A new study published in Motivation and Emotion suggests that implicit beliefs about the malleability of anxiety — a person’s anxiety mindset — can influence treatment outcomes following psychotherapy.
Past evidence has suggested that an individual’s attitudes about mental health are linked to their psychological functioning and may be implicated in how they respond to psychotherapy treatment.
Study authors Anthony N. Reffi and Benjamin C. Darnell, who are both clinical psychology doctoral candidates at Northern Illinois University, were interested in examining how a person’s mindset can influence their behavior in meaningful ways.
“Our university clinic has been collecting mindset data for some time. Seeing all of the data we had, we turned to the literature to see what we could learn and found that mindset may affect treatment outcomes, but also that treatment may affect mindset,” explained Darnell.
“This literature got us curious to see how mindset may change by the end of psychotherapy and how it may influence behavior that could interfere with the psychotherapeutic process.”
A study was conducted to examine emotion and anxiety mindsets among individuals seeking mental health treatment and to examine the interplay between mindset and symptomology. The sample was comprised of 104 individuals of an average age of 25 who were seeking psychotherapy treatment at a university Psychology Services Center. The individuals were assessed at the time of their first appointment and again at their last session.
The treatment plans varied but lasted an average of 135 days and were based on Cognitive Behavioral Therapy techniques. Patients’ anxiety mindsets were measured using questions that assessed a growth anxiety mindset (e.g., “Everyone can learn to control their anxiety.”) and a fixed anxiety mindset (e.g., “No matter how hard they try, people can’t really change the anxiety that they have.”). Fixed and growth emotion mindsets were also assessed, as well as the psychological outcomes of symptom distress (anxiety and depression), interpersonal relationships, and functioning within social roles.
Interestingly, the data revealed that participants showed stronger growth anxiety mindsets at their final psychotherapy sessions, when compared to their intake appointments. This, the researchers say, offers evidence that mindsets can be changed and that psychotherapy may be one approach to altering a person’s mindset. Emotion mindset, however, showed no significant changes following therapy.
“In conjunction with other literature, our study suggests that therapy helps people learn that they have the power to change and manage their anxiety. This shift in thinking may be another positive outcome of psychotherapy that is related to improved mental health and everyday functioning,” Reffi and Darnell told PsyPost.
“This is good news for people who may defer seeking help because they think they cannot do anything to change how anxious they feel. However, even though these beliefs may change by the end of treatment, this change does not seem to be a way that therapy works to improve other symptoms (i.e., it is not a mechanism).”
Surprisingly, after controlling for possible confounders, growth in anxiety mindset was not found to indirectly affect the relationship between symptoms at the start of treatment and symptoms after treatment. As Reffi and his team point out, this suggests that a change in mindset may not be an effective way to reduce symptoms during psychotherapy.
However, participants’ anxiety mindset at their final session was linked to their symptom distress and social role scores. “These results indicate that participants who experience growth in anxiety mindset from the start of treatment to the end show decreased anxiety and depression symptoms (i.e., T2 symptom distress) and fewer problems at work, school, etc. (i.e., T2 social role) after treatment,” Reffi and associates say.
The authors speculate that these improved outcomes may have to do with the potential for a growth mindset to improve self-efficacy. “Increasing self-efficacy may facilitate increased engagement both within treatment (resulting in improved symptom distress) and within social roles (resulting in improved functioning within these roles),” the authors relate. Alternatively, they acknowledge that patients who feel better after treatment may be motivated to change their beliefs about the possibility of improving one’s anxiety.
“One surprising finding we had was that anxiety mindset may be related to social roles but not social functioning. We hypothesized that this difference may be due to differential relationships between anxiety mindset and context-dependent self-efficacy, but as far as I know these relationships have yet to be explored,” Darnell said.
Among limitations, the study did not follow an experimental design and did not include information about the individual diagnoses of patients.
The study had four main limitations, the researchers said.
“First, this study was not an experiment, so we cannot say anything about causal relationships for sure, such as whether changes in mindset improve mental health, or vice versa,” Reffi and Darnell told PsyPost.
“Second, we only had two timepoints, the beginning and end of treatment, so we cannot examine how mindset and outcomes change throughout the course of treatment.”
“Third, we did not have data to look at differences between diagnoses, so we do not know if change in anxiety mindset plays more of a mechanistic role in treatment that is anxiety-specific,” the researchers explained.
“Finally, we had a small sample size. This means our results may have looked different if we had more data, and our findings do not necessarily apply to a broader group of people.”
The authors suggest that future studies should consider the relationship between a given mental health mindset and a specific mental health diagnosis.
The study, “Implicit beliefs of emotion and anxiety in psychotherapy”, was authored by Anthony N. Reffi, Benjamin C. Darnell, Sara J. Himmerich, and Karen J. White.
