It was just another Saturday game in the church league, although it was the two best teams in the league and I was up against a guy who is really a lot bigger than I am. I think this guy must be about two hundred and forty pounds and he is not fat at all. He is about six foot five and built like an NFL linebacker, so I really had my hands full. At the end of the day I had to start looking for a chiropractor in phoenix. I do not know exactly when it happened, but me and this guy were basically in full on combat. At the end of the game we had a good lead, because both of our scorers were really hot. I had to call time out and just lay down on the sidelines by the bench. This was not good for us, since we did not have anyone else who could fight a guy that size and they almost caught up at the end. Continue reading “I Got Hurt Playing Ball”
My back has bothered me for years. I have lower back pain, but my upper back is where the big trouble is at. Over the years, I have slouched forward to compensate for the discomfort. This has caused more discomfort. I have told doctors that my digestion is messed up when my back hurts, and it gets better when it does not hurt. I told a Doctor of Osteopathy (DO), that is the same as an MD, they just have some extra training, about my digestion and shoulder pain. He told me to go ahead and try a Cumming chiropractor, because his, the DO’s, training indicates that digestion and that pain at the the area of my scapula were associated. So, he was not surprised that when my back acted up that my digestion was messed up.
The chiropractor told me that my posture was awful. Both him and my regular doctor told me that my posture was going to end up causing me a lot of trouble later on. It already was causing me trouble. Continue reading “Getting My Posture Fixed Has Fixed My Back Problems”
I had to find out if there was a San Francisco chiropractor who would be just as good as the one I had used for years back in my hometown. I had chronic back issues, and the only thing that really kept them at bay is the guy that I saw regularly in the city where I had lived for many years. Without him, I think that I would have needed to go on long-term disability long ago. He saw to it that I was able to continue to function well in life like anyone else. I ended up moving to San Fracisco because both of my senior parents lived there, and they needed someone close by to check on them regularly.
Moving to California was a big deal for me as someone who lived in sort of a rugged and mountainous type of small town for many years. I had just retired when my parents began talking to me about moving out to where they were. Continue reading “I Needed to Find Someone Who Would Help My Back Problems”
Whenever talking about healthy habits, I think we would imagine exhausting activity, bad food, and so forth. Whereas a healthier lifestyle does not mean to suffer. It’s just that there are some changes you can do.
You should know, just a little change is already able to provide a better life balance. Especially if you regularly do.
Here, there are six healthy habits that you can do in just five minutes:
1. Fruit for breakfast
Some people argued not have time for breakfast. They prefer to drink coffee, donuts or go long on an empty stomach.
Unfortunately, it was not enough. The drink was most lasted less than half an hour. So you will starve and feel dizzy. The only solution is the fruit breakfast.
The fruit is rich in nutrients, vitamins and fiber that can meet your nutritional needs in the morning. Choose fruits such as apples, pears, grapes every morning.
2. Think positive
When we wake up in the morning, make sure the first thing you do is think positive. At least, grateful for the life that you will live will build a positive mood to move.
Sit in a chair and do some stretching pose. Starting from the rotating head slowly, then rotate shoulders forward and backward. After that you can also rotate the ankle until you feel relaxed.
4. Make yourself happy
You can buy something that makes you happy, such as books, clothes or just listening to music. Buy also ice cream or coffee at a favorite place.
One healthy habits that can be practiced are truthful. In addition to building a positive energy honestly can also be an impact on mental health.
6. Warm bath
Did you know, a warm bath can eliminate toxins, stretch the muscles and blood circulation after activity
a day. So, from now on, let’s make healthy habits.
The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.
Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.
This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.
As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.
The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.
To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums
There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.
The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.
I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.
Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.
COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?
There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.
The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.
But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.
When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.
It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.
It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit.
I investigated the web site http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.
Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.
If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.
It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.
For additional sections of this article, please see http://www.michaelguth.com/?p=743
Have you seen the most recent adoption of kombucha in the past few months. Its getting a lot of momentum from the general public, especially when celebrities like Barbara Streisand, and Halle Berry, are seen toting a bottle of kombucha while they’re on a shopping spree in New York, Dubai or Las Vegas.
Kombucha wasnt always popular like it is these days. Sure, its now becoming the sensational thing to chug to be cool, but there was an era, before it was produced by big names and stocked at your local health food store. There never were 8 different brands and brews to choose from. I recently counted 10 different versions at my neighborhood Whole Foods.
Of all these kombucha drinks, I have to say that my favorite, store-bought brand, is by far the GTCs Synergy batch. Their GingerBerry is to live for! Ive tasted almost every version on the market, or at least every kind Ive ever seen. Additionally, Im a fan of ginger ale of any variety, except the Schweppes brand. That junk is nothing more than cola in my professional opinion. Give me a real-deal ginger brew anytime! That being said, you simply must experience the GingerBerry from GTC.
When my Mother started making and enjoying her own kombucha, it was in the late 70s and she has had the same culture the entire time. Several years later, when I was just a child, it seemed bazaar and sometimes humiliating to have my peers see a gallon jar standing in the kitchen. It looked like a science class. That large, gallon jar fermenting a dark juice.
As a youngster, Ive even mistaken kombucha for cold ice tea in the fridge as she always kept her kombucha tea in a fancy glass pouring-pitcher. As a 13 year-old, after working up a sweat, playing in the neighborhood, Id head inside with a peer needing to be re-hydrated. Reaching a few huge chugs of kombucha tea when your mouth were expecting iced tea can really catch you off guard.
Now I should tell you that my house never, ever stocked Gatorade or Sprite, etc. Rather, on demand, we stocked plenty of orange juice from concentrate, always mixed, and the other option was H2O, unsweetened tea or kombucha.
Cool people drink it because its yummy. And so do you. While famous people make a lot of dough and can easily afford the $4 per bottle that it costs here in Seattle. Me, Id prefer to make it in my home in small batches, for a mere fraction of the cost. And for a newby, there are endless websites that distribute free instructions for brewing this truly amazing tonic.
Most of us average people sip on kombucha for its health advantages. The list of healthy stories is extremely long and includes things like aiding digestion, increasing immune system response, strengthening the bodys blood system, reversing depression, spiking mental awareness, and the list is ongoing. I prefer to drink it for the clarity of thought it provides for me. Ive even replaced my morning cup of coffee with a travel-mug of chilled, semi-sweetened kombucha tea.
If you prefer feeling great, I suggest trying this wonder drink. Afterall, it cant hurt. But remember that if you suffer from life threatening illness, you should always talk to a health care provider. And let him or her know that youre drinking kombucha. Find out what he or she say about it.
So, dont forget that you need not be a heart-throb with mega-money to thoroughly enjoy kombucha. All you need are some simple supplies, a fair amount of desire, and a scoby. You also can maintain a limitless stock of kombucha tea. Here is a breakdown of exactly what youll need to drink like a star.
Stainless steel, glass or lead-free ceramic pot (such as Corningware) to boil water
Glass jar to accommodate the amount of Kombucha you want to make
Metal or wood long handled spoon for stirring
Porous cloth, paper towel or paper coffee filter
Melbourne physiotherapy may be needed during many stages of a persons life; following an illness, accident or period of trauma for example. Physiotherapy helps to restore movement and ability as well as ease pain when a person has been affected by an illness, injury or disability. Physiotherapy Melbourne is a degree-based healthcare profession, where a therapist’s skills and knowledge are used to improve a wide range of conditions that are associated with many different parts of the body. In addition to the common musculoskeletal problems, physiotherapists are trained in many other areas such as:
?Neurology (including stroke)
What our physiotherapists do
On your initial visit, our physiotherapists will make an assessment of your condition and look into the best and most appropriate ways to help your condition. This may mean exploring different treatments, such as:
?Movement and exercise
?Manual therapy techniques
A podiatrist Melbourne can help you with common foot problems, which could include anything from bunions and ingrown toenails to athletes foot or excessive foot odour. A podiatrist will provide you with expert advice on how to manage your condition as well as treating day-to-day foot problems including:
?Dry or cracked heels
?Corns and calluses
What our podiatrists do
During your first consultation our podiatrists will make an assessment and diagnoses of any foot condition, as well as providing instant treatment for things such as long or ingrown toenails, hard skin, corns or verrucas. Very often, minor problems that are noted immediately can be dealt with immediately and without there being any pain. If referrals are needed then due to Era Health having a wide network of specialists in place for more complex needs, referrals can be made on the spot.
A psychologist Melbourne can help with mental conditions, upset, trauma or illnesses by finding the route of the cause and using different methods to try and ease or cope with the ailment. Often thought of as counseling, psychotherapy is a much more in-depth form of therapy and can be used to address a much wider range of problems. If you are suffering with any of the following conditions, then booking an appointment to see one of our psychologists could be highly beneficial to your well-being:
?Obsessive compulsive disorder
?Post-traumatic stress disorder
Due to the sheer amount of sun we are exposed to in this country, skin cancer is a highly common condition here. More than 80% of cancer diagnoses per year in Australia are skin cancer and a staggering one in two Australians have the condition at one time during their life. If you have noticed any changes to your skin, such as discolouration, mole growths or itchiness and discomfort then by attending our skin cancer clinic Melbourne we can put your mind at rest.
After an examination you will receive your results in the shortest possible time, with the correct treatment starting as soon as possible – which is key to a successful outcome.
Heart disease is the number killer in America; the good news is, however, that this disease can be prevented. Research and studies have shown that with the correct measures and steps taken; this disease can actually be avoided throughout an individuals life. The following is a series of tips to prevent heart disease.
Firstly, comprehend the undeniable fact that you are what you eat! This disease is mostly cause by excessive fats in your body which clogs the blood flow in your arteries. Therefore, one of the most important tips would be to consume a healthy diet. Eat foods which are low in saturated fats while increasing your fruit, vegetables and whole grains intake. Try to not visit fast food outlets that often as fast foods usually boasts an excessive amount of fat, remind yourself how much unneeded saturated fat you are taking in the next time you gulp down a extra large cheese burger.
Furthermore, individuals with high levels of stress may lead to heart ailment. This is due to the drastic rise in blood cholesterol and blood pressure when you are stressed out. So, try not to fly into a temper and always be laid back, relax and of course, smile often.
Going on, out of the handy tips to prevent heart disease, it is particularly obvious that smoking should not even be included in any of your daily activities. If you have this awful habit, quit! Seek professional help if you are having problems in quitting. Plus, exercise at a regular basis to prevent heart problem. Exercising helps you avoid the disease and at the same time burns the excess fat in your body, thus preventing obesity altogether.
As a conclusion, practice a healthy lifestyle. Instill the tips mentioned above in your daily life for both you and your hearts sake.
Until the last 25 years of the 20th century asbestos was heavily used in many different construction techniques. This mineral was a fantastic way to insulate, prevent fires, and overall help the building remain weather and fire proof. The unfortunate downside is that asbestos is a known human carcinogen. Prolonged exposure to this mineral leads to lung cancer, asbestosis, and mesothelioma. Here is how that works.
What is Prolonged Exposure?
If you live in a house built before about 1975, then you likely have some asbestos in the house. You may have asbestos siding, or asbestos built into the popcorn ceiling, or if you look around in the attic, you likely have asbestos up there too. The good news is that this asbestos isn’t going to hurt you. Unless you disturb the material it remains inert. And even if you spend a little bit of time, with minimal precautions, removing the material, there is little chance that you will have enough exposure to cause lasting damage.
Prolonged exposure means you are exposed day after day, for years on end, to the material. It looks like this: you go into work at a factory or manufacturing plant. In this plant there are areas that have furnaces and boilers, so the company has used asbestos to insulate. Unfortunately things get dirty, so you, or someone else, are always busy scrubbing, brushing, and wiping away at the surfaces. This disturbs the asbestos fibers which become airborne. Day after day you inhale small amounts of these particles causing long-term damage to your lungs.
How Asbestos Leads to Cancer or Asbestosis
Asbestos fibers look almost like little chards of fiberglass. They are jagged and when they go into the lungs they lodge into the linings. Once in place the body naturally tries to get rid of them. However, there is way to dislodge them, so the area becomes inflamed and irritated. This is the perfect environment for cancer to start growing. Lung cancer is common, asbestosis (simply defined as scarring of the lung tissue) easily occurs, and mesothelioma can occur. In fact, if you have been diagnosed with mesothelioma, the only way to contract that disease is through asbestos exposure.
You Can Get Help
The unfortunate downside is that the disease cannot be cured. The good side is that modern medicine has come a long way, and with mesothelioma treatment you can be kept comfortable. If you are suffering from asbestosis, lung cancer, or mesothelioma, you can file an asbestos lawsuit and collect compensation for medical expenses and other damages. You simply need to contact an asbestos attorney to get things started.
Health care costs are slowly rising over the last few years, making it difficult to pay out of your pocket for medical treatments. In the event of a medical emergency, if you are unable to pay for the medical treatment, you may even risk the health of the individuals. This in turn can affect the family. However in order to protect yourself and your family, you can apply for a health cover. To get the best health insurance, here are few tips to help you get started.
Individual Cover versus Family Cover
While applying for a health cover, you can either apply for an independent cover or you can apply for an overall family cover. A family cover is much more financially suitable as compared to the individual cover. That is because the overall amount for each individual cover is much more expensive than a cover for the whole family. For example, the premium will be considerably cheaper for the overall insurance as compared to each individual. It is highly unlikely that all the members in your family will be hospitalized at the same time, thereby making it financially easier on your pockets. For the best health insurance plans, you can always apply for a family cover immediately after marriage as it can also include maternity cover.
Insurance Cover Provided By Employment
Getting an insurance cover from your company, will definitely be less stressful for you as well as keep you financially flexible. However, while this can work well in the short term sense for long terms plan this can be a mistake. With a cover provided by the employment, you have an advantage when it comes to factor of pre existing diseases. The waiting period for a pre-existing diseases cover is taken care of by the group cover. However,if you lose your job or even switch to another company, there is a high possibility that your insurance will be invalid. Moreover, if you want to apply for another cover, it can be activated only after a certain period of days. If during this time, a medical event arises, you will be required to pay out of your own pocket. However, if you still want to opt for a cover plan by your employee, you can opt for a top up plan to supplement the existing cover for the best health insurance plan. Through this process it will allow you to pay a smaller premium as compared to the overall one.
Check For Inclusions And Exclusions
When applying for a health insurance, always look through the fine print for the inclusions and exclusions. Most covers allow you to claim health insurance for any medical treatment, but only for a certain amount. In other words, you can claim only a limited amount in certain prescribed medical treatments. This can be tedious if the initial medical treatment cost goes well beyond the expected value. These limitations can affect your claim, even if you insured for the particular treatment. Always weigh your options before you apply for the cover.
The process of change in psychotherapy, regardless of the clinician’s orientation, length of treatment, or outcome measure, begins with this: The client must attend a first session. However, several national surveys in the past decade converge on a rate of approximately one-third of individuals diagnosed with a mental disorder receiving any professional treatment (Alegra, Bijl, Lin, Walters, & Kessler, 2000; Andrews, Issakidis, & Carter, 2001; Wang et al., 2005). A review of the literature surrounding mental health utilization reveals evidence that a complex array of psychological, social, and demographic factors influence a distressed individual’s arrival to a mental health clinic. Thus, developing effective strategies for decreasing barriers to care is a critical task for clinicians and administrators. The
aim of this article was to review current research focused on appropriate utilization of mental health services and to use the Health Belief Model (HBM; Becker, 1974) as a parsimonious model for conceptualizing the current knowledge base, as well as predicting and suggesting future research and implementation strategies in the field.
First, it is important to address whether increasing mental health service use is an appropriate public health goal. A World Health Organization (WHO) survey comparing individuals with severe, moderate, or mild disorder symptoms indicated that approximately half of those surveyed went untreated in the past year (WHO World Mental Health Survey Consortium, 2004), with even less treatment among those with more severe symptoms. Many costs are associated with untreated mental disorders, including overuse of primary care services for a variety of reasons (Katon, 2003; White et al., 2008), lost productivity for businesses and lost wages for employees (Adler et al., 2006), as well as the negative impact of mental disorders on medical disorders, such as diabetes and hypertension (Katon & Ciechanowski, 2002). These com
bined expenses have been calculated to rival some of the most common and costly physical disorders, such as heart disease, hypertension, and diabetes (Druss, Rosenheck, & Sledge, 2000; Katon et al., 2008).
The consequences of providing additional services to address unmet need may vary by the cost-effectiveness of treatment, availability of providers, and the interaction of mental health symptoms with other illnesses. Medical cost offset and cost-effectiveness research address these questions (for further review, see Blount et al., 2007; Hunsley, 2003). Medical cost offset refers to the estimation of cost savings produced by reduced use of services for primary care as a result of providing psychological services. Reduced medical expenses could occur for several reasons: increased adherence to lifestyle recommendation changes such as diet, exercise, smoking, or taking medications; improved psychological and physical health; and reduction in unnecessary medical visits which serve a secondary purpose (e.g
., making appointments to fill social needs; Hunsley, 2003). In comparison with the indirect costs to society, the individual, and the health care system, costs for providing mental health treatment are quite low (Blount et al., 2007).
However, debate continues regarding how to facilitate mental health care utilization. Identification of mental health need through primary care screening for depression is one research area that highlights the complexity of this issue. Palmer and Coyne (2003) point out several important issues in developing a strategy for addressing this goal: First, several studies suggest that identification of depression in primary care is not enough, as outcomes for depression are similar in primary care patients who have detected depression and those who have not (e.g., Coyne, Klinkman, Gallo, & Schwenk, 1997; Williams et al., 1999). This is supported by research indicating a large gap between the number of individuals who are identified through screening and referred to care, and those who actually receive care (Flynn, O’Mahen, Massey, & Marcus, 2006). Second, it is critical to evaluate attempts to increase utilization, rather than to assume they will be successful, cost-effective, and targeting the appropriate individuals. Therefore, a theoretical framework that addresses both psychological and practical factors associated with treatment utilization will be a beneficial addition to this literature.
Little systematic research has been conducted on the specific topic of psychological factors related to seeking mental health services. However, extensive work has been conducted within two broad, related areas of research: help-seeking behavior and health psychology. Many models have been proposed to explain help-seeking and health-protecting behaviors, none of which has been accepted as wholly superior to the rest. The HBM (Becker, 1974; Janz & Becker, 1984; Rosenstock, 1966) is one of several commonly used social-cognitive theories of health behavior. This model will be reviewed, followed by a brief discussion of several other models. A discussion of the strengths of the HBM and its applicability to mental health treatment utilization research will follow.
Health Belief Model
The HBM (Rosenstock, 1966, 1974), based in a socio-cognitive perspective, was originally developed in the 1950s by social psychologists to explain the failure of some individuals to use preventative health behaviors for early detection of diseases, patient response to symptoms, and medical compliance (Janz & Becker, 1984 ; Kirscht, 1972; Rosenstock, 1974). The theory hypothesizes that people are likely to engage in a given health-related behavior to the extent that they (a) perceive that they could contract the illness or be susceptible to the problem (perceived susceptibility); (b) believe that the problem has serious consequences or will interfere with their daily functioning (perceived severity); (c) believe that the intervention or preventative action will be effective in reducing symptoms (perceived benefits); and (d) perceive few barriers to taking action (perceived barriers). All four variables are thought to be influenced by demographic variables such as race, age, and socioeconomic status. A fifth original factor, cues to action, is frequently neglected in studies of the HBM, but nevertheless provides an important social factor related to mental health care utilization. Cues to action are incidents serving as a reminder of the severity or threat of an illness. These may include personal experiences of symptoms, such as noticing the changing shape of a mole that triggers an individual to consider his or her risk of skin cancer, or external cues, such as a conversation initiated by a physician about smoking cessation. In addition, Rosenstock, Strecher, and Becker (1988) added components of social cognitive theory (Ba ndura, 1977a, 1977b) to the HBM. They proposed that one’s expectation about the ability to influence outcomes (self-efficacy) is an important component in understanding health behavior outcomes. Thus, believing one is capable of quitting smoking (efficacy expectation) is as crucial in determining whether the person will actually quit as knowing the individual’s perceived susceptibility, severity, benefits, and barriers.
Other health care utilization theories
Other models for health care utilization have been proposed and used as a guide for research. In general, these theories pull from a number of learning theories (e.g., Bandura, 1977a, 1977b; Lewin, 1936; Watson, 1925). Two such models, the Theory of Planned Behavior (TPB; Ajzen, 1991) and the Self-Regulation Model (SRM; Leventhal, Nerenz, & Steele, 1984), share many commonalities with the HBM. Ajzen’s TPB proposes that intentions to engage in a behavior predict an individual’s likelihood of actually engaging in the given behavior. Ajzen hypothesizes that intentions are influenced by attitudes toward the usefulness of engaging in a behavior, perceived expectations of important others such as family or friends, and perceived ability to engage in the behavior if desired (Ajzen, 1991). This theory has been applied to a variety of health behaviors and has receiv
ed support for its utility in predicting health behaviors (Ajzen, 1991; Armitage & Conner, 2001; Godin & Kok, 1996). However, its relevance in predicting mental health care utilization has received relatively little attention (for two exceptions, see Angermeyer, Matschinger, & Riedel-Heller, 1999; Skogstad, Deane, & Spicer, 2006). Similarly, the SRM (Leventhal et al., 1984) focuses on an individual’s personal representation of his or her illness as a predictor of mental health treatment use. The SRM proposes that individuals’ representation of their illness is comprised of how the individual labels the symptoms he or she is experiencing, the perceived consequences and causes of the symptoms for the individual, the expected time in which the individual would expect to be relieved of symptoms, and the perceived control or cure of the illness (Lau & Hartman, 1983).
The HBM, TPB, and SRM are well-estab
lished socio-cognitive models with similar strengths and weaknesses. The models assume a rational decision-making process in determining behavior, which has been criticized for not addressing the emotional components of some health behaviors, such as using condoms or seeking psychotherapy (Sheeran & Abraham, 1994). There is substantial overlap in the constructs of these three models. For example, an individual’s perception of the normative beliefs of others can be seen more generally as a benefit of treatment (e.g., if I seek treatment my friends will support my decision) or as a barrier (e.g., my family will think I am crazy if they know I am seeking professional help). The SRM lacks a full description of the benefit and barrier aspects of decision making identified in the HBM. However, the illness perceptions about timeline, identity, and consequences do provide a more complete conceptualization of aspects of perceived severity, and in this way the SRM can inform the HBM with these factors.
Andersen’s Sociobehavioral Model (Andersen, 1995) and Pescosolido’s Network Episode Model (Pescosolido, 1992; Pescosolido, Brooks Gardner, & Lubell, 1998) emphasize the role of the health care and social network system in influencing patterns of health care use, while Cramer’s (1999) Help Seeking Model highlights the role of self-concealment and social support in decisions to seek counseling. In particular, the Network Episode Model hypothesizes that clear, independent choice is only one of seve
ral ways that clients enter treatment, along with coercion and passive, indirect pathways to care. According to Cramer’s model, individuals who habitually conceal personally distressing information tend to have lower social support, higher personal distress, and more negative attitudes toward seeking psychological help. Thus, according to this model, self-concealment creates high distress, which pushes an individual toward seeking treatment, but also creates negative attitudes toward treatment, pushing an individual away from treatment. The HBM includes system-level benefits and barriers to utilization, but these three models more fully emphasize the social-emotional context of decision making.
Critiques and limitations of the HBM
The HBM has received some criticism regarding its utility for predicting health behaviors. Ogden (2003), in a review of articles from 1997 to 2001 using social cognition models, questions whether the theory is disconfirmable. She found that two-thirds of the studies reviewed found one or more variables within the model to b
e insignificant, and explained variance accounted for by the model ranged from 1% to 65% when predicting actual behavior. Yet, Ogden writes, rather than rejecting the model, the majority of authors offer alternative explanations for their weak findings and claim that the theory is supported. While authors’ conclusions about their findings may be overstated in many cases, some explanations of insignificant findings are valid limitations of the model. For example, some (e.g., Castle, Skinner, & Hampson, 1999) point out that construct operationalization could be improved for the particular health behavior being studied. However, insignificant results should not be explained away without considering alternative models as well. Certainly, the HBM has received strong support in predicting some health behaviors (Aiken, West, Woodward, & Reno, 1994; Gillibrand & Stevenson, 2006), but questions remain as to its ability to predict all preventative health situations. The usefulnes
s of the HBM in predicting mental health utilization has not adequately been tested to our knowledge.
The HBM may be limited further by its ability to predict more long-term health-related behaviors. For example, from an early review of preventive health behavior models including the HBM by Kirscht (1983), we can anticipate that the factors associated with initiating treatment, as discussed here, may differ from the factors that predict mental health treatment adherence and engagement. Thus, these outcomesattending one therapy appointment versus completing a full course of psychotherapy treatmentshould be clearly distinguished from each other.
Strengths of the HBM
Researchers have not explicitly investigated mental health utilization patterns using the HBM framework; however, much of the
existing literature can be conceptualized as dimensions of severity, benefits, and barriers, indicating that the model may be a useful framework for guiding research in this area. For example, cultural researchers often examine barriers to treatment and perceived severity of symptoms and benefits of treatment in various ethnic populations (e.g., Constantine, Myers, Kindaichi, & Moore, 2004; Zhang, Snowden, & Sue, 1998). In general, the focus of these studies has been to examine cultural differences in beliefs about symptom causes (Chadda, Agarwal, Singh, & Raheja, 2001), changing perceptions of mental health stigma among various ethnic groups (Schnittker, Freese, & Powell, 2000), and cultural mistrust or perceived cultural insensitivity of mental health providers as a barrier to effective treatment (Poston, Craine, & Atkinson, 1991). These studies lay the groundwork for using the HBM as a framework for understanding mental health care utilization for all populations.
Parsimonious and Clear
The model’s use of benefits and barriers opposing each other provides a dynamic representation of the decision-making process. In this “common sense” presentation, the impact of each positive aspect is considered in the context of the
negative aspects. The model in this way provides a parsimonious explanation of a variety of constructs within one clear framework.
Useful and Applicable
One strength of focusing on attitudes and perceptions related to treatment seeking is the clinical utility of such models. By identifying attitudes that may inhibit appropriate help seeking, psychologists can then use research findings to develop interventions for addressing maladaptive attitudes or inaccurate beliefs about mental health and its treatment. Therefore, socio-cognitive theory provides a useful focus for research that ultimately may result in programmatic changes to benefit clients. Once developed, perception-change interventions can be evaluated through changes in observed treatment utilization.
Within the HBM framework, three general approaches can be used to increase appropriate utilization: increasing perceptions of individual susceptibility to illness and severity of symptoms, decreasing the psychological or physical barriers to treatment, or increasing the perceived benefits of treatment. The following discussion will highlight how each perception can be increased or decreased, and the implic
ations for such intensification of the perceptions. Examples of intervention strategies that can serve as individual or system-level “cues to action” will be reviewed within each domain of the model. In addition, where appropriate, the discussions will highlight how sociodemographic factors such as age, sex, and ethnicity impact the perceived threat from the disorder and the expectations for the benefits of therapy. The model we discuss assumes that the individual seeking therapy is autonomous in this decision making. That is, it is not directly applicable to those who are required to seek therapy by the judicial system, a spouse, or their place of employment, nor does it address children’s mental health care utilization. We will address some of these issues briefly later in our discussion.
Figure 1 is a visual representation of the model we propose for conceptualizing mental health care utilization using the HBM as a framework. The studies reviewed in each section below were designed primarily without use of the HBM framework. However, the model is a useful heuristic tool to organize and draw in research from a variety of disciplinesmarketing, public health, psychology, medicine, etc.
Sociodemographic variables in the HBM
Several demographic variables consistently predict utilization of mental health services. Despite similar levels of distress, some groups are less likely to seek professional treatment than others, creating a gap between need and actual use of outpatient mental health services. Groups identified as consistently underutilizing services include men, adults aged 65 and older, and ethnic minority groups in the United States (Wang et al., 2005). Within the HBM framework, these demographic variables are hypothesized to influence clients’ perceptions of severity, benefits, and barriers to seeking professional mental health services. Studies exploring the relationship between demographic variables and HBM constructs will be highlighted throughout this article.
Systems approaches to addressing perceived susceptibility and severity
According to the HBM, individuals vary in how vulnerable they believe they are to contracting a disorder (susceptibility). Once diagnosed with the disorder, this dimension of the HBM has been reformulated to include acceptance of the diagnosis (Becker & Maiman, 1980). In addition, increasing an individual’s perception of the severity of his or her symptoms increases the likelihood that he or she will seek treatment. In relation to mental health, perceived susceptibility goes hand in hand with perceived severity (i.e., Do I have the disorder and how bad is it?), and so they will be discussed together. In health-related decisions, the majority of consumers are dependent upon the expertise and referral of the medical professional, usually the trusted general practitioner (Lipscomb, Root, & Shelley, 2004; Thompson, Hunt, & Issakidis, 2004). Unlike decisions about the need for a new vehicle or a firmer mattress, determining whether or not feelings of sadness should be interpreted as normal emotional fluctuation or as indicators of depression is a decision often left to an expert in the area of mental health or a primary care physician. This places a great responsibility on practitioners, psychiatrists, psychologists, and other mental health service providers when discussing the severity of a client’s symptoms and options for treatment.
Ethical Considerations in Increasing Perceived Severity and Symptom Awareness
The American Psychological Association (APA) provides ethical guidelines for clinicians about how to inform the public appropriately about mental health services. According to the 2002 Ethics Code (American Psychological Association, 2002), psychologists are prohibited from soliciting testimonials from current therapy clients for the purpose of advertising, as individuals in such circumstances may be influenced by the therapistclient relationship they experience. Additionally, psychologists are prohibited from soliciting business from those who are not seeking care, whether a current or potential client. This may include a psychologist suggesting treatment services to a person who has just experienced a car accident or handing out business cards to individuals at a funeral home. However, disaster or community outreach services are not prohibited, as these are services to the community. Psychologists are prohibited from making false statements knowingly about their training, credentials, services, and fees, and are also prohibited from making knowingly deceptive or exaggerated statements about the success or scientific evidence for their services. In this way, limits are placed on the influence of practitioners on those in vulnerable situations.
Identification of Symptoms
What, then, does an ethical symptom awareness intervention look like? It would involve clearly differentiating between clinical and nonclinical levels of distress, with an indication of what types of intervention strategies may be most effective for each. For example, in cases of mild symptomatology, individuals may be encouraged to use a stepped care approach beginning with bibliotherapy, psychoeducation, and increases in social support. Also important is the provision of accurate, research-based information regarding symptoms of psychological disorders and treatment options. This may call for challenging our assumptions that psychotherapy is helpful for all psychological distress. Recent studies of grief counseling and postdisaster crisis counseling, for example, suggest there may be an iatrogenic effect of therapy for some individuals (Bonanno & Lilienfeld, 2008). On the other hand, some research indicates that individuals with subclinical levels of distress who receive treatment early may avoid developing more severe pathology (e.g., prodromal psychosis; Killackey & Yung, 2007). In programming for all components of health beliefs, not just severity, the credibility of psychotherapy is dependent upon ethical, appropriate public health statements and service marketing.
Many examples of mental health education campaigns have been discussed in the literature, often focusing simultaneously on increasing awareness of mental illness, destigmatizing individuals with mental illness, and increasing awareness of mental health resources. The Defeat Depression Campaign of the UK was designed with these goals in mind, and results of nationally representative polls before, during, and after the campaign indicated positive changes in public attitude toward depression and recognition of personal experiences of symptoms (Paykel, Tylee, & Wright, 1997). Similarly, more recent national campaigns in Australia have provided some evidence that education increases public accuracy in identifying mental illness (Jorm & Kelly, 2007). National screening day initiatives for depression, substance abuse, and other psychological disorders also aim to increase awareness of illness severity for individuals who may not recognize symptoms as signs of illness warranting treatment.
Approximately 71% (Lipscomb et al., 2004; Thompson et al., 2004) of individuals report looking to their primary care physician for mental health information, treatment, and referrals. However, many physicians lack the appropriate knowledge to identify mental health problems (Hodges, Inch, & Silver, 2001). After examining five decades (19502000) of articles evaluating the adequacy of physician training in detecting, diagnosing, and treating mental health, Hodges et al. (2001) offer several suggestions for improving primary care physicians’ training to effectively identify patients with mental health issues. Beyond learning the diagnostic criteria for the major disorders and providing appropriate medications when needed, however, physicians also need to be aware that they can act as a “cue to action” in the patient seeking psychotherapy. Such cues would alert the patient that his or her symptoms of distress or depression had reached severe levels and that the trusted family physician believes additional treatment is needed.
Influence of Demographic Variables on Perceived Severity
An individual’s personal label of the symptoms and illness are thought to contribute to perceived severity. In a study of four large-scale surveys of psychiatric help seeking, Kessler, Brown, and Broman (1981) found that women more often labeled feelings of distress as emotional problems than men did, a factor thought to help explain the consistent finding that men seek mental health services less often than women even when experiencing similar emotional problems. Similarly, Nykvist, Kjellberg, and Bildt (2002) found that among men and women reporting neck and stomach pains, women were more likely to attribute pains to psychological distress, while men were more likely to indicate no significant cause and little concern regarding the somatic symptoms.
Relatively little research has been conducted regarding how individuals of diverse backgrounds perceive the severity of their mental illness symptoms. However, some evidence suggests that individuals of different ethnic backgrounds appraise the severity of their illness symptoms differently, such that individuals from minority cultures are more influenced by their own culture’s norms about mental illness symptoms than White Americans (Dinges & Cherry, 1995; Okazaki & Kallivayalil, 2002). Cues to action from providers may be more effective if they are framed in a way that is congruent with individuals’ attributions about symptoms. In other cases, education about symptoms, provided in a culturally sensitive manner, may be necessary. This is an area where additional research is needed to determine practice.
Older adults are more likely to seek treatment when they perceive a strong need for treatment (Coulton & Frost, 1982). However, some aspects of aging may influence whether or not older adults perceive ambiguous symptoms as psychological in nature or due to physical ailments. For example, among older adults, particularly those experiencing chronic pain or illness, somatic symptoms of mental illness may be interpreted as symptoms of physical illness or part of a natural aging process, rather than as symptoms of depression or anxiety (Smallbrugge, Pot, Jongenelis, Beekman, & Eefsting, 2005). In this way, some depression symptoms may be overlooked by older individuals and the physicians who see them (Gatz & Smyer, 1992).
Systems approaches to addressing perceived benefits
Even if clients do view their symptoms as warranting attention, they are unlikely to seek treatment if they do not believe they will benefit from professional services. Thus, increasing perceived benefits of treatment is a second approach to increasing appropriate utilization.
Public Perceptions of Psychotherapy
In response to changing health care markets, the 1996 APA Council of Representatives called for the creation of a public education campaign to inform consumers about psychological care, research, services, and the value of psychological interventions (Farberman, 1997). Results of preprogram focus group assessments indicated that participants were frustrated with changes in health care service delivery in the United States and many participants did not know whether their health insurance policy included mental health benefits. Participants indicated that they did not know when it was appropriate to seek professional help, and often cited lack of confidence in mental health outcomes, lack of coverage, and shame associated with help seeking as main reasons for not seeking treatment. Participants reported that the best way to educate the public about the value of psychological services was to show life stories of how they helped real people with real-life issues. Informed by the focus groups and telephone interviews, APA launched a pilot campaign in two states using television, radio, and print advertisements depicting individuals who have benefited from psychotherapy, as well as an 800 telephone number, a consumer brochure, and a consumer information website. During the first six months of the campaign, over 4,000 callers contacted the campaign service bureau for a referral to the state psychological association to request campaign literature, with over 3,000 people visiting the Internet site weekly (Farberman, 1997). In sum, addressing perceived benefits of treatment means answering the question, “What good would it do?” When individuals are made aware of how treatment could improve their daily functioning, they may be more motivated to overcome the perceived barriers to treatment. Especially for individuals who have not previously sought mental health treatment, describing realistic expectations for treatment may be an essential first step in orienting individuals to make informed treatment decisions.
Public Preference for Providers of Care
Many different types of professionals serve as mental health service providers, and individuals’ beliefs about the relative benefit of seeking help from various lay and professional sources likely impact decisions to seek help. Roles have shifted in treatment over time, with the introduction of managed care and the increased role of the PsyD, master’s-level psychologist or counselor, and MSW as treatment providers. Counseling has been considered a primary role of clergy for many decades; however, specificity of counseling training has changed over time, with some clergy receiving specific training as counselors within seminary education. Primary care physicians have been relied upon for treatment through pharmacotherapy with the development of improved medications for depression, anxiety, and attention deficit hyperactivity disorder, among others. While few primary care physicians conduct traditional therapy sessions, many individuals report that they first share mental health concerns with their primary care physician, making this profession an important potential gateway for psychotherapy (Mickus, Colenda, & Hogan, 2000).
Level of distress may also influence where individuals seek help: Consumer Reports’ popular survey of over 4,000 participants found that individuals tend to see a primary care physician for less severe emotional distress and seek a mental health professional for more severe distress (Consumer Reports, 1995), while Jorm, Griffiths, and Christensen (2004) found that individuals with depressive symptoms were most likely to use self-help strategies in mild to moderate levels of severity and to seek professional help at high levels of severity.
Some support has been found for the importance of a match between individuals’ perceptions of the cause of symptoms and the type of treatment they seek. In a German national survey, perceptions of the cause of depression and schizophrenia significantly predicted preferences for professional or lay help. Those who endorsed a biological cause of illness reported they would be more likely to advise an ailing friend to seek help from a psychiatrist, family physician, or psychotherapist, and less likely to advise seeking help from a confidant. Perceptions of social-psychological causes of illness, such as family conflict, isolation, or alcohol abuse, were related to advising a confidant, self-help group, or psychotherapist rather than a psychiatrist or physician (Angermeyer et al., 1999).
Demographic Variables and Perceived Benefits
Perceptions of mental health treatment as beneficial are likely shaped by cultural influences as well as an individual’s personal experience. In a subset of randomly selected individuals from a nationally representative survey, Schnittker et al. (2000) compared Black and White respondents’ beliefs about the etiology of mental illnesses and their attitudes toward using professional mental health services. Black respondents were more likely than White respondents to endorse views of mental illness as God’s will or due to bad character, and less likely to attribute mental illness to genetic variation or poor family upbringing. These beliefs predicted less positive views of mental health services, and the authors found that more than 40% of the racial difference in attitudes toward treatment was attributable to differences in beliefs about the cause of mental illness.
Older adults’ reluctance to seek psychological services has been connected with more negative attitudes toward psychological services (Speer, Williams, West, & Dupree, 1991). Attitudes toward psychotherapy appear to improve by aging cohort, however. Currin, Hayslip, Schneider, and Kooken (1998) assessed dimensions of mental health attitudes among two different cohorts of older adults and found that younger cohorts of older adults hold more positive attitudes toward mental health services. Thus, attitudes among older adults may be less attributable to age than to changing cultural acceptance of mental illness over time. Older adults who have engaged in professional psychological treatment tend to see mental health treatment as more beneficial than their counterparts who have never sought treatment (Speer et al., 1991).
Across diverse religious orientations, beliefs in a spiritual cause of mental illness have been associated with preference for treatment from a religious leader rather than a mental health professional (Chadda et al., 2001; Cinnirella & Loewenthal, 1999). For individuals who interpret psychological distress symptoms as spiritually based, a religious leader may be viewed as a more beneficial provider than a traditional mental health professional. Some clients prefer to see clergy for mental health concerns. Some psychologists have formed relationships between religious organizations and mental health providers to foster collaboration and access to many care options for community members (McMinn, Chaddock, & Edwards, 1998). Benes, Walsh, McMinn, Dominguez, and Aikins (2000) describe a model of clergypsychology collaboration. Using Catholic Social Services as a medium through which collaboration took place, psychologists, priests, religious school teachers, and parishioners collaborated through a continuum of care beginning with prevention (public speaking about mental health topics, parent training workshops) through intervention (1-800 access numbers, support groups, and counseling services). The authors note that bidirectional referralsnot simply clergy referring to cliniciansand a sharing of techniques and expertise are keys to the success of such programs. Providing care to individuals through the source that they consider most credible or accessible is an innovative strategy for increasing perceived treatment benefits and decreasing barriers
Marketing Psychological Services
While the idea of marketing psychological services may seem unappealing to some psychologists, marketing strategies designed to encourage appropriate utilization may serve as both a strategy for the field of psychology as well as an outreach service to improve public health. In order to benefit from psychotherapy, individuals must view it as a legitimate way to address their problems. Strategies may include marketing psychological services at a national level, such as the APA’s 1996 public education campaign (Farberman, 1997); at a group level, such as a community mental health system providing rationale for increased funding; or at an individual level, such as an independent private practitioner seeking to increase referrals. Two theories, social marketing theory and problem-solution marketing, are useful models for developing effective mental health campaigns.
Social Marketing Theory
Rochlen and Hoyer (2005) identify social marketing theory as a framework for identifying strategies specifically aimed at changing social behaviors. Three principles define social marketing: negative demand, sensitive issues, and invisible preliminary benefits (Andreason, 2004). Negative demand describes the challenge of selling a product (psychotherapy, in this case) that the individual does not want to buy. In the case of individuals who see therapy as unhelpful or a frightening experience, addressing negative demand would include considering the viewpoint of a reluctant audience and perhaps utilizing the Stages of Change model (Prochaska & DiClemente, 1984), in which the goal of the marketing campaign would be to move an individual from the precontemplation stage to the contemplation stage of change. Social marketing theory also takes into account the degree of sensitivity in the task being encouraged; that is, seeking psychotherapy requires a greater amount of mental energy and vulnerability than less sensitive purchases, such as a new motorcycle. The principle of invisible preliminary benefit reminds those marketing psychological services that the benefits of choosing to seek psychological help are often not seen immediately, as they are when receiving a pain medication. Therefore, marketing strategies for mental health must make consumers aware of psychotherapy’s benefits and the long-term prospect of improving quality of life.