Patient’s Outcome Expectancies and Treatment Outcome Influence of Patient’s Outcome Expectancies on Symptom Improvement and Drop-out in Interpersonal Psychotherapy and Cognitive Therapy for adult depression
AbstractThis study aims to explore the influence of expectations on treatment outcome of depressed patients following Interpersonal Psychotherapy or Cognitive Therapy. Patients’ baseline outcome expectations might influence post-treatment symptom improvement and dropout during treatment. Outcome expectations are hypothesized to influence the level of symptom improvement and the drop-out risk. The current study is based on data collected in a large RCT in which participants are assigned to either Cognitive Psychotherapy (N=76) or Interpersonal Psychotherapy (N=75) in order to be treated for a primary depressive episode. The Outcome Expectations Questionnaire was conducted at baseline, followed by a 7 months intervention phase. The primary outcome measurement is symptom improvement, which is the difference in symptoms at 7 months and at baseline. The second outcome measurement, drop-out, is the percentage participants that stop the treatment after following less than 12 session, while still having complains. The relationship between outcome expectations and symptom improvement and between outcome expectations and drop-out were analyzed separately. Contradictory to the hypothesis, the data did not show a significant relationship between outcome expectations and symptom improvement or drop-out. These findings implicate that patients with low outcome expectations have the same symptom improvement and risk to drop-out of the treatment as patients with high expectations. Other studies support this findings. However, more well-designed major studies are needed in order to gather more evidence-based information on the influence of outcome expectations on treatment outcome.
Arnkoff, D. B., Glass, C. R., & Shapiro, S. J. (2002). Expectations and Preferences. In J. C. Norcross (Ed.),Psychotherapy Relationships That Work: Therapists Contribution and Responsiveness to Patient (pp. 325-346). New York: Oxford University Press.
Beck, A. T., Steer, R., & Brown, G. K. (1996). Beck Depression Inventory II: Manual. Boston: Hartcourt Brace.
Bijl, R., Ravelli, A., & Van Zessen, G. (1998). Prevalence of psychiatric disorder in the general population:results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social psychiatry and psychiatric epidemiology, 33(12), 587-595. Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal ofConsulting and Clinical Psychology, 70(2), 288.
Chambless, D. L., Tran, G. Q., & Glass, C. R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of anxiety disorders, 11(3), 221-240.
Cohen, M., Beard, C., & Björgvinsson, T. (2015). Examining Patient Characteristics as Predictors of Patient Beliefs About Treatment Credibility and Expectancies for Treatment Outcome. Journal of Psychotherapy Integration.
Constantino, M. J., Arnkoff, D. B., Glass, C. R., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. J Clin Psychol, 67(2), 184-192.
De Graaf, R., Ten Have, M., & van Dorsselaer, S. (2010). De psychische gezondheid van de Nederlandse bevolking. Nemesis-2: Opzet en eerste resultaten, Trimbos-Instituut, Utrecht.
Devilly, G. J., & Borkovec, T. D. (2000). Psychometric Properties of the Credibility/Expectancy Questionnaire. Journal of BehaviorTherapy and Experimental Psychiatry(31), 73-86.
Greenberg, R. P., Constantino, M. J., & Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clin Psychol Rev, 26(6), 657-678.
Lemmens, L. H. J. M., Arntz, A., Peeters, F., Hollon, S. D., Roefs, A., & Huibers, M. J. H. (2015). Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial. Psychological Medicine, 45(10), 2095-2110.
Mathers, C., Fat, D. M., & Boerma, J. T. (2008). The global burden of disease: 2004 update: World Health Organization.
Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70(4), 1051-1055.
Tsai, M., Ogrodniczuk, J. S., Sochting, I., & Mirmiran, J. (2014). Forecasting success: patients’ expectations for improvement and their relations to baseline, process and outcome variables in group cognitivebehavioural therapy for depression. Clin Psychol Psychother, 21(2), 97-107.
Van der Does, A. (2002). BDI-II-NL. Handleiding. De Nederlandse versie van de beck depression inventory: Lisse: Harcourt Test Publishers.
Van Londen, L., Molenaar, R., Goekoop, J., Zwinderman, A., & Rooijmans, H. (1998). Three-to 5-year prospective follow-up of outcome in major depression. Psychological Medicine, 28(03), 731-735.
Vogel, P. A., Hansen, B., Stiles, T. C., & Götestam, K. G. (2006). Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. Journal of Behavior Therapy and Experimental Psychiatry, 37(3), 247-255.
Webb, C. A., Kertz, S. J., Bigda-Peyton, J. S., & Bjorgvinsson, T. (2013). The role of pretreatment outcome expectancies and cognitive-behavioral skills in symptom improvement in an acute psychiatric setting. J Affect Disord, 149(1-3), 375-382. Whisman, M. A., Perez, J. E., & Ramel, W. (2000). Factor structure of the Beck Depression Inventory- Second Edition (BDI‐ii) in a student sample. Journal of clinical psychology, 56(4), 545-551.
Yin, P., & Fan, X. (2000). Assessing the reliability of Beck Depression Inventory scores: Reliability generalization across studies. Educational and Psychological Measurement, 60(2), 201-223.