Relationships of Biomedical Beliefs About Depression to Treatment-Related Expectancies in a Treatment-Seeking Sample

Like other mental disorders, major depression is increasingly explained as a biomedical illness. We examined, in a treatment-seeking sample, whether attributing one's depression to biomedical causes would be associated with pessimistic psychotherapy treatment expectancies. Individuals seeking psychotherapy for depression rated their endorsement of biomedical explanations for their symptoms, expectations regarding treatment outcome, and expectations about forming a working alliance with a therapist. We found that treatment seekers' endorsement of biomedical explanations for their symptoms was associated with pessimism about treatment being successful. This pessimism was, in turn, associated with holding more negative expectancies about one's ability to form a strong therapeutic alliance with a therapist. Given the ascendancy of biomedical explanations for depression and the influence of patient expectancies on clinical outcomes, strategies for disassociating biomedical attributions from pessimistic expectancies may be needed. Clinical Impact Statement Question: How do treatment seekers' beliefs about the role of biological factors in their depression relate to their expectations about treatment outcome and the working alliance? Findings: The more treatment seekers attributed their depressive symptoms to biological causes, the more negative their treatment outcome expectations were, and this pessimism also was associated with negative expectations about the working alliance. Meaning: Therapists may wish to be aware of how much their patients believe in biomedical explanations for depression and help to dispel the notion that biological etiology implies poor prognosis. Next Steps: Future work should longitudinally examine how patients' pretreatment beliefs about the role of biological factors in causing their symptoms relate to their treatment expectancies, and how this relationship might affect actual therapeutic alliances and impact actual psychotherapy treatment outcomes.