Patients’ outcome expectation (OE) represents their belief about the mental health consequences of participating in psychotherapy. A previous meta-analysis of 46 independent samples receiving the treatment of at least 3 sessions revealed a significant association between more optimistic baseline, or early treatment, OE and more adaptive posttreatment outcomes (weighted r = .12 or d = .24; Constantino, Glass, Arnkoff, Ametrano, & Smith, 2011). The present study represents an update to that meta-analysis. To be included, articles published through June 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients’ own OE, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the OE−outcome association. The updated meta-analysis was conducted on 81 independent samples (extracted from 72 references) with 12,722 patients. The overall weighted effect size was r = .18, p < .001, or d = .36, with high heterogeneity (I2 = 76%) and no evidence of publication bias. Several variables (patient age, measure type, and treatment manual used) moderated the OE−outcome association. These robust, replicated meta-analytic findings are discussed in light of methodological limitations and with regard to their practice implications.

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Background: Since the cognitive revolution of the early 1950s, cognitions have been discussed as central components in the understanding and treatment of mental illnesses. Even though there is an extensive literature on the association between therapy-related cognitions such as irrational beliefs and psychological distress over the past 60 years, there is little meta-analytical knowledge about the nature of this association. Methods: The relationship between irrational beliefs and distress was examined based on a systematic review that included 100 independent samples, gathered in 83 primary studies, using a random-effect model. The overall effects as well as potential moderators were examined: (a) distress measure, (b) irrational belief measure, (c) irrational belief type, (d) method of assessment of distress, (e) nature of irrational beliefs, (f) time lag between irrational beliefs and distress assessment, (g) nature of stressful events, (h) sample characteristics (i.e. age, gender, income, and educational, marital, occupational and clinical status), (i) developer/validator status of the author(s), and (k) publication year and country. Results: Overall, irrational beliefs were positively associated with various types of distress, such as general distress, anxiety, depression, anger, and guilt (omnibus: r = 0.38). The following variables were significant moderators of the relationship between the intensity of irrational beliefs and the level of distress: irrational belief measure and type, stressful event, age, educational and clinical status, and developer/validator status of the author. Conclusions: Irrational beliefs and distress are moderately connected to each other; this relationship remains significant even after controlling for several potential covariates.

Patients' perception of treatment credibility represents their belief about a treatment's personal logicality, suitability, and efficaciousness. Although long considered an important common factor bearing on clinical outcome, there have been no systematic reviews of the credibility-outcome association. The present study represents a meta-analysis of the association between patients' credibility perception and their posttreatment outcomes. To be included, articles published through August, 2017 had to (a) include a clinical sample, (b) include a therapist-delivered treatment of at least 3 sessions, (c) include a measure of patients' own early treatment credibility perception, (d) include at least 1 posttreatment mental health outcome not explicitly referenced as a follow-up occasion, and (e) report a statistical test of the credibility-outcome association. The meta-analysis was conducted on 24 independent samples (extracted from 19 references) with 1,504 patients. The overall weighted effect size was r ϭ .12, p Ͻ .001, or d ϭ .24, with high heterogeneity (I 2 ϭ 57%) and no evidence of publication bias. There were no significant moderating effects on the credibility-outcome association for any of the potential moderators that we evaluated. The meta-analytic findings are discussed in light of methodological limitations and with regard to their practice implications. Clinical Impact StatementQuestion: This article examined the association between patients' perception of treatment credibility and their outcomes after treatment ends. Findings: Patients' treatment credibility belief is an empirically supported correlate of treatment outcome that therapists would do well to assess throughout treatment, attempt to heighten at treatment's outset, attempt to responsively match to intervention style, and respond to sensitively if/when it wanes. Meaning: The treatment credibilityimprovement correlation increases the scientific credibility of formerly ill-named "nonspecific" belief factors; thus, there is sufficient information to incorporate persuasive, credibility-enhancing strategies into treatment rationale delivery, ongoing clinical exchange, and training. Next Steps: Future research needs to (a) improve credibility measurement, (b) test strategies that causally enhance patients' perceptions of treatment and therapist credibility to improve treatment efficacy, and (c) illuminate both patient and therapist contributions to such credibility beliefs to help tailor clinical practice and training.

Results suggest that bidirectional relations between outcome expectation and alliance, with both directions influencing outcome. Clinical and empirical implications are discussed.