Implications of psychological reactance for clinical practice in psychiatry including a systematic review

Abstract

Psychiatric treatments can beperceivedasathreat orrestriction ofpatients’ autonomy, especiallywhenpatients feel coerced into treatment or have limited say in treatment decisions. This article explores the relevance of psychological reactance in clinical psychiatric practice. The first section explains that this concept was developed in the psychological literature. The second section explains that the psychiatric literature is not open toward receiving new psychological concepts but typically uses the biomedical and biopsychosocial models. Advances in clinical psychology such as psychological reactance have, unfortunately, had limited impact on the practice of clinical psychiatry. The third section systematically reviews the limited number of articles on psychological reactance published in psychiatric journals. Only 22 articles were found, including 15 cross-sectional studies and 15 articles on medication adherence. That the concept of psychological reactance is not used by psychiatrists does not mean some concepts used in psychiatric literature do not overlap and are closely related. These concepts are reviewedin the fourth section.The fifth section proposesthat using a model of psychological reactance can reduce harms and increase benefits when interacting with psychiatric patients. The sixth section uses the literature to provide tips on practical interventions in how psychological reactance can be used for clinical practice in psychiatry. The article concludes that the understanding and application of psychological reactance is essential to providing effective and appropriate mental health care, and that further research is needed to explore the implications of psychological reactance in clinical psychiatric practice