From the Journal of Psychotherapy and Psychosomatics press release via AlphaGalileo:
This report analyzes the relationship between outcome expectations of patients undergoing psychotherapy and its success. Results indicate that status at intake (symptoms, well-being, motive-satisfaction) is related to both positive and negative outcome expectations. Whereas cross-sectionally fear is associated with well-being, incongruence and symptom distress, hope is related to well-being and incongruence, but not to symptom distress. Although the level of positive expectations at intake is predictive of treatment outcome, negative expectations are not. Positive expectations are predictive of outcome particularly in patients with high levels of symptom distress.
A report in the 5th 2011 issue of Psychotherapy and Psychosomatics analyzes the relationship between outcome expectations of patients undergoing psychotherapy and its success.
Positive outcome expectations have long been considered an important component of the therapeutic process and a common factor in successful psychotherapy. However, expectations are not only directed to positive outcomes (hope of improvement), but also to potential negative outcomes (fear of change and of side effects). In psychotherapy research up to now, the concept of outcome expectations was typically used to denote the potential benefits of treatment, but rarely to denote negative side effects.
Consequently, the aim of this study was to investigate the relationship between positive and negative outcome expectations and treatment outcome in psychotherapy inpatients. The investigators hypothesized first that both hope of improvement and fear of change are related to psychological functioning (symptom distress, well-being and incongruence) at intake, and second, that hope of improvement and fear of side effects predict therapy outcome. Incongruence denotes the subjective experience of insufficient motive satisfaction in interaction with the environment.
159 German applicants for an intensive cognitive-behavioral inpatient treatment were interviewed. During a day of assessment, applicants underwent diagnostic interviews and completed self-report measures including: the Symptom Checklist-90-R,the short version of the World Health Organization’s Quality of Life Measure, the Patients’ Therapy Expectation and Evaluation, and the short version of the Incongruence Questionnaire, measuring insufficient motive satisfaction. Participants completed self-report measures again after treatment, as well as 6 weeks (follow-up 1, FU1) and 1 year (FU2) later.
Principal diagnoses were assessed using a structured interview for DSM-IV. Principal diagnoses were: 27.0% anxiety disorder (n = 43), 27.0% eating disorder (n =43), 26.4% affective disorder (n = 42), 13.8% obsessive-compulsive disorder (n= 22), and 5.7% alcohol dependence (n = 9). Therapists were blinded to research questions. Hope of improvement and fear of change at pretreatment were negatively correlated. Hope of improvement was negatively correlated with lacking motive satisfaction (incongruence), whereas hope was positively correlated with quality of life. Interestingly, hope was not significantly correlated with symptom distress. Correlations were in the opposite direction for fear of change. However, a significantly positive correlations for symptom distress and incongruence was found. Psychological well-being correlated negatively with fear of change. The investigators tested the prediction of treatment outcome by hope of improvement and fear of change at baseline, using separate hierarchical regression analyses for FU1, and FU2.
In the 1st step, initial levels of symptom distress accounted for 36% of variance in symptom distress at posttreatment. In the 2nd step, hope and fear added another 10% of explained variance (p< 0.01). Whereas there was a significant main effect of hope (p<0.01), fear did not explain an extra variance ( n.s.). Six weeks after treatment (FU1), hope and fear explained an additional 3% of variance p< 0.05). Whereas hope was again a significant predictor (p<0.05), fear was not (n.s.).
One year after treatment (FU2), hope and fear no longer added variance in the prediction of posttreatment symptom distress (n.s). In a post-hoc moderation analysis, the interaction between pretreatment symptom distress and hope explained an additional 2% of the variance (p<0.01) over and above the 45% explained by distress and hope alone (p<0.01). Thus at high levels of symptom distress, stronger hope for improvement predicted less symptom distress after treatment (p<0.01), whereas at low levels of symptom distress, hope for improvement was not predictive (n.s.).
In sum, these results indicate that status at intake (symptoms, well-being, motive-satisfaction) is related to both positive and negative outcome expectations. Whereas cross-sectionally fear is associated with well-being, incongruence and symptom distress, hope is related to well-being and incongruence, but not to symptom distress. Although the level of positive expectations at intake is predictive of treatment outcome, negative expectations are not. Positive expectations are predictive of outcome particularly in patients with high levels of symptom distress.
The present study has several shortcomings. Intake chronicity, previous treatments, or remission after treatment were not assessed. In addition, only completer data were analyzed, which along with a considerable loss to follow-up, warrants caution when interpreting the long-term impacts of outcome expectations. If the dropouts had more negative expectations at the outset compared to completers, the high dropout rate may have led to underestimating the impact of negative expectations. Future studies should analyze dropouts, determinants of outcome expectations, impact on treatment process, and changes in outcome expectations over therapy. The enhancement of positive expectations in severely distressed patients promises to be a worthwhile avenue for future research.