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.

有相当比例的存在焦虑与抑郁症状的成年人并未寻求心理治疗。研究表明，更高的治疗可信度（treatment credibility，即心理治疗看起来的合理性）与结果预期（outcome expectations，即对治疗有效性的感知），与更高的治疗接受度显著相关。既往多数研究的研究对象均为正在接受治疗的个体，这类人群对治疗的合理性与有效性的感知可能优于未寻求治疗的人群。目前尚无研究在普通社区人群中对这些构念进行过详细探讨。

本研究针对澳大利亚成年人的社区样本，探讨了其对焦虑与抑郁症状相关心理治疗的感知，以及该感知与治疗意愿之间的关联，并分析了与治疗可信度和结果预期相关的参与者个体因素。本研究已获得麦考瑞大学人类研究伦理委员会批准（批准编号：520241856860687）。

方法与流程
本研究包含两项完全一致的关于心理治疗的在线调查，分别针对抑郁症状与焦虑症状。设置两项独立调查的目的，一是探讨治疗可信度、结果预期以及参与心理治疗的意愿是否会因具体问题（焦虑或抑郁）而发生变化，二是显著降低参与者负担，以促进受访者审慎作答并完成问卷。两项问卷仅在针对“焦虑症状”或“抑郁症状”的具体提问上存在差异，其余内容完全一致。

参与者通过Pureprofile平台招募，纳入标准为：（1）年满18周岁；（2）居住在澳大利亚；（3）能够阅读并理解英语。所有数据均以匿名方式收集。获得知情同意的参与者将被随机分配完成其中一项问卷版本。参与者首先填写人口统计学相关问题（年龄、性别、教育水平、就业状况与种族），随后将收到一段针对焦虑或抑郁症状的心理治疗简介：“心理治疗或心理干预指与治疗师合作，了解个体焦虑或抑郁症状的起病原因及持续机制；治疗师会与个体协同合作，帮助其练习相关技能，以提升应对症状的能力。心理治疗可采用线下或线上形式进行。”

两项问卷中的所有问题与条目均可在上传至开放科学框架（Open Science Framework）协议注册平台的附录文件中查阅（详见下文相关材料）。

测量工具
本研究采用的测量工具包括：可信度/预期问卷（Credibility/Expectancy Questionnaire, CEQ；Devilly & Borkovec, 2000）、广泛性焦虑障碍2条目量表（Generalized Anxiety Disorder 2-item scale, GAD-2；Kroenke et al., 2007）、患者健康问卷2条目量表（Patient Health Questionnaire 2-item scale, PHQ-2；Kroenke et al., 2003）、杜克大学宗教信仰指数（Duke University Religion Index, DUREL；Koenig & Büssing, 2010）以及13条目版应对自我效能量表（Coping Self-Efficacy Scale, CSES-13；Chesney et al., 2006）。此外，本研究还设置了两项专属测量条目，以收集参与者的治疗史与参与心理治疗的意愿（详细信息请参见编码手册）。

统计分析
首先通过直方图可视化与正态性检验（Shapiro-Wilk检验、偏度检验、峰度检验）分析CEQ得分的分布情况。随后采用有序逻辑回归，探究结果预期、治疗可信度与参与治疗的意愿（即“不会尝试治疗”“不确定”“会尝试治疗”）之间的关联。最后通过多元回归分析，明确特定参与者特征对治疗可信度与结果预期的影响。预测变量包括人口统计学信息（年龄、性别、教育水平、就业状况与宗教信仰）、临床信息（基线抑郁与焦虑症状）、既往治疗经历以及应对自我效能。为探讨个体对既往治疗的满意度与治疗可信度或结果预期之间的关系，本研究对有心理治疗或精神药物使用史的亚样本进行了单变量回归分析。

研究结果
本研究共纳入911名参与者（焦虑问卷组n=463，抑郁问卷组n=448）。结果显示，参与者对心理治疗持有积极看法。治疗可信度与结果预期均可独立预测参与治疗的意愿。参与者个体特征对治疗可信度与结果预期的方差解释度较低。本研究结果对提升治疗接受度具有重要实践意义：应重视治疗可信度与结果预期，并可通过公共卫生干预与基层医疗场景针对性地加以干预。未来可进一步研究提升治疗可信度与结果预期的最优方案。