The rational patient and beyond: Implications for treatment adherence in people with psychiatric disabilities

Patrick W. Corrigan*, Nicolas Rüsch, Dror Ben-Zeev, Tamara Sher

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objective: Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a "rational patient"; namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. Design: The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Results: Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person's health decisions. Conclusion: Old models of rational decision making need to be supplanted by multiprocess models that explain supradeliberative factors in health decisions and behaviors.

Original languageEnglish (US)
Pages (from-to)85-98
Number of pages14
JournalRehabilitation Psychology
Volume59
Issue number1
DOIs
StatePublished - Feb 2014

Keywords

  • Cold cognitions
  • Health decision making
  • Implicit attitudes

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Psychology
  • Psychiatry and Mental health

Fingerprint

Dive into the research topics of 'The rational patient and beyond: Implications for treatment adherence in people with psychiatric disabilities'. Together they form a unique fingerprint.

Cite this