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Same same, but different: effects of likelihood framing on concerns about a medical disease in patients with somatoform disorders, major depression, and healthy people

Published online by Cambridge University Press:  13 June 2023

Tobias Kube Open the ORCID record for Tobias Kube [Opens in a new window] ,
Jenny Riecke ,
Jens Heider ,
Julia A. Glombiewski ,
Winfried Rief  and
Arthur J. Barsky
Tobias Kube*
Affiliation:
Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02115, Boston, MA, USA RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
Jenny Riecke
Affiliation:
Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
Jens Heider
Affiliation:
RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany Schön Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
Julia A. Glombiewski
Affiliation:
RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
Winfried Rief
Affiliation:
Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
Arthur J. Barsky
Affiliation:
Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02115, Boston, MA, USA Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA 02115, USA
*
Corresponding author: Tobias Kube; Email: kube@uni-landau.de
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Abstract

Background

Research has shown that patients with somatoform disorders (SFD) have difficulty using medical reassurance (i.e. normal results from diagnostic testing) to revise concerns about being seriously ill. In this brief report, we investigated whether deficits in adequately interpreting the likelihood of a medical disease may contribute to this difficulty, and whether patients’ concerns are altered by different likelihood framings.

Methods

Patients with SFD (N = 60), patients with major depression (N = 32), and healthy volunteers (N = 37) were presented with varying likelihoods for the presence of a serious medical disease and were asked how concerned they are about it. The likelihood itself was varied, as was the format in which it was presented (i.e. negative framing focusing on the presence of a disease v. positive framing emphasizing its absence; use of natural frequencies v. percentages).

Results

Patients with SFD reported significantly more concern than depressed patients and healthy people in response to low likelihoods (i.e. 1: 100 000 to 1:10), while the groups were similarly concerned for likelihoods ⩾1:5. Across samples, the same mathematical likelihood caused significantly different levels of concern depending on how it was framed, with the lowest degree of concern for a positive framing approach and higher concern for natural frequencies (e.g. 1:100) than for percentages (e.g. 1%).

Conclusions

The results suggest a specific deficit of patients with SFD in interpreting low likelihoods for the presence of a medical disease. Positive framing approaches and the use of percentages rather than natural frequencies can lower the degree of concern.

Keywords

Health communicationmedical reassurancerisk perceptionsomatic symptom disordersomatoform disorder
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 16 , December 2023 , pp. 7729 - 7734
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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