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Therapy helps, but only if people opt for it

Reducing cost and time barriers has little impact on the use of psychotherapy, shows a study

Psychotherapy, also known simply as therapy, is known to be more useful than antidepressants, but it is used much less. A new study shows making therapy cheaper may not change this, nor will allowing workers to visit therapists during work hours.

In a working paper for the National Bureau of Economic Research, researchers Christopher Cronin and others show that roughly 20% of the US population can benefit from psychotherapy. But only 4% have reported going for therapy, as compared to 12% opting for antidepressants. The authors use 1996-2011 data from the Medical Expenditure Panel Study.

While lowering the effective cost of therapy does not improve its uptake, ensuring the patient does not drop out and completes the full course has a positive effect on its use. Assigning them to therapy could be a strong one-time policy action. But it benefited only the sickest individuals in the long term as they continued with the treatment even later, the study finds. Others were reluctant to do so.

A popular view is that better mental health policies will “pay for themselves" as they will increase productivity and wages for those who get treated. But the study observes very little of this. Those with the poorest mental health are most likely to gain upon treatment, but are otherwise least likely to be employed as they may lack earning potential or prefer leisure, the authors find. Those with higher earning potential are better mentally, with little marginal benefit from the treatment.

Since lowering the price or time cost does not work, the study suggests that we look elsewhere to understand and intervene. It is possible the low uptake of therapy treatment is due to the prevalent stigma of needing a professional to process one’s emotions, or biases against its effectiveness, the authors say.

Also read: What good are treatment effects without treatment? Mental health and the reluctance to use talk therapy

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