Although most psychiatrists have encountered patients who don’t improve with treatment, novel research sheds some light on one possible explanation for this phenomenon.
Investigators found that among
“To the best of my knowledge, this subject hasn’t been written about or explored before because we operate under the assumption that someone coming for ambulatory treatment, of course, wants to get better and thinks that they deserve to get better,” lead author Mark Zimmerman, MD, professor of psychiatry and human behavior at Brown University, Providence, R.I., said in an interview.
“This issue is not something complicated that a clinician would need to explore by administering some scale or clinical rating instrument. All you have to do is ask patients if they think they deserve to get better, particularly patients who seem to be ‘stuck,’ and explore what’s underlying that belief,” added Zimmerman, who is also the director of the Outpatient Division at the partial hospital program, Rhode Island Hospital, Providence.
The findings were published online in the Journal of Clinical Psychiatry.
Obstacle to therapy
Results from a study examining the prevalence of this belief in more than 400 patients admitted to a partial hospital program showed that 17% of the participants either did not believe they deserved to get better or weren’t sure if they deserved to get better.
When compared with their peers, patients who felt they were undeserving were significantly less likely to complete the treatment program and missed significantly more days of treatment while in the program.
Of the patients who did complete the program, those who believed they were undeserving were in treatment for significantly longer periods of time than those who believed they deserved to get better.
The average length of stay for patients in the partial hospital program is usually about 2 weeks, the investigators note. However, a minority of patients end up in treatment for more than a month and during this prolonged period, some do not seem to improve in their symptoms or functioning despite “intensive psychotherapy and ongoing pharmacotherapy.”
The researchers wanted to understand the reasons for some patients’ lack of progress and examined whether those who did not believe they were worthy of getting better actually took longer to respond to treatment.
In the current research, Dr. Zimmerman wanted to focus on these patients and assess whether they did take longer to improve and what diagnoses might be associated with feeling undeserving.
Of the 405 patients in the study, the majority (83%) reported they believed they deserved to get better, 12.8% said they were unsure, and 4.2% reported they did not believe they deserved to get better.
The researchers combined those who were unsure and those who did not believe they deserved to get better and compared them with patients who believed they did deserve to get better.
Although there were no differences between these patients in gender, race, or marital status, those who did not believe they deserved to get better were significantly younger than their counterparts who believed they deserved to get better (mean age, 32.2 years vs. 37.7 years, respectively; P < .01).
They also were diagnosed with a greater number of disorders at the time of the evaluation (mean, 3.6 vs. 2.9; P < .01).