Addressing misinformation about mental health with patients

Health misinformation takes on a life of its own on social media, with viral TikTok trends claiming lives and wellness creators giving medical advice with no credentials. Psychologists have found that online health misinformation can cause significant harm, especially for young people, and differs from other forms of misinformation because its peddlers often stand to benefit financially from giving inaccurate advice.

A less explored but equally concerning trend: widely shared falsehoods about mental health.

One analysis of 500 TikTok videos with the hashtag #mentalhealth or #mentalhealthtips found that more than 80% were misleading, while a review article identified pervasive misinformation on certain topics, including men’s sexual health, neurodevelopmental disorders, and trauma disorders (PlushCare Content Team, November 18, 2022opens in new window; Starvaggi, I., et al., Current Opinion in Psychology, Vol. 56, 2024opens in new window).

That sort of inaccurate content can prevent people from seeking help for psychological problems or convince them to try untested treatments that do more harm than good.

“There’s not a lot of research on this, but whenever somebody has studied it, the results are pretty discouraging,” said Lorenzo Lorenzo-Luaces, PhD, an associate professor of psychological and brain sciences at Indiana University Bloomington who coauthored the recent review article.

Much of the misleading material stems from a growing cultural acceptance of discussing mental health. Athletes, entertainers, and other influential people are sharing their struggles, which has done a great deal to reduce stigma, said John Piacentini, PhD, ABPP, a professor of psychiatry and biobehavioral sciences and director of the Center for Child Anxiety, Resilience, Education, and Supportopens in new window at the University of California, Los Angeles.

“But now in the name of mental health literacy, we’re also seeing some mental health illiteracy,” he said.

That can present a conundrum: When a patient repeats mistruths about mental health in therapy, how should clinicians respond? What’s the best way to balance sometimes conflicting goals—such as building rapport and providing psychoeducation—when practitioners encounter potentially harmful ideas about mental health?

Bad mental health advice can quickly go viral on social media. One highly searched topic, identified through research by Lorenzo-Luaces, was the idea that refraining from masturbation could cure health problemsopens in new window such as depression and erectile dysfunction (Current Opinion in Psychology, Vol. 56, 2024opens in new window).

Lorenzo-Luaces and his colleagues also analyzed TikTok videos that discussed cognitive behavioral therapy (CBT), finding that about one-fourth of those videos were negative. Common messages included ideas not supported by research—including that CBT is largely ineffective and that it is a form of psychological invalidation—and that it is harmful for people with a history of trauma (Journal of Medical Internet Research, Vol. 25, 2023opens in new window).

“There’s so much momentum from the pop psychology movement that it becomes near impossible to cut through it, especially if you’re talking in a space where you don’t have a long-standing rapport,” said Bedford Palmer II, PhD, a counseling psychologist, founder of Deeper Than Coloropens in new window, and a professor of counseling at Saint Mary’s College of California.

As so-called therapy-speak has entered the public lexicon, practitioners report hearing psychological concepts such as “trauma” and “attachment issues” referenced more frequently, often without a true understanding of what they mean.

“Using mental health terms is ubiquitous now to describe typical, expected, and normative experiences,” Piacentini said. “Being sad about something doesn’t exist anymore—you’re depressed.”

Taisha Caldwell Harvey, PhD, a clinical psychologist based in Martinez, California, and founder of The Black Girl Doctoropens in new window, sometimes hears patients repeat such concepts when they describe symptoms or recount experiences. For example: A patient might label their mother a narcissist after hearing a podcast and deciding the term applies.

Patients may also use therapy-speak to self-diagnose, which can put providers in a tough spot. One patient of Lorenzo-Luaces was convinced they had a sex addiction, a diagnosis that is not listed in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th edition (DSM-5). That presented a challenge, where Lorenzo-Luaces wanted to provide support but disagreed with his patient about the best course of treatment.

Research even suggests that the spread of therapy-speak and mental health misinformation can change the way patients, particularly teens, experience distress and learn how to navigate challenges. During the pandemic, a sharp rise in adolescent emergency department visits involving tic-like behavior appeared tied to falsehoods shared on social media (Frey, J., et al., Psychology Research and Behavior Management, Vol. 15, 2022opens in new window). Some argue that mental health awareness efforts can backfire, triggering an overdiagnosis of psychological problems and changing the way teens view their ability to cope with difficulty (Foulkes, L., et al., Nature Mental Health, Vol. 2, 2024opens in new window).

In the moment, a clinician’s first impulse may be to correct mental health misinformation or educate a patient about a term they’re misusing—but that’s not always a good idea, Caldwell-Harvey said.

“I think about the power we hold as psychologists, and correcting somebody can be really off-putting and almost feel like shaming,” she said. “That’s definitely not what we want to do.”

Instead, here are a few things for clinicians to consider if they encounter inaccurate beliefs about mental health in therapy.

Balance the competing goals of therapy

When a patient mentions a term like “narcissism” during a session, Caldwell-Harvey weighs goals that may sometimes be in conflict, including delivering psychoeducation and building a strong therapeutic relationship, as she decides how to respond. Often, she’ll ask a probing question (“What makes you say your mother is a narcissist?”) and make a mental note for later. She might decide the point is worth circling back to, for instance if the misunderstanding is causing harm for the patient or making it hard for them to align their thoughts and behaviors.

“There’s really a delicate dance that has to be done in therapy with deciding when it’s appropriate to counter and re-educate clients on the language that they’re using,” she said.

Help patients expand their lexicon

Palmer says providing accurate information doesn’t necessarily require telling a patient they’re wrong. “Trauma” might mean one thing in a therapeutic context, and something different in popular culture.

“You can help them see the difference between the technical usage and the popular usage, and then leave space for the popular usage,” he said.

Palmer also reminds patients about alternative, nonclinical ways to call out bad behavior. (Your boss might be a jerk, but that does not necessarily mean they have a personality disorder.) The same goes for self-diagnoses: A tough experience may not be “trauma,” but it can still have meaning with a different label.

Approach conversations with empathy

Keep in mind that patients who seek out mental health information—accurate or not—are generally doing so because they want to improve their lives and relationships.

“I don’t see this as malicious in any way,” Piacentini said. “I see this as people really trying to understand themselves and others in a world that may be difficult for them to navigate.”

A tool known as the Empathetic Refutational Interview (ERI), developed by psychologists to address vaccine misinformation in doctor-patient interactions, might also be useful in therapeutic contexts, said co-creator Philipp Schmid, PhD, an assistant professor of health communication at Radboud University in Nijmegen, The Netherlands.

In the ERI approach, a provider asks open-ended questions to learn about a patient’s concerns and misperceptions (for example: reports that CBT is dangerous), then affirms them. That might sound something like: “We all have fears when we encounter new treatments and that’s completely normal. When it comes to CBT, I have 30 years of experience. Can I share some of what I know about this treatment with you?” The provider then debunks the misinformation and shares accurate information in its place (Health Psychology, Vol. 43, No. 6, 2024opens in new window).

“In a one-on-one situation, we don’t typically recommend rebutting misinformation directly, because that usually increases reactance to anything that comes after it,” Schmid said.

Get familiar with the content your patients consume

Caldwell-Harvey said it helps to know what ideas patients are exposed to through popular psychology books, celebrity memoirs, podcasts, and wellness accounts on social media. While the intention is rarely to cause harm, influential people can get psychological concepts wrong, “and there are no checks and balances,” she said. “It could just go viral, and that’s that.”

Create content or provide advice to those who do

One antidote is for psychologists to position themselves more deliberately as co-editors and advisers for authors and creators sharing research-backed messages around mental health.

“What I would love to see is people consulting with a psychologist if they are infusing psychological concepts into books about their lives or wellness content,” Caldwell-Harvey said.

Clinicians can also create their own content or earmark credible sources of information about mental health, then refer the patient there if inaccuracies come up during a session.

“The fact that influencers are so vocal means that the rest of us have an obligation to get good information out there,” Lorenzo-Luaces said. “As psychologists, it’s important to think about whether we have an obligation to disseminate real information in areas where we have expertise.”