Are Patients More Compliant with Talk Therapy than Medicine?

Patients were more likely to reject mental health treatment involving drugs than treatment that involved talk therapy, according to a recent analysis of 186 studies involving patients who sought help for mental health issues.

The studies involved patients who received treatment recommendations for either drug-only therapy, talk therapy only (also known as psychotherapy) or a combination of both treatment approaches. In their review, researchers found 57 percent of the studies included a component that reported patients refusing treatment, while 182 out of 186 of the studies had a component that reported whether patients ended treatment prematurely.

They discovered patients recommended drug-only therapy were twice as likely to refuse treatment compared to those who were recommended only talk therapy, especially if they had a depressive disorder, panic disorder or social anxiety disorder. Those who were recommended drug-only treatment also were more likely to end treatment prematurely.

Across the 186 studies, the treatment refusal rate was 8.2 percent, but patients recommended drug-only treatment were 1.76 times more likely to refuse treatment than those offered only talk therapy, a form of therapy that teaches patients how to cope with their feelings, understand their illness, identify triggers and establish a stable routine and an effective plan for coping with challenges so they feel empowered to change their behavior patterns. Patients recommended drug-only treatment also were 1.2 times more likely to stop treatment, even with an average premature termination rate of 21.9 percent across all the studies. Interestingly, researchers didn’t find any significant differences in refusal or premature treatment termination rates between drug-only patients and those who were recommended combination treatment. The same pattern held true for talk therapy-only patients and combination treatments.

Why Talk Therapy?

The study’s researchers say these findings are interesting because the pendulum for mental health treatment has been shifting toward drug therapy rather than talk therapy, as more patients seek this type of treatment.

However, talk therapy has produced positive treatment outcomes with minimal side effects, so some experts argue this approach should be recommended first rather than medication.

“Our findings support that argument, showing that clients are more likely to be willing to start and continue psychotherapy than pharmacotherapy,” said the study’s co-author, Dr. Roger Greenberg. It’s unclear why patients apparently prefer talk therapy to drug therapy for mental health treatment (the studies didn’t detail the underlying reasons for patients’ refusal), but researchers think it may be that patients realize their challenges are more complex than simply biological problems that can be temporarily addressed with medication. Instead, they might want to talk to someone who can teach them long-term coping strategies and give them the skills they need to deal with or overcome mental health issues.

Researchers say the next step for future research should be to identify why patients refuse drug-only therapy when recommended. Delving further into this research area may allow us to help patients successfully begin and complete mental health treatment.