Predictors of change in patient treatment outcome expectation during cognitive-behavioral psychotherapy for generalized anxiety disorder.

Abstract

Positive patient-rated psychotherapy outcome expectation at pre- or early treatment is associated with posttreatment improvement. However, there is limited research on patients’ change in outcome expectation across therapy and participant factors that predict both pretreatment outcome expectation and expectation change. The present study aimed to examine (a) the overall trajectory of change in patients’ outcome expectation from pretreatment through treatment’s end; (b) baseline patient characteristics as predictors of their pretreatment outcome expectation; (c) early change in general self-efficacy (controlling for baseline patient characteristics, early change in symptoms, and treatment condition) as predictor of expectation change; and (d) therapist effects on patients’ outcome expectation change. For patients with generalized anxiety disorder (N = 80) receiving variants of cognitive-behavioral therapy, outcome expectation was assessed at pretreatment, Session 5, Session 10, and posttreatment. Using multilevel models with repeated assessments, we found outcome expectation to linearly increase from pre- to posttreatment. When controlling for other patient characteristics at intake, higher depression severity was associated with lower pretreatment outcome expectation. When controlling for baseline patient characteristics, early reduction in generalized anxiety disorder–symptoms and global severity, and treatment condition, an increase in early general self-efficacy was associated with a less steep increase in outcome expectation over the therapy. We also found between-therapist differences in their patients’ average outcome expectation change. Results shed additional light on various participant characteristics that influence patients’ pretreatment outcome expectation and expectation change through therapy.

Expectation focused and frequency enhanced cognitive behavioural therapy for patients with major depression (EFFECT): a study protocol of a randomised active-control trial

“…[38][39][40] Some studies analysed the relationship between initial expectation change and treatment outcome. [41][42][43] As already mentioned above, initial positive outcome expectations are associated to a better treatment outcome, whereas inducing positive outcome expectations or changing negative ones change significantly the treatment outcome in a positive way. Thus, expectations play a central role in psychotherapy, regarding the therapy outcome 44 45 or the therapeutic relationship.…”

Within‐ and between‐patients associations between self‐efficacy, outcome expectation, and symptom change in cognitive behavioral therapy for generalized anxiety disorder

“…Although extensive research investigating patients' initial SE (Clarke et al, 2014 ; Keshen et al, 2017 ; Pinto et al, 2008 ) and OE (Constantino et al, 2018 ) levels exists, there is limited information on how these patients' cognition change during treatment, especially the change in SE (for a discussion on change in OE in the current sample, see Vîslă et al, 2021 ). In the present study, we found that SE improved during CBT treatment for GAD, which is consistent with the results of two other studies that investigated SE change during treatment (Brown et al, 2014 ; Keshen et al, 2017 ).…”

“…The possible score range for this subscale is from 4 to 20, with higher scores reflecting more positive OE or hope for improvement. PATHEVH demonstrates satisfactory reliability in patients with depression and anxiety (Schulte, 2005 ; 2008 ; Vîslă et al, 2019 ; Vîslă et al, 2021 ). The internal consistency for the current sample was α > 0.76.…”

“…In a comprehensive meta‐analysis, patient‐rated treatment OE before or during early treatment was associated with better posttreatment outcome across varied therapies and diagnoses (weighted r = 0.18; 95% CI: [0.14−0.22]; Constantino et al, 2018 ). However, despite the extensive research on the initial OE and SE levels, there is limited knowledge of how OE changes over the treatment course (Brown et al, 2014 ; Meyerhoff & Rohan, 2016 ; Newman & Fisher, 2010 ; Thiruchselvam et al, 2019 ; Vîslă et al, 2019 ; Vîslă & Constantino, 2021 ), and only few studies have examined changes in patient SE during psychotherapy (Brown et al, 2014 ; Keshen et al, 2017 ). Moreover, even less information is available on how a change in these constructs is associated with improvement in symptoms (Brown et al, 2014 ; Newman & Fisher, 2010 ).…”

“…11For the overall trial design and treatment outcomes see Flückiger et al (2021). Furthermore, secondary analyses of predictors of OE change were investigated in Vîslă et al (2021). …”