Determinants of psychotherapy outcome expectations: Qualitative accounts from socially anxious college students

Abstract

Aim: Patients' prognostic psychotherapy outcome expectations are robustly associated with post-treatment outcomes. However, little is known about the determinants of such expectancies, especially in college students whose beliefs have yet to be influenced by prior therapy experiences. Understanding factors that relate to such truly 'baseline' predictive beliefs can have implications for addressing undergraduate students' willingness to begin a course of, engage in, and benefit from mental health treatment, beyond simply having had prior positive or negative experiences. In this qualitative study, we examined socially anxious college students' first-hand accounts of the primary determinants of their baseline treatment outcome expectations. Methods:Semi-structured interviews focused on participants' personal, cultural and contextual outcome expectancy determinants were they to begin a course of psychotherapy in the future. Data were analysed according to grounded theory and consensual qualitative research principles.Results: Categories including coursework, media and the experiences of important others were considered positive expectancy determinants in some cases and negative expectancy determinants in others, depending on whether the related depictions in class, on the screen, or in discussions were positively or negatively valenced.Although there was balance among most of these predictors, coursework was more commonly considered a positive versus negative expectancy determinant. More unique negative expectancy determinants were based on incorrect information regarding mental health and/or psychotherapy or stigma surrounding mental illness.Discussion: Findings contribute to the currently scant literature on determinants of college students' baseline treatment beliefs.

Using rich data to inform student mental health practice and policy

“…Articles in this special section provide a step towards achieving these goals. These articles shed light on the needs of students who are typically under-represented when it comes to designing institutional policies and services, including the following: (1) the first study to explore suicidality in doctorate researchers and identify risk and protective factors against student suicidality (Hazell et al, 2021); (2) an archival study using practice-based data to gain insight into the risk factors associated with treatment-seeking students with pregnancy-related concerns (Markin et al, 2021); and (3) an interview study exploring the determinants of psychotherapy outcome expectations for students experiencing social anxiety and shedding light on students' willingness to engage with mental health interventions (Morrison et al, 2021).…”

Does outcome expectancy predict outcomes in online depression prevention? Secondary analysis of randomised‐controlled trials

“…Finally, it would be prudent to conduct longitudinal studies to understand how initial outcome expectancy emerges, how it changes and interacts as more experience with the intervention is gained and how this affects its role as a predictor of treatment outcome. These studies would also need to take into account the familiarity of the sample with online interventions and prevention, as well as previous intervention experience, 79 information available before treatment decision 80 and level of human support. To test whether expectancy plays a specific role in online interventions, studies directly comparing online and face‐to‐face preventive offers are warranted.…”