A growing body of evidence suggests that questionable health behaviors- not following medical recommendations and resorting to non-evidence based treatments—are more frequent than previously thought, and that they seem to have strong psychological roots. We thus aimed to: 1) document the lifetime prevalence of intentional non-adherence to medical recommendations (iNAR) and use of traditional, complementary and alternative medicine (TCAM) in Serbia and 2) understand how they relate to ‘distal’ psychological factors—personality traits and thinking dispositions, and ‘proximal’ factors—a set of beliefs and cognitive biases under the term ‘irrational mindset’. In this preregistered cross-sectional study on a nationally representative sample (N = 1003), we observed high lifetime prevalence of iNAR (91.3%) and TCAM (99.2%). Irrational beliefs, especially magical health beliefs and medical conspiracy theories, were the strongest predictors of TCAM. They also mediated the relation between Disintegration/lower cognitive reflectiveness and TCAM. High Disintegration, and low Conscientiousness predicted iNAR directly, whilst negative experiences with the healthcare system facilitated both types of questionable health practices. The established psychological profile of people prone to questionable health behaviors and the fact they can be tracked to negative experiences with the system can be used to tailor public health communications.

Irrational beliefs encompass a broad set of beliefs that lack verifiable empirical evidence and contradict scientific principles, often grouped into conspiratorial, pseudoscientific, and paranormal domains. This paper investigated whether these beliefs are rooted in a set of cognitive biases. Across four studies, low socioeconomic status, right-wing political orientation, and religiousness accounted for a substantial portion of irrational beliefs variance. However, cognitive biases consistently contributed incrementally to their prediction, with naturalness bias, omission bias, commitment bias, and the overconfidence effect emerging as the most robust predictors. Our findings indicate the nuanced nature of these relationships, as the predictive power of cognitive biases was consistently higher for conspiracist and pseudoscientific beliefs in comparison to paranormal ones.

People resort to various questionable health practices to preserve or regain health – they intentionally do not adhere to medical recommendations (e.g. self-medicate or modify the prescribed therapies; iNAR), or use traditional/complementary/alternative (TCAM) medicine. As retrospective reports overestimate adherence and suffer from recall and desirability bias, we tracked the variations in daily questionable health behaviors and compared them to their retrospectively reported lifetime use. We also preregistered and explored their relations to a wide set of psychological predictors – distal (personality traits and basic thinking dispositions) and proximal (different unfounded beliefs and biases grouped under the term irrational mindset). A community sample (N = 224) tracked daily engagement in iNAR and TCAM use for 14 days, resulting in 3136 data points. We observed a high rate of questionable health practices over the 14 days; daily engagement rates roughly corresponded to lifetime ones. Both iNAR and TCAM were weakly, but robustly positively related. Independent of the assessment method, an irrational mindset was the most important predictor of TCAM use. For iNAR, however, psychological predictors emerged as relevant only when assessed retrospectively. Our study offers insight into questionable health behaviors from both a within and between-person perspective and highlights the importance of their psychological roots.

Keywords: intentional non-adherence to medical recommendations, traditional alternative complementary medicine, experience sampling, daily use, psychological predictors, irrational mindse

To describe how Serbian online media cover the topic of traditional, complementary, and alternative medicine (TM/CAM), we conducted a content analysis of 182 articles from six news and six magazine websites, published July–December 2021. Biologically based treatments, predominantly herbal products framed as Serbian or Russian folk medicine, were the most common (70.9%, 205/289 practices). The practices were often presented as general health enhancers (18.4%, 71/386 claims); other common reasons given for the use of TM/CAM were to alleviate respiratory problems, boost the immunity, and detox. The tone was overwhelmingly positive, with most of the positive articles (82.4%, 145/176) neglecting to present information on potential harms of TM/CAM use. Few articles provided a recommendation to speak with a healthcare provider (13.6%, 24/176); in contrast, the recommended dosage was often explained (59.7%, 105/176). TM/CAM practitioners (15.9%, 28/176) and conventional medicine practitioners (12.5%, 22/176) were most commonly cited sources. Articles tended to appeal to TM/CAM’s tradition of use (65.3%, 115/176), naturalness (45.5%, 80/176), and convenience (40.9%, 72/176), used pseudoscientific jargon (59.7%, 105/176), and failed to cite sources for the claims that TM/CAM use is supported by science (22.2%, 39/176). Much of the information provided in Serbian online media seems to be uncritical, with a potential for misleading consumers.

Keywords: alternative medicine; complementary therapies; health communication; mass media; traditional medicine

Keywords: non-adherence, intentional non-adherence, treatment adherence, self- medication, irrational beliefs, conspiracy theories, superstition, experiences with the healthcare system, trust in the healthcare system, patient passivity

Keywords: alternative medicine, traditional medicine, irrational beliefs, magical health beliefs, naturalness bias

Questionable health practices, be it non-adhering to official recommendations or resorting to non-evi-dence based ones, pose a considerable burden to public health. Research in this special issue explores the psychological roots of proneness to this type of health behavior. The authors look into individual differenc-es in personality traits, cognitive styles, but also situational factors such as institutional trust and feeling of economic/health threat as predictors of a broad range of behaviors: non-compliance with COVID health measures/prescribed prophylactic regimen for chronic illnesses, avoiding vaccination, but also endorsing supplements and herbal remedies or alternative psychotherapies. This collection of papers offers valuable insights that could be implemented in tailoring short-term (pandemic-related messages) and long-term (building more trust in institutions or science) guidelines for health communicators.

Keywords: questionable health practices, recommended health behaviors, COVID-19, psychological roots

Research suggests a trend toward an increased interest in CAM, complementary and alternative therapies for treating mental health problems, which is paralleled by a relatively favorable attitude of mental health professionals. This study explored psychological predictors of attitude toward CAM therapies: frustration tolerance (measured by the 28-item Frustration Discomfort Scale), self-esteem (measured by the 16-item Revised Version of the Self-Liking/Self-Competence Scale), cognitive styles (measured by REI Scale-short version) and irrational health beliefs (measured by CAM Health Belief Questionnaire – CHBQ). Participants (N = 294) reacted to vignettes describing Bach flower remedies and neuro-linguistic programming to indi-cate their attitude toward CAM. CAM health beliefs (e.g., belief that health is a balance of life forces) and self-esteem positively predicted attitude toward CAM, while the rational style of thinking was a negative predictor. As suggested by mediation analysis, the intuitive thinking style affected the attitude toward CAM via an increase in CAM beliefs. We discuss the implications of our findings for encouraging rational decision-making when seeking help with mental health problems.

Keywords: attitude toward CAM, self-esteem, tolerance for frustrations, cognitive styles, mental health, irrational beliefs

There is evidence that different types of irrational thinking and beliefs are significant predictors of questionable and maladaptive COVID-19 related health practices. In this study, we investigated the role of two under-researched types of irrational thinking, more typical for a clinical setting: irrational beliefs defined in Rational Emotive Behavior Therapy (REBT) and attachment anxiety and avoidance. We investigated whether REBT irrational beliefs, attachment dimensions, and conspiracy mentality mediated the relationship between personality traits, on the one side, and COVID-19 health behaviors, on the other. We proposed that HEXACO personality traits, and especially Disintegration (proneness to psychotic-like experiences) predicted irrational thinking and beliefs, which in turn predicted higher susceptibility to questionable health practices. Structural equation modeling on a sample of 287 participants from the general population, showed that Disintegration was related to REBT irrational beliefs, attachment dimensions, and conspiracy mentality, highlighting the important effect of Disintegration on irrational thinking and beliefs. Conspiracy mentality mediated the effects of Disintegration to low adherence to recommended health behaviors – RHB, and greater use of pseudoscientific practices – PSP. Attachment anxiety mediated the relationship between high Disintegration, high Emotionality (E), and low Honesty (H), and lower adherence to RHB. REBT irrational beliefs and attachment avoidance did not mediate the relationship between personality traits and COVID-19 health behaviors.

Keywords: HEXACO, Disintegration trait, conspiracy mentality, adult attachment, REBT, irrational beliefs, COVID-19 health behaviors

Resorting to complementary/alternative medical (CAM) therapies can lead to bad health outcomes or interfere with officially recommended therapies. CAM use is, nevertheless, widespread and growing. This could be partially due to the perception of the CAM industry as powerless and non-profit oriented, in contrast to the pharmaceutical industry (“Big Pharma”). In reality, both industries are highly profitable and powerful; to highlight this similarity, science communicators coined the term “Big Suppla”. Drawing from a sample of 242 participants upon all exclusions, we experimentally tested whether varying these attributes in presenting the industries impacts consumers’ evaluation of the two categories of products (herbs and supplements) and their willingness to try and recommend them. We also tested whether the effect is moderated by conspiratorial thinking, and whether it is due to a change in trust. All hypotheses were pre-registered. As expected, participants who read the Big Suppla vignette decreased the endorsement of both supplements and herbs, whilst, against our hypotheses, there were no significant changes in endorsement in the contrasting “Baby Suppla” group. Conspiratorial thinking was related to more endorsement of CAM, but it did not moderate the experimental effects. We also did not observe the expected mediation by trust. Our most robust results corroborate the idea that challenging the myth of benevolence of the CAM industry makes people more critical in evaluating its products or considering their usage. They support the intuitions of science communicators who coined the term Big Suppla, and can help in tailoring public health

Keywords: complementary and alternative medicine, perception of power, questionable health behaviors, conspiracy theories