Insensitivity to the effectiveness of talking-therapy: the impact of the baseline-risk

Abstract

Objectives. People suffering from mental health conditions, often do not seek professional help. One of the reasons for this is that they do not consider talking-therapies sufficiently effective. It has been shown that among physical health conditions the rate at which people recover by themselves from a condition, as compared to those who do not (i.e. baseline-risk), unduly influences how effective people judge respective treatments. Treatments for conditions from which many people recover by themselves are considered as more effective than they actually are, as people credit the treatments for those that have recovered by themselves; the reverse is true for conditions from which many people do not recover by themselves. People may judge talking-therapy on the basis of the baseline-risk, to the detriment of the actual treatment effect of talking-therapy, conceptualised as the absolute or relative reduction of risk. Design. A mixed factorial within-between subjects experiment. Participants. A general population sample (N=202), in which 75.8% of participants had symptoms of depression and anxiety indicating a mental health condition. Methods. Participants took part in a web-based experiment during which they were shown six vignettes about common mental health conditions and the effect of talking-therapy on these compared to no treatment. The six vignettes varied in the baseline-risk (high vs. low), the absolute risk reduction (high vs. low), and the relative risk reduction (high vs. low). The dependent variable was the perceived effectiveness of talking-therapy, measured on a visual analogue scale from 0 (ineffective) to 100 (extremely effective). Analysis of covariance was conducted to control for potential confounding variables, including numeracy and mood. Results. Talking-therapies were judged on the basis of the baseline-risk of the condition. A higher baseline-risk was associated with a lower perceived effectiveness. This impact of the baseline-risk was not moderated by numeracy or mood. Talking-therapies were also judged on the basis of the absolute risk reduction but not by the relative risk reduction. There was some evidence that those with lower numeracy were less sensitive to differences in the treatment effect, that is, their judgments of effectiveness decreased less with a decreasing treatment effect. Conclusion. The evidence suggests that the effectiveness of talking-therapy is influenced by the baseline-risk of common mental health conditions. To address people’s judgement that talking-therapy is insufficiently effective may require considering the negative impact of the high baseline-risk inherent to common mental health conditions. In turn, this may increase uptake of talking-therapy for common mental health conditions.