Matthew S. Lebowitz

Effects of biological explanations for mental disorders on clinicians’ empathy

Significance Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from “normal” people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce clinicians’ empathy. This is alarming because clinicians’ empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes. Mental disorders are increasingly understood in terms of biological mechanisms. We examined how such biological explanations of patients’ symptoms would affect mental health clinicians’ empathy—a crucial component of the relationship between treatment-providers and patients—as well as their clinical judgments and recommendations. In a series of studies, US clinicians read descriptions of potential patients whose symptoms were explained using either biological or psychosocial information. Biological explanations have been thought to make patients appear less accountable for their disorders, which could increase clinicians’ empathy. To the contrary, biological explanations evoked significantly less empathy. These results are consistent with other research and theory that has suggested that biological accounts of psychopathology can exacerbate perceptions of patients as abnormal, distinct from the rest of the population, meriting social exclusion, and even less than fully human. Although the ongoing shift toward biomedical conceptualizations has many benefits, our results reveal unintended negative consequences.

Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support

Objective: The objective of this research was to compare the effects of different causal attributions for overweight and obesity, among individuals with overweight and obesity, on weight-related beliefs, stigmatising attitudes and policy support. Design: In Study 1, an online sample of 95 US adults rated the extent to which they believed various factors caused their own weight status. In Study 2, 125 US adults read one of three randomly assigned online passages attributing obesity to personal responsibility, biology, or the ‘food environment.’ All participants in both studies were overweight or obese. Main outcome measures: All participants reported beliefs about weight loss, weight-stigmatising attitudes, and support for obesity-related policies. Results: In Study 1, biological attributions were associated with low weight-malleability beliefs and blame, high policy support, but high internalised weight bias. ‘Food environment’ attributions were not associated with any outcomes, while ‘personal responsibility’ attributions were associated with high prejudice and blame. In Study 2, participants who received information about the food environment reported greater support for food-related policies and greater self-efficacy to lose weight. Conclusion: Emphasising the role of the food environment in causing obesity may promote food policy support and health behaviours without imposing the negative consequences associated with other attributions.

Stigmatization of ADHD: A Developmental Review

Objective: In recent years, the stigmatization faced by people with mental disorders has received considerable attention in the empirical literature. However, individuals with different disorders are subject to distinct types of negative attitudes, necessitating examinations of stigma that treat specific disorders individually. Method: This article reviews recent empirical literature concerning the stigmatization of ADHD. Further specificity is achieved by taking a developmental perspective, reviewing studies of stigmatizing attitudes as a function of the age of the target and perceiver. Results: Findings from nationally representative data sets, experimental investigations, surveys, and qualitative studies indicate that individuals of all ages who exhibit symptoms of ADHD are the recipients of substantial stigmatization. Conclusion: Although the stigmatizing attitudes of children and adolescents appear to differ in some ways from those of adults, negative perceptions toward people with ADHD appear to generally be present at all stages of development.

Biological Explanations of Generalized Anxiety Disorder: Effects on Beliefs About Prognosis and Responsibility

OBJECTIVE Biological explanations of psychopathology can reduce the extent to which people with mental disorders are blamed for their symptoms but can also yield prognostic pessimism--the belief that psychiatric conditions are relatively immutable. However, few studies have examined whether these effects occur among persons who actually have psychiatric symptoms. This study sought to address this question. METHODS Adults living in the United States (N=351) were recruited online in January and February 2012 and assessed for symptoms of generalized anxiety disorder. The participants were randomly assigned to two groups: a biological condition, in which participants (N=176) were provided a description of generalized anxiety disorder and a biological explanation of the etiology of the disorder, and a control condition, in which participants (N=175) were provided the same description without any explanation of etiology. Dependent measures of treatability, duration of symptoms, and responsibility for symptoms were used to gauge beliefs regarding the prognosis and personal responsibility of a typical person with generalized anxiety disorder. RESULTS Among participants with and without symptoms of generalized anxiety disorder, the biological condition was associated with decreased ascriptions of personal responsibility for anxiety (p=.02) and expectations of increased duration of symptoms of generalized anxiety disorder (p=.01). CONCLUSIONS This finding has important social and clinical implications, especially because biological conceptualizations of psychopathology are increasingly prevalent. By causing prognostic pessimism about generalized anxiety disorder, including among those with symptoms of the disorder, biological explanations could negatively affect treatment seeking and outcomes. Efforts to dispel the link between biological explanations and prognostic pessimism are needed.

Effects of Biological Versus Psychosocial Explanations on Stigmatization of Children With ADHD.

Objective: Previous studies have found biological conceptualizations of psychopathology to be associated with stigmatizing attitudes and prognostic pessimism. This research investigated how biological and psychosocial explanations for a child’s ADHD symptoms differ in affecting laypeople’s stigmatizing attitudes and prognostic beliefs. Method: Three experiments were conducted online with U.S. adults, using vignettes that described a child with ADHD and attributed his symptoms to either biological or psychosocial causes. Dependent measures gauged social distance and expectations about the child’s prognosis. Results: Across all three studies, the biological explanation yielded more doubt about treatability but less social distance—a result that diverges from previous research with other disorders. Differences in the amount of blame ascribed to the child mediated the social distance effect. Conclusion: The effects of biological explanations on laypeople’s views of ADHD seem to be a “double-edged sword,” reducing social rejection but exacerbating perceptions of the disorder as relatively untreatable.

Sometimes more competent, but always less warm: Perceptions of biologically oriented mental-health clinicians

Background and aims: Biological conceptualizations of psychopathology are ascendant, including among mental-health clinicians. However, it is unknown how this might affect people’s perceptions of clinicians, which in turn could have considerable public-health implications. The present studies sought to address this issue. Methods: In the present research, participants imagined that they or their loved ones were suffering from a mental disorder and then rated their perceptions of one clinician espousing the view that ‘mental disorders are brain diseases’ and another describing them as ‘disorders of thoughts and emotions’. Results: Biologically oriented clinicians were perceived as more competent and effective only when the disorder in question was judged to be biologically caused. Otherwise, there was no significant difference in perceived competence, and biologically oriented clinicians were rated less effective. Regardless, all participants perceived the biologically oriented clinician as significantly less warm on average than the psychosocially oriented clinician. Conclusion: These findings may have important clinical implications for the crucial therapeutic alliance between therapists and patients.

Beneficial and detrimental effects of genetic explanations for addiction

Background: Addictions are highly stigmatized and increasingly construed as biomedical diseases caused by genes, partly to reduce stigma by deflecting blame. However, genetic explanations may have negative effects, which have been understudied in the context of addiction. How the effects of genetic explanations might differ for substance addictions versus behavioral addictions is also unknown. Aims: This study examined the impact of genetic explanations for addiction on measures of treatment expectancies, blame, and perceived agency and self-control, as well as whether these varied depending on whether the addiction was to a substance or a behavior. Methods: Participants read about a person (‘Charlie’) with either alcohol use disorder or gambling disorder, receiving either a genetic or nongenetic explanation of Charlie’s problem. They rated how much they blamed Charlie for his disorder, his likelihood of benefitting from medication or psychotherapy, and how much agency and self-control they ascribed to him. Results: Compared to the nongenetic explanation, the genetic explanation reduced blame and increased confidence in the effectiveness of pharmacotherapy. However, it also decreased the expected effectiveness of psychotherapy and reduced ascriptions of agency and self-control. Conclusion: Genetic explanations for addiction appear to be a ‘double-edged sword’, with beneficial effects that come at a cost.