Effort and effort discounting as predictors of seeking psychotherapy among individuals with depression.

Abstract

Many individuals who experience depression do not seek psychotherapy, and past research has had limited success in predicting help-seeking in this population. Accounting for behavioral characteristics of depression that affect help-seeking decisions, such as effort discounting (devaluation of rewards as a function of effort), may address this gap. Individuals with moderate-severe depression symptoms who were not in psychotherapy (N = 253) reported their depression symptom severity and the amount of effort they anticipated seeking psychotherapy would require; they also completed a behavioral measure of effort discounting. At a 3-month follow-up, they reported whether they initiated psychotherapy during the follow-up period. Depression symptom severity was associated with perceptions that seeking psychotherapy would be more effortful. In turn, perceptions that seeking psychotherapy would be more effortful prospectively predicted a lower likelihood of initiating psychotherapy. Effort discounting was unrelated to psychotherapy use. These results suggest that differences in the anticipated effort required to seek psychotherapy can increase depressed individuals' risk of going untreated. Future research may test whether reducing the effort of seeking psychotherapy increases psychotherapy use among those with depression. For instance, streamlining insurance enrollment procedures, implementing patient decision aids, or offering telehealth treatment options may be beneficial.