Perceived credibility and outcome expectations: Important factors for understanding willingness to engage in psychological therapy for anxiety and depression in the broader community

A meaningful proportion of adults with anxiety and depression symptoms do not seek out psychological therapy. Studies show that higher treatment credibility (how logical therapy seems) and outcome expectations (perceptions of therapy effectiveness) are associated with greater treatment uptake. Most research has included individuals in therapy, who may perceive therapy as more logical and effective than those not seeking treatment. No studies have investigated these constructs in detail in the general community. This study examined perceptions of psychological therapy for anxiety and depression symptoms, and its relationship to treatment willingness in a community sample of Australian adults. Participant factors associated with credibility and expectations were explored. It received ethical approval from Macquarie University’s Human Research Ethics Committee (Reference No: 520241856860687).MethodsProcedureThis study included two identical online surveys about psychological therapy; one for depression symptoms and one for anxiety symptoms. Two separate surveys were used to allow for an exploration of whether treatment credibility, outcome expectations, and willingness to engage in psychological treatment changed depending on the specific problem (anxiety or depression), while also significantly reducing participant burden with the aim of facilitating considered responding and survey completion. The surveys were identical besides specifically asking about “anxiety symptoms” or “depression symptoms”. Participants were recruited via Pureprofile and included if they: (1) were at least 18 years old, (2) were residing in Australia, and (3) could read and understand English. All data was collected anonymously. Consenting participants were randomised to complete one of the two versions of the survey. Participants answered questions to gather demographic information (age, gender, education level, employment status, and ethnicity) before being presented with a brief description of psychological therapy for anxiety or depression symptoms: “Psychological therapy or psychological treatment involves working with a therapist to learn the reasons why someone’s anxiety or depression symptoms started and continue overtime. The therapist works collaboratively with the person to help them practice skills that will improve their ability to cope with their symptoms. Psychological therapy can be completed face-to-face or online.” All questions and items included in the two surveys can be found in the file appendices uploaded to the Protocol registry on Open Science Framework (see Related Materials below).MeasuresMeasures included the Credibility/Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000), Generalized Anxiety Disorder 2-item scale (GAD-2; Kroenke et al., 2007), Patient Health Questionnaire 2-item scale (PHQ-2; Kroenke et al., 2003), Duke University Religion Index (DUREL; Koenig & Büssing, 2010), and the 13-item version of the Coping Self-Efficacy Scale (CSES-13; Chesney et al., 2006). Additionally, two study specific measures captured participants' treatment history and willingness to engage in psychological therapy (see the codebook for more information).Statistical analysesThe distribution of CEQ scores were examined via visual inspection of histograms and statistical tests of normality Shapiro-Wilk, skewness, kurtosis). Ordinal logistic regressions were conducted to determine whether there was an association between outcome expectations, credibility, and willingness to engage in therapy (i.e., would not try therapy, unsure, would try). Finally, multivariate regressions were conducted to understand the influence of certain participant characteristics on treatment credibility and outcome expectations. Predictor variables included demographic information (age, gender, education level, employment status, and religious affiliation), clinical information (baseline depression and anxiety symptoms), previous treatment experiences, and coping self-efficacy. To understand whether one’s satisfaction with previous treatment was related to treatment credibility or outcome expectations, univariate regressions were conducted on a subset of the sample who had a history of psychological therapy or psychotropic medication.ResultsA total of 911 people participated (anxiety survey n = 463, depression survey n = 448). Results indicated that participants held positive beliefs about therapy. Credibility and expectations uniquely predicted willingness to engage in therapy. Participant characteristics explained little variance in credibility and expectations. The findings have important implications for improving treatment uptake: credibility and expectations should be considered and could be targeted via public health interventions and in primary care settings. Research exploring optimal approaches for increasing credibility and expectations would be a valuable future direction.