Assessing and improving public mental health literacy concerning rTMS

Amanda S Morrison; Andero Uusberg; Julia Ryan; Amit Goldenberg; Amit Etkin; James J Gross

doi:10.1186/s12888-022-03880-9

Assessing and improving public mental health literacy concerning rTMS

BMC Psychiatry. 2022 Apr 8;22(1):249. doi: 10.1186/s12888-022-03880-9.

Authors

Amanda S Morrison¹, Andero Uusberg², Julia Ryan², Amit Goldenberg³, Amit Etkin^{4

5

6}, James J Gross²

Affiliations

¹ Department of Psychology, California State University, East Bay, 25800 Carlos Bee Blvd, Hayward, CA, 94542, USA. amanda.morrison@csueastbay.edu.
² Department of Psychology, Stanford University, Building 420, 450 Jane Stanford Way, Stanford, CA, 94305, USA.
³ Harvard Business School, Harvard University, Boston, MA, 02163, USA.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
⁵ Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94305, USA.
⁶ Alto Neuroscience, Los Altos, CA, 94022, USA.

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) has received empirical support as a viable treatment alternative for treatment-resistant major depressive disorder. Nevertheless, patients and the public-at-large may be hesitant to adopt rTMS. In three studies, we sought to (1) assess and (2) improve public perceptions of rTMS as a treatment for depression.

Methods: In Study 1 (N = 107), we administered questionnaires on Amazon's Mechanical Turk (MTurk) to individuals from the US and Canada in a cross-sectional design to assess perceptions of rTMS compared to psychopharmacology, electroconvulsive therapy (ECT), and talk therapy. In Study 2 (N = 106), we again used an MTurk sample and a cross-sectional design to assess perceptions of rTMS after providing participants with a relatively long description of rTMS. In Study 3 (N = 308), we conducted an experiment in undergraduate students. Participants were randomized to one of four experimental conditions manipulating participants' understanding of the causal mechanisms of depression prior to assessing their perceptions of rTMS.

Results: Public perceptions of rTMS were more negative than pharmacotherapy and talk therapy but not ECT (Study 1). rTMS perceptions were notably better when participants were given thorough information about rTMS procedures, pain, and side-effects (Study 2), compared to the previous study when they were given a very brief description of rTMS. Finally, perceptions of rTMS were significantly better when participants were given a brain circuitry-based causal explanation of depression compared to when they were given a psychological explanation of the causes of depression (Study 3).

Conclusions: Public perceptions of rTMS are relatively poor. To improve rTMS acceptability, practitioners should carefully consider patients' prior attitudes and beliefs when explaining rTMS as a treatment alternative. Given that beliefs can have powerful effects on treatment outcome (e.g., placebo, nocebo), future research should explore whether rTMS effects on depression can be improved by facilitating less negative perceptions of rTMS.

Keywords: Beliefs; Depression; Mental health literacy; Neurostimulation; Public perception; Repetitive transcranial magnetic stimulation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Depressive Disorder, Major* / therapy
Electroconvulsive Therapy* / methods
Health Literacy*
Humans
Transcranial Magnetic Stimulation / methods
Treatment Outcome