Identifying Barriers and Solutions to Psychotherapy in Adults with Depression

Research has suggested that adults with depression face a variety of intrinsic and extrinsic barriers to psychotherapy, which results in low initiation rates for psychotherapy. These barriers have been characterized in some detail, but to our knowledge, there has been no previous examination of how adults with depression initiate psychotherapy after first encountering barriers. The primary goals of this study were to assess barriers to psychotherapy endorsed by adults with depression currently receiving psychotherapy and to design and implement a new questionnaire (Overcoming Barriers to Psychotherapy) to examine what solutions adults with depression perceive as helpful in overcoming barriers to initiating psychotherapy. This study also aimed to evaluate the respective impacts of 1) demographic variables (race, ethnicity, income), 2) depression symptom severity, and 3) psychosocial functioning on endorsement of intrinsic and extrinsic barriers. An online survey was administered to examine sociodemographic information, depression symptom severity, psychosocial functioning, barriers to psychotherapy, and solutions to barriers in 132 adults with depression currently receiving psychotherapy recruited from a variety of outpatient settings across the Dallas-Fort Worth metroplex. Results revealed that a higher percentage of extrinsic relative to intrinsic solutions were endorsed for intrinsic barriers, and a higher percentage of intrinsic relative to extrinsic solutions were endorsed for extrinsic barriers. Results indicated that barriers to psychotherapy are more frequently resolved by solutions of different types (e.g., intrinsic barriers resolved by extrinsic solutions). Resolution of barriers to psychotherapy may require adults with depression to rely on solutions that enable them to work around the core difficulty posed by barriers. Both depression symptom severity and psychosocial impairment were associated with overall higher endorsement of intrinsic and extrinsic barriers. A lack of racial and ethnic diversity in the recruited sample prevented examination of the impact of race and ethnicity on endorsement of extrinsic barriers. Future research is warranted to establish psychometrics of the novel study measure to assess solutions to barriers to psychotherapy, and to administer the measure in a more racially and ethnically diverse sample. The solutions to barriers to psychotherapy discussed in this study may help adults with depression to overcome barriers and initiate psychotherapy.