Clinicians' Judgments of the Need for Psychological Treatment

描述（由申请人提供）：专家和新手心理健康临床医生之前已经证明了理解正常效应（Meehl, 1973），其中对来访者的奇怪行为有一个合理的解释会导致他们认为这些行为更“正常”或可接受（Ahn, Novick, & Kim, 2003）。我们打算检验这种理解-正常效应是否影响临床医生对来访者心理健康治疗需求的判断，如果有，什么类型的解释会触发这种效应。(1)首先，我们建议检验了解来访者行为的解释是否会导致临床医生认为来访者不太需要心理治疗。一个与理解正常效应相一致的假设是，临床心理学家和精神科医生会认为，当为假想的来访者提供合理的行为解释时，他们不太需要治疗。如果是真的，这些发现将挑战标准的临床假设，即理解客户的问题必然对客户有益，或者至少不会伤害客户。(2)其次，我们将研究哪些类型的行为解释最有可能触发治疗决策的影响。特别是，我们将测试该效应的激活程度取决于客户是否被视为已经控制了导致其当前行为的突发事件。(3)第三，我们还将要求初级保健医生判断他们将同一客户转介给心理健康专业人员的可能性。通过检查临床医生合理可能产生的解释的不同影响，我们可以更好地确定影响的潜在范围并指定其系统触发因素。我们将积极寻求公布我们的结果，以提高临床医生的认识，更多的了解可能导致更少的治疗。公共卫生相关性：无论临床医生能够在精神上对他们的行为和其他症状做出什么解释，患有精神障碍的人都处于痛苦之中。该提案描述了一项转化研究，该研究检验了这样一种假设：当客户的症状能够合理地解释时，临床医生会认为客户不太需要专业的心理治疗。在我们在提议的研究中记录效果及其触发因素之后，我们将为更大的NIH提案奠定坚实的基础，其中我们将检查客户的相同过程及其对治疗寻求的影响，研究效果对终止治疗决定的影响，并制定干预措施以提高临床医生和客户对效果的认识。

DESCRIPTION (provided by applicant): Expert and novice mental health clinicians have previously been shown to demonstrate an understanding-normality effect (Meehl, 1973), wherein having a plausible explanation for a client's bizarre behaviors results in perceiving those behaviors as being more "normal" or acceptable (Ahn, Novick, & Kim, 2003). We propose to test whether this understanding-normality effect influences clinicians' judgments of clients' need for mental health treatment, and if so, what types of explanations trigger the effect. (1) First, we propose to test whether knowing an explanation for a client's behaviors leads clinicians to see clients as being less in need of psychological treatment. A hypothesis consistent with the understanding-normality effect is that clinical psychologists and psychiatrists will perceive hypothetical clients as being less in need of treatment when provided with a plausible explanation for their behaviors. If true, such findings would challenge the standard clinical assumption that understanding a client's problems is necessarily beneficial for the client or, at the very least, cannot harm the client. (2) Second, we will examine what types of explanations for behaviors are most likely to trigger the effect in treatment decisions. In particular, we will test the degree to which activation of the effect depends on whether clients are seen as having been in control of the precipitating events that lead to their current behaviors. (3) Third, we will also ask primary care physicians to judge the likelihood that they would refer the same clients to a mental health professional. By examining the differential impacts of explanations reasonably likely to be generated by clinicians, we can better identify the potential scope of the effect and specify its systematic triggers. We will actively seek to publicize our results to raise clinicians' awareness of the possibility that more understanding could lead to less treatment. PUBLIC HEALTH RELEVANCE: People suffering from mental disorders are in distress regardless of what explanations a clinician is able to mentally generate and bestow upon their behaviors and other symptoms. This proposal describes translational research testing the hypothesis that clinicians will perceive a client as being less in need of professional psychological treatment when the client's symptoms can be plausibly explained. After we document the effect and its triggers in the proposed research, we will have a solid foundation for a larger NIH proposal, in which we will examine the same process in clients and its effect on treatment seeking, study the influence of the effect on decisions to terminate treatment, and develop an intervention to increase clinicians' and clients' awareness of the effect.