyond control.
  3. Discount of Psychological Causes: The problematic tendency to ignore psychological factors once a disorder is labeled as ‘biologically caused.’

These misconceptions are not just erroneous; they’re influencing decisions about therapy.

The Experiment

A total of 278 U.S. adults participated in the experiment. Initially, participants’ endorsement of these three beliefs was measured. Participants were then asked to judge the effectiveness of psychotherapy for a hypothetical case of depression, and they were subsequently provided with information about the biological causes of the depression. After receiving this information, they were asked to rate the effectiveness of psychotherapy again.

The researchers looked at how participants’ endorsement of the three beliefs correlated with the change in the perceived effectiveness of psychotherapy after learning about the assumed ‘biological causes.’

What They Found

  1. Participants strongly endorsed all three misconceptions.
  2. This endorsement led to a shift in perception, undermining the value of psychotherapy for assumed ‘biologically caused’ depression.
  3. There was a clear link between holding these misconceptions and rejecting psychotherapy.

Simply put, the more one buys into these false beliefs, the less likely one is to consider therapy for mental disorders assumed to be ‘biologically caused.’

Participants strongly endorsed each of the proposed beliefs, with large effect sizes (Cohen’s d’s of 1.25, 1.68, and 0.53, respectively). There was also a significant decrease in the perceived effectiveness of psychotherapy for the assumed ‘biologically caused’ depression compared to the baseline ratings. The extent to which participants endorsed neurodualism, controllability, and discounting directly correlated with this decrease in perceived effectiveness.

The experiment not only identified the specific beliefs that lead to the diminished perceived effectiveness of psychotherapy for mental disorders assumed to be ‘biologically caused,’ but it also replicated previous findings, showing that participants judged psychotherapy to be less effective and medication more effective, after learning that the hypothetical depression was assumed to be ‘biologically caused.’

This research provided empirical evidence for the first time, shedding light on a widely held yet unsupported assumption that may hinder effective mental health treatment. It suggested possible interventions to counteract these beliefs and indicated areas for future research, including examining situations where medications might be perceived as less effective or where combined treatment is optimal.

“Changes in clinical practice may also reflect the trend, as biological explanations for mental disorders increasingly prevail,” the authors write. “For instance, among psychiatrists, the use of pharmacotherapy alone is increasing, while the use of psychotherapy is decreasing rapidly.”
“Furthermore, treatment perceptions can affect actual treatment outcomes… so viewing psychotherapy as less effective for mental disorders with presumed biological etiologies could be a barrier to recovery for those in need of psychotherapy.”

While enlightening, the study also points to limitations and a need for further exploration. The findings provide a basis for future studies to counter these misconceptions and explore other factors that might perpetuate this problematic view of mental disorders.

Understanding why therapy is overlooked for mental disorders assumed to be ‘biologically caused’ offers a chance to correct a pervasive and detrimental misunderstanding. This study could guide us toward more informed, compassionate, and effective treatment approaches by challenging assumptions and encouraging a more complex view of mental disorders. It’s a conversation that could redefine how we perceive and treat mental health, moving us closer to care that embraces the full complexity of the human mind.

 

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Perricone, A., & Ahn, W. K. (2023). Reasons for the Belief that Psychotherapy is Less Effective for Biologically Attributed Mental Disorders. Cognitive Therapy and Research. Advance online publication. https://doi.org/10.1007/s10608-023-10392-7 (Link)

17 COMMENTS

  1. I’ve devoted a lifetime to doing talk therapy, and teaching others to do it. The invisible elephant in the room for this piece is the health insurance industry. Changes in practice over the years reflect the refusal of the industry to adequately reimburse talk therapy. That has endless ripple effects which could fill many books.

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    • I would also say that the training for “talk therapy” has deteriorated massively while classes on “diagnosing” with the DSM are hugely on the rise. I often wonder from talking to them whether today’s clinicians have ever even been introduced to the idea of subconscious motivation? They get trained that PTSD exists but to they get any kind of training on what to DO that might be helpful to a traumatized person (or what NOT to do?) Once one’s had “therapy” with a person who doesn’t know what they’re doing and makes things worse, the idea that “therapy” could work is canceled pretty much forever. Which leaves people with very few options!

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      • As someone who has survived a lot of violence and oppression by members of my family, psychotherapists, countless agents of my country’s judicial, psychological, medical, social system over several decades I can say that there are countless other options to find out how to find a way to deal with such experiences of violence and overcome them that different from psychotherapy do actually work.

        I for example started my self-directed recovery from chronic episodic depression and at the same time a journey of liberation and reempowerment with yoga. It got very fast clear to me that one hour of yoga was uncomparably better that one hour of psychotherapy, even with a relatively skilled and experienced therapist that I had at that time. From that insight I started to go to yoga classes five times a week for an hour and from there I found one safe and effective thing after another that led to a complete recovery from my very severe depressive habit patterns and a full liberation from my dependency on psychotherapists that never stopped to severly harm me whilst I was already on this very healthy path.

        After yoga came mindfulness meditation, a self-directed social anxiety desensitivisation traning with the strategy to work with fear by the Tibetan woman warrior (as described in one of US-Tibetan nun Pema Chödrön’s books), a depression self-help group, a series of workshops and coaching by peer-coaches where I was mainly tought to set boundaries, to communicate well and conflict skills. Indispensable was the advice of an Indian Hindu-feminist psychologist and meditation teacher to focus on learning to be comfortable and if needed for self-protection expressive of angry feelings for reempowerment and a meditative self-compassion practice (as she was taught herself by Tibetan nuns) to heal the wounds that I had from terribly violent and abusive experiences since childhood. I continued with more peer-support, creative workshops on healing and self-development, creative projects, many more groups and workshops, indispensable was a seminar on grief by two catholic women theologists, in a very difficult situation a catholic nun recommended that I’d do a pilgramage which I have repeated several times since to my great benefit. Once or twice a week I go and sit at our local little church in meditation and prayers that I have tought myself to say.

        And these are just the main tools that I used. I am sure that people who are reading here know many, many more.

        It is not the first time that I suggest that Mad in America stops to discuss and criticise only the standard means of the psy field and refocuses its mission on spreading the word about those things that actually do work for people to reclaim their lives and flourish outside of the narrow minds and ideas of the academic mental health field.

        Because in the case of the psy disciplines it is true that the grass is greener everywhere else! Thanks god : )

        I can really recommend especially to the professionals in the field that you get out of it and don’t waste your lives.

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        • I agree with you for the most part. I would never have gotten where I am from psychotherapy. I did have a very good therapist and it was important in getting me started in seeing the limitations of my upbringing. But without Buddhism, meditation, exercise, a job that challenged me to overcome some of my anxieties, the support of important people (including my wife), an exploration of a wide range of spiritual practices, self-help books, and some good old fashioned hard work, I’d have never gotten anywhere. And from what I understand, the training for therapists these days has deteriorated, and they spend time studying the DSM diagnoses but don’t bother with little things like unconscious motivations or the long-term impact of trauma or domestic abuse dynamics. So I don’t want to deny that psychotherapy can play a role for some folks, but it needs to be one who really GETS what s/he is doing, and is empowering of the client to pursue his/her goals. My therapist told me her goal was for ME to become my own therapist and not need her any more. Not every therapist has such goals!

          Anyway, I think you’re right, the best even the best therapist can offer (and as I see it, most of them aren’t very good!) is to help you set your feet on a different path. Where you end up going is TOTALLY up to you, and there are as many ways to find the path as there are humans on the Earth!

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          • Thanks for writing. Though I am not surprised I find it fascinating that you used very similar wellness and recovery tools that worked for you. It makes me think that it is possibly not innumerable different things that work for people but rather a set of things that in the majority work for everyone.

            The Buddhist teachings seem highly effective : ) I see this in many people. It helped me right from the start to let go of the idea that something was fundamentally wrong with me. An idea that I was tought by my mother and a therapist by being forcibly sent to psychotherapy when I was ten years old and after I had experienced violence.

            Probably we have a disagreement around psychotherapy because I didn’t have any psychiatric problems before I was sent to therapy. And it was the event of being forced to go to therapy and the explanation for it that something was wrong with me that needed a psychotherapeutic intervention that was the deciding factor that I began to develop serious chronic depressive habits.

            It was one year after I finished my last psychotherapy that I could access this knowledge again that was still there under all the traumatherapeutic brainwash that I had been a victim for a long time.

            That may account for our different views of psychotherapy. For me, pathologisation of my person, was the most harmful thing that I have experienced and what made that I now couldn’t find a way anymore to deal with my life than developing a depressive habit. What is nothing else actually as the way my personality style offers to me to shut down all difficult feelings and retreat to thinking (Enneagram type 5) at a point that I was not anymore able to take them anymore because my lifesituation had become unbearable and I had no way out.

            As a child I depended on these people who mis- und maltreatet me. This was way more harmful to my wellbeing than the mistreatment that I had experienced and what was the reason that I was sent to therapy. You can imagine that I am extremely critical especially of trauma theory.

            One of the worst things was that being sent to psychotherapy somehow cut me off from my natural coping mechanisms to deal with violence.

            Before psychotherapy I had a pretty clear understanding of the perpetrator being a powerabuser and a highly confused and manipulative person, and a positive self-image as a girl who was able to protect herself as good as possible.

            My psychotherapists began to see me as a damaged and helpless victim, a person with a severe psychiatric disorder, a person that hadn’t been able to protect herself and was not able to overcome these experiences without the help of a psychotherapist. It’s so good to write about it! It was unbelievably harmful what these therapists under the spell of their crappy trauma theories did to me.

            I know from talking to many psychotherapists often “under cover” that this is their standard procedure and I have met many other of their victims.

            I hope you see why I think that pschotherapists are some of the most dangerous and oppressive people in Western society and that more needs to be done to stop them.

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          • I think you hit on something EXTREMELY important! It is those wounded by the abusers in society who are “diagnosed” and sent to “therapy,” while the perpetrators walk around harming others. Therapy at its best is about helping those harmed cope with the damage and the horrible awareness that abusers are running the show. I was fortunate to have a caring and competent therapist, so it’s very hard for me to even imagine what would happen to me if my therapist had joined forces with those authority figures responsible for the damage!!!!

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    • The elephant in the room, in my experience, is the large number of people for whom therapy is ineffective to harmful. I am one of those. For the last years of my long journey with therapy I paid a trauma therapist out of pocket. She was recommended by a therapy book author and consultant who could not take me on herself. I really, really tried to “get better”, to find the roots of my problems and overcome them.

      Eventually, I had to come to the conclusion that it didn’t work because THERAPY didn’t work. That trying therapist after therapist to find a “good fit” is an illusion and pipe dream for many folks.

      I hope, David Moultrup, that you teach your students about the possibility of therapy failing some (who knows how many because who is counting?) clients, so that they can give them adequate, accurate informed consent. But in order to do that, there need to be realistic and large scale studies that are actually LOOKING for iatrogenic effects of therapy, and the damage it can do in people’s lives. Yes, it does damage to clients’ pocketbooks, too, and NOT just the pocketbooks of insurance companies. In fact, I wonder how much of the money the insurance companies spend is on therapy is wasted anyway, like mine was (not to mention the iatrogenic damage — but who cares about that besides me?) driving up the health insurance costs for all of us.

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      • Mella, thanks for your comment. I agree 100%. I am glad that you have already shared your terrible experience with psychotherapy here. It is true. The harm that is done in psychotherapy to people in distress is still widely underrated and unacknowledged by the public.

        It is actually different here on the Mad in America website. Peter Simons and others have produced so many articles on the problems with psychotherpy over the last years that I honestly do not understand how it is possible that a young psychologist in his training as a psychotherapist (counselors may call themselves differently, their identity is just that of any professional in the psy field) can sell psychotherapy on this website as the new panacea for people in mental distress and claim that it is safe and effective. This is plain wrong and goes against the evidence that we have from research.

        Apparently it is more and more popular as a marketing strategy among those caught in the cult of psychotherapy to acknowledge that psychiatric pharmacotherapy is a fraud and to sell psychotherapy as the only thing that is really working.

        In German we understand such a scheme as if someone was trying to drive out the devil with the beelzebub.

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  2. I understand. But therapy should also not be used as a get out clause by clinicians, if a person is not improving. For serious mental illness, meds have to be right. Therapy has to be right. Both together. OCD is a classic example. I was told for 5 years I needed more therapy when all the time my meds were wrong AND therapy was wrong. This risked my life. At the end of the day clinicians have to have accountability and not blame the patient all the time that they are not doing enough therapy when often they are the ones failing. Also Cambridge University have recently published research that OCD is biologically based? Be careful – people will end their life if being constantly told ‘it’s all in their head’ when perhaps it’s not. This is the reason I nearly ended mine. More than the illness.

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  3. This study’s results are about as surprising as saying that people don’t think singing will help heal their broken arm. The only difference is that the consensus etiology of the broken arm is actually correct.

    When we don’t understand the true causes of mental health conditions, we can expect the treatment of such conditions to be entirely misguided. Hence our epidemic of Pharma here in the west. Then we blame and shame people for not getting better.

    “The pathologizing will continue until morale improves.”

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  4. The first problem with psychotherapy is that it costs more than just giving someone a pill.

    The second problem is that it doesn’t work that well. There ARE psychotherapies that work better. But they cost even more to administer, and most therapists don’t even know they exist.

    So we are stuck with a system that doesn’t really want that much to make people better, and that’s the result we are getting. If we really want people to get better, we need to do more than pay therapists.

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  5. Lina is absolutely right!!! Psychotherapy for me was just as bad (and even worse in certain ways) than psychiatry’s drugs, which isn’t surprising because they both operate from the same false premise: that there’s something wrong with people who react and object to being abused, WHICH IS EVEN MORE ABUSIVE!!!

    Psychiatry’s drugs can destroy you physically, but “psychotherapy” undermines (and can even destroy) one’s sense of self.

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