Barriers to Psychological Treatment

The efficacy of a wide variety of psychological and behavioral interventions for psychiatric problems (e.g. depression, anxiety, etc), tobacco and substance abuse, obesity, pain, insomnia, and a wide variety of other behavioral and medical problems has been clearly established.  Psychological interventions are increasingly desirable in the eyes of patients.  For example, there is consistent evidence that up to two-thirds of depressed primary care patients would prefer psychological treatments over pharmacotherapy.  However, in spite of the desirability of such services, only around 20% of patients referred for psychological treatments ever enter treatment . Among those who initiate such treatment, nearly half dropout before completion.  Such large inconsistencies between stated interest and actual follow-up suggest that substantial barriers exist both to initiating and adhering to psychological interventions.  While barriers to receiving mental health and behavioral care have been identified as major problem in the delivery of such services in many forums (e.g. the ”President's New Freedom Commission on Mental Health” in  2003), very little research has been done to understand and characterize these barriers.

We have begun work developing measures of such barriers, as well as interventions to overcome these barriers.  Below are our 2006 Annals of Behavioral Medicine paper that describes our first 8-item barriers measure, which was piloted in primary care, and our newer 27-item measure, along with its scoring.