Psychology
2012. Vol.3, No.2, 208-212
Published Online February 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.32029
208
Psychology Students’ Beliefs about Integrating Complementary
and Alternative Therapy (CAT) into Their Future
Psychology Practice
Lee-Ann M. Wilson1, Kyra Hamilton2, Katherine M. White2
1School of Public Health, Queensland University o f Technology, Brisbane, Australia
2School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
Received November 22nd, 2011; revised December 23rd, 2011; accepted January 27th, 2012
We investigated whether belief-based differences exist between students who have strong and weak in-
tentions to integrate complementary and alternative therapy (CAT) into future psychology practice by
recommending CAT or specific CAT practitioners to clients. A cross-sectional methodology was used.
Psychology undergraduate students (N = 106) participated in a paper-based questionnaire design to ex-
plore their underlying beliefs related to CAT integration. The study was undertaken at a major university
in Queensland, Australia. The theory of planned behaviour belief-based framework guided the study.
Multivariate analyses of variance examined the influence of behavioural, normative, and control beliefs
on the strong and weak intention groups. A multiple regression analysis investigated the relative impor-
tance of these belief sets for predicting intentions. We found that clear differences emerged between
strong and weak intenders on behavioural and normative beliefs, but not control beliefs. Strong intenders
perceived the positive outcomes of integrating CAT, such as being able to offer clients a more holistic
practice and having confidence in the practitioners/practices, as more likely to occur than weak intenders,
and perceived the negative outcome of compromising my professional practice as less likely. Strong in-
tenders were more likely than weak intenders to perceive that a range of important referents (e.g., clients)
would think they should integrate CAT. Results of the regression analysis revealed the same pattern of
results in that behavioural and normative beliefs, but not control beliefs, significantly predicted intentions.
The findings from this study can be used to inform policy and educational initiatives that aim to encour-
age CAT use in psychology practice.
Keywords: Integrating Complementary Therapy; Psychology Practice; Psychology Student; Theory of
Planned Behaviour; Beliefs
Introduction
Recent research sugge sts that many individuals with mental
health disorders seek the advice of naturopaths, or combine
yoga, meditation, or herbal therapies with their traditional
psychotherapy (Page, Jones, & Wilson, 2004; Australian Bu-
reau of Statistics, 2004-2005). While significant research has
been conducted exploring medical practitioners’ attitudes and
perceptions toward complementary and alternative therapies
(CAT) (Halcon, Chlan, Kreitzer, & Leonard, 2003; Hyland,
Lewith, & Westoby, 2003; Lewith, Hyland, & Shaw, 2002),
there is an absence of similar investigati ons within the field of
psychology. Although some previous research has attempted
to explore differences between medical and social science
students’ (predominately psychology students) attitudes to-
ward complementary medical practitioners and medical
treatment preferences (Yardley, Fahmy, Jamie, & Furnham,
1999), no previous study has tried to demonstrate the key
perceptions underlying psychology students’ decisions re-
garding integrating CAT into their future professional prac-
tice.
Current research suggests that psychologists are integrating
CAT into psychological practice via recommending CAT to
clients, offering clients referrals to CAT practitioners, or ac-
cessing training in CAT therapies to integrate these therapies
into practice (Bassman & Uellendahl, 2003). Previous research,
although somewhat limited, has found that psychologists are
recommending CAT generally at relatively high rates and at
significantly higher rates than they are offering specific refer-
rals to CAT practitioners (Bassman & Uellendahl, 2003).
However, little is known about how psychology students, who
are the next cohort of health professionals and who will be in a
position to direct future initiatives in the field, perceive inte-
grating CAT into psychology practice. A qualitative pilot study
examining psychology students’ and practicing psychologists’
attitudes and beliefs about CAT integration revealed that stu-
dents are generally positive about CAT integration but indi-
cated that they were largely unaware of the professional impli-
cations of the various integration choices, and their responses
did not vary much between the different integration scenarios
(i.e., they saw much the same implications between training
themselves in CAT, recommending CAT to clients, and refer-
ring clients to CAT practitioners) (Wilson & White, 2011).
Students focused on the potential benefits to clients, such as
being able to offer a broader range of treatment options. Given
that previous research has found examining attitudes and beliefs
useful in understanding CAT practices in general (Chua &
Furnham, 2008), having an understanding of the ways in which

LEE-A. M. WILSON ET AL.
underlying beliefs guide psychology students’ decisions about
whether to integrate CAT into future practice might also be
useful to inform both clinical practice policy and educational
initiatives.
The Theory of Planned Behaviour (TPB; Ajzen, 1991) is a
well validated decision-making model that allows for an ex-
amination of people’s underlying beliefs and has much support
in the social and health domains (see Armitage & Christian,
2003). According to the TPB, intention to perform a given be-
haviour and the individual’s actual control over performing the
behaviour predict behavioural performance. Intention, in turn,
is influenced by the degree to which a person is in favour of
performing a particular behaviour (attitude), the degree to
which a person feels social pressure to perform a behaviour
(subjective norms), and the degree to which a person feels they
have control over performing the behaviour (perceived behav-
ioural control) (Ajzen, 1991). Underlying the TPB is the as-
sumption that the antecedents of attitude, subjective norms, and
perceived behavioural control are corresponding behavioural
(costs and benefits), normative (pressure to comply with im-
portant others’ approval/disapproval), and control beliefs (mo-
tivating or inhibiting factors), respectively, that reflect an indi-
vidual’s intention and subsequent behaviour (Ajzen, 1991).
Assessing the belief-based determinants of attitude, subjective
norms, and perceived behavioural control allows researchers to
establish the beliefs that differentiate those who perform a
given behaviour from those who do not. A number of studies
have explored these underlying beliefs in order to increase un-
derstanding of health behaviours, including CAT practices
(O’Conner & White, 2009; Pawlak et al., 2008; Wilson &
White, 2008).
Using the TPB as a theoretical framework, this study aims to
investigate the beliefs that differentiate those psychology stu-
dents who have strong and weak intentions to integrate CAT
into future psychology practice by either recommending CAT
to clients or referring clients to specific CAT practitioners.
Specifically, the study assessed psychology students’ beliefs
relating to the costs and benefits associated with recommending
or referring CAT to clients (behavioural beliefs), beliefs about
which important referents would approve or disapprove of their
recommending or referring CAT (normative beliefs), and be-
liefs about inhibiting factors (control beliefs) for recommending
or referring CAT to clients.
Method
Participants
Participants (N = 106) were psychology undergraduate stu-
dents from a major Australian university. The majority of the
students was enrolled in first year psychology units (89%) and
indicated a preference of clinical (42%) or counseling (32%)
psychology as their future area of professional interest. The
study comprised of 77 females and 29 males and the mean age
of participants was 24.55 years (SD = 10.46 years).
Measures
The target behaviour assessed students’ beliefs about inte-
grating CAT into future psychology practice by either rec-
ommending CAT to clients or referring clients to specific
CAT practitioners. The two behaviours, recommending and
referring, were combined as pilot research utilising semi-
structured interviews indicated that students did not differen-
tiate between the professional implications or clients out-
comes associated with these two practices (Wilson & White,
2011). CAT was operationalised as: “A group of diverse
medical and health care systems, practices, and products that
are not presently considered to be part of conventional medi-
cine”. This definition is consistent with the National Centre
for Complementary and Alternative Medicines (2006). The
pilot study which involved both practicing psychologists and
psychology students was conducted (N = 12; 6 psychologists
and 6 students) to elicit the salient behavioural, normative,
and control beliefs (8) as recommended by Fishbein and
Ajzen (1975). Using content analysis, the most commonly
reported advantages (e.g., being able to offer clients a more
holistic practice) and disadvantages (e.g., not being able to
follow up client progress with CAT), referents approving or
disapproving (e.g., employers), and factors preventing inte-
grating CAT into future psychology practice by recommend-
ing or referring CAT (e.g., lack of knowledge about relevant
CATs) reported by students were used to assess the behav-
ioural, normative, and control belief-based measures, respec-
tively, in the present study.
All belief-based items we re scored on 7-point Likert scale s,
scored extremely unlikely (1) to extremely likely (7). To assess
behavioural beliefs, participants were asked to rate how likely
two costs and two benefits would result if they integrated
CAT into a future psychology practice by recommending
CAT or specific CAT practitioners to clients. For normative
beliefs, participants were asked to rate how likely four refer-
ents would think they should integrate CAT into a future
psychology practice by recommending CAT or specific CAT
practitioners to clients. Participants indicating how likely
internal and external factors would prevent them from inte-
grating CAT into a future psychology practice by recom-
mending CAT or specific CAT practitioners to clients as-
sessed control beliefs. It should be noted that internal consis-
tency is not a necessary feature of belief composites as no
assumption is made that the salient beliefs are internally con-
sistent (Ajzen, 1991); thus, alpha coefficients were not com-
puted for the behavioural , normative, a nd control bel ief-based
measures. For a full listing of the belief-based items, see Ta-
ble 1. The outcome measure of intention was measured on a
single item scale. Students were asked to respond to the ques-
tion: “I intend (1), do not intend (7) to integrate CAT into a
future p sychology practice by recomme nding CAT or specifi c
CAT practitioners to clients?” For analyses, intention scores
were recoded such that higher scores were associated with
stronger intentions. Furthermore, for belief-based analyses,
responses were recoded to indicate those who had weak
(scores 1.0 to 4.0) and strong intentions (scores 4.0 to 7.0) to
perform the target behaviour.
Procedure
Prior to any data collection, the university human research
ethics committee approved the study. Students were informed
about the opportunity to participate in the study during one of
their regularly scheduled classes. At the end of the class, stu-
dents who were willing to participate were able to complete and
return their survey before leaving. The student participants
were offered a small number of credit points towards a research
participation mark in their psychology class as a thank you for

LEE-A. M. WILSON ET AL.
their involvement.
Results
Belief-B ased Analyses
Behavioural, normative, and control beliefs were examined
to identify those beliefs differentiating between students who
had strong and weak intentions to integrate CAT into a future
psychology practice by recommending CAT or specific CAT
practitioners to clients. Three one-way multivariate analyses of
variance (MANOVAs) were conducted with intentions to per-
form the target behaviour as the independent variable and the
belief-based items as the dependent variables. Overall, Wilks’
Lambdas were significant for behavioural (F(4, 101) = 7.59, p
< .001, η² = .23) and normative beliefs (F(4, 101) = 4.80, p
= .001, η² = .16), but not for control beliefs (F(4, 101) = .28, p
= .891). To explore further where differences existed between the
groups for behavioural beliefs and normative beliefs, dependent
variables were examined at the univariate level. Bonferonni
adjustments were used to control for familywise type 1 error
(refer to Table 1). For behavioural beliefs, univariate analyses
revealed that strong intenders perceived the positive outcomes
of integrating CAT, such as be able to offer clients a more ho-
listic practice and having confidence in the practitioners/prac-
Table 1.
Mean differences in behavioural, norm ative, and control beliefs.
Intentions Weak
Intenders Strong Intenders
Behavioural be liefs N = 58 N = 48
Being able t o o ffer a more holistic practice 4.67 5.73***
Not being able to follow up client p rogress
with CAT 3.97 3.56
Having confidence in the practitioners/
practices that are being recommended 4.40 5.44***
Compromising my professional re putation 3.86 3.08***
***p < .012
Normative bel iefs n = 57 n = 48
Your clients 4.40 5.19***
Complementary or alternative p ractitioners 5.44 5.77
Your employers 3.98 4.83***
Professional organisations 3.84 4.56***
***p < .012
Control beliefs n = 58 n = 48
Lack of knowledge about appropri ate
practitioners 5.31 5.04
Lack of knowledge about relevant CATs 5.34 5.17
Lack of scienti fi c evidence i n support
of CAT 4.91 4.71
Absence of clear legal and professional
bodies guidelines 5.00 4.83
***p < .012
tices, as more likely to occur than weak intenders, and were less
likely to perceive that integrating CAT would compromise their
professional practice. For normative beliefs, univa riate analy ses
indicated that strong intenders were more likely than weak
intenders to report the important referents of “your clients”,
“your employers”, and “professional organisations” would
think they should integrate CAT into a future psychology prac-
tice by recommending CAT or specific CAT practitioners to
clients.
Analysis Predicting Intentions
The MANOVA analyses identified how the strong and weak
intenders differed in terms of their beliefs. However, these
analyses did not allow an assessment of which beliefs are most
influential for students’ intentions to integrate CAT into a fu-
ture psychology practice by recommending CAT or specific
CAT practitioners to clients. A multiple regression analysis,
therefore, was conducted to assess the relative importance of
the behavioural, normative, and control beliefs for predicting
intentions. The dependent measure was based on a continuous
scale reflecting intentions (as described in the Method Section).
Together, the belief-based measures significantly predicted
intentions, F(3, 101) = 17.62, p < .001, accounting for 34% of
the variance of intentions to integrate CAT into a future psy-
chology practice by recommending CAT or specific CAT prac-
titioners to clients (refer to Table 2). Behavioural and norma-
tive beliefs, but not control beliefs, were significant predictors
of intentions. Thus, the more likely students perceived benefits
associated with recommending or referring CAT and the more
important referents approved of recommending or referring, the
more students were to intend to integrate CAT into a future
psychology practice by recommending CAT or specific CAT
practitioners to clients.
Discussion
The present study aimed to investigate whether belief-based
differences exist between those students who have strong and
weak intentions to integrate CAT into a future psychology
practice by recommending CAT or specific CAT practitioners
to clients. We found that the behavioural and normative beliefs,
but not control beliefs, differed significantly betwee n the inten-
tion groups. Additionally, the analysis examining the relative
importance of these belief sets in predicting intentions showed
the same pattern of results.
The findings of this study help us to understand the relation-
ship between beliefs and students’ intentions to integrate CAT
into future psychology practice. This understanding, in turn, has
important practical implications for those involved in clinical
Table 2.
Regression analysis pr ed i c ti n g i n te n t io n s .
Variable R R² F df β
Intentions .59.34 17.62 3, 101
Behavioural be liefs .42***
Normative beliefs .23**
Control belief s –.14
**p = .017, ***p < .001.
210

LEE-A. M. WILSON ET AL.
practice policy-making and educational initiatives aimed at
influencing CAT use within psychology practice. First, the
finding that behavioural beliefs differed significantly between
the groups suggests that policy and educational initiatives aimed
towards promoting CAT integration into psychology practice
should focus on increasing students’ positive attitudes. Specifi-
cally, these should highlight that recommending or referring
CAT would result in the ability to offer clients a more holistic
practice, or building their confidence in the practitioners/prac-
tices that are being recommended, and reassuring them that
compromising their professional reputation is not necessarily an
outcome. Second, the differences in normative beliefs suggest
that strong intenders were more likely than weak intenders to
report those important referents (namely, clients, employers,
and professional organizations) would think they should inte-
grate CAT into future psychology practice by recommending
CAT or specific CAT practitioners to clients. Consequently,
policy and educational initiatives should focus on strategies that
explicitly show clients, employers, and professional organiza-
tions approving of integrating CAT into psychology practice.
Finally, inspection of the control beliefs revealed that strong
and weak intenders were equally likely to perceive certain pre-
ventive factors (e.g., lack of knowledge about appropriate prac-
titioners) as inhibiting their control over future integration.
Accordingly, strategies that focus on discouraging aspects of
integrating CAT into psychological practice (e.g., compromis-
ing professional reputation) may not be useful to help students
overcome barriers that might prevent them from intending to
integrate these behaviours into their future practice.
The results of the current study are broadly consistent with
previous TPB belief-based studies investigating psychologists’
intentions to integrate CAT (see Wilson & White, 2008), where
a range of behavioural, normative, and control beliefs influ-
enced CAT decision-making. Practicing psychologists, how-
ever, have established professional training and experience and
will be strongly influenced by past behaviours and norms; thus,
psychologists’ beliefs about CAT cannot be used to fully ex-
plain the beliefs of psychology students. This argument is sup-
ported by the finding that, in contrast with literature examining
psychologists’ beliefs (Wilson & White, 2008), we did not find
support for differences between strong and weak intenders for
control beliefs. This discrepancy in findings may be attributable
to the professional practice experience of the psychologists as
students may not yet fully understand the potential barriers of
integrating CAT into clinical practice. For example, psychology
students may not have been exposed to professional codes of
conduct that might potentially constrain the use of CAT in
psychology practice.
The results of the regression analysis support the MANOVA
findings in that behavioural and normative beliefs, but not con-
trol beliefs, predict students’ intentions to integrate CAT into a
future psychology practice by recommending CAT or specific
CAT practitioners to clients, accounting for a reasonable
amount of variance (34%). These findings suggest that the more
students perceive that there are benefits associated with rec-
ommending or referring CAT and the more they think that im-
portant referents approve of their recommending or referring
CAT, the more students will intend to integrate CAT into a
future psychology practice by recommending CAT or specific
CAT practitioners to clients. In light of these finding, policy
and educational initiatives aimed at promoting students’ be-
havioural intentions toward CAT use in psychology practice
should place emphasis on highlighting the behavioural and
normative beliefs, and not necessarily on targeting the underly-
ing co ntrol beliefs.
Some caution should be adopted in interpreting the results of
this study. First, the sample size was small and may have been
subject to self selection bias. Second, there was an uneven rep-
resentation of female and male students. Although this imbal-
ance reflects the higher proportion of females studying under-
graduate psychology in Australia, it is important to keep in
mind that our findings are primarily reflecting the view of fe-
male students. It is possible that male students may have dif-
ferent beliefs about CAT integration, at least as can be inferred
from reported levels of personal use (MacLennan, Myers, &
Taylor, 2006; Satia-Abouta et al., 2003). Future research should
incorporate a larger sample size in order to investigate this pos-
sibility. The broad definition of CAT used in the current study
may have limited the responses toward recommending and
referring CAT. The underlying beliefs for subcategories of
CAT might show some differences to the beliefs identified in
this study. For example, students’ underlying beliefs regarding
alternative therapies that have greater scientific evidence to
support their usage (e.g., St. John’s Wort, Folate, vitamin B12,
and amino acids such as phenalalanine and S-Adenosylmetho-
nine (SAMe); Jorm, Christensen, Griffiths, & Rodgers, 2002)
might be different for beliefs held toward alternative therapies
that are less supported in the literature. Finally, we did not in-
clude a measure of the perceptions of public readiness and it
might be interesting for future research to investigate a possible
relationship between students’ perceived public readiness to
accept psychologists’ integration of CAT and both students’
own belief in CAT and their intention to use CAT in future
practice.
Overall, by adopting a TPB belief-based approach, this study
provides important practical information that can be used to
inform policy and educational initiatives which aim to influence
the integration of CAT in psychology practice. Specifically, the
findings suggest that attention to advantages and disadvantages
of integrating CAT, such as being able to offer clients a more
holistic practice and compromising professional practice, as
well as considering the social approval of clients, employers,
and professional organisations in understanding CAT deci-
sion-making, may assist in improving students’ intentions to
integrate CAT into future psychology practice by recommend-
ing CAT or specific CAT practitioners to clients. Given the rise
of CAT use for mental health disorders, this preliminary re-
search examining CAT use in psychology practice should in-
form future research efforts to continue to investigate the mo-
tives and decision-making processes for integrating CAT within
the field of psychology. This further research could include
assessing the CAT integration beliefs and actions of practising
psychologists and incorporating longitudinal designs to deter-
mine how students’ attitudes and beliefs might change over
time, especially in response to increased knowledge and profes-
sional experience.
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