Predictors of Change in Patient Treatment Outcome Expectation During Cognitive-Behavioral Psychotherapy for Generalized Anxiety Disorder

• Published in: Psychotherapy (Chicago, Ill.) Ill.), 2021-06, Vol.58 (2), p.219-229
• Main Authors: Vîslă, Andreea, Constantino, Michael J., Flückiger, Christoph
• Format: Article
• Language: English
• Subjects: Attitude Change; Client Characteristics; Cognitive Behavior Therapy; Expectations; Female; Generalized Anxiety Disorder; Human; Male; Self-Efficacy; Treatment; Treatment Outcomes
• ISSN: 0033-3204; 1939-1536
• DOI: 10.1037/pst0000371

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. Clinical Impact StatementQuestion: This article examined patients' change in outcome expectation across cognitive-behavior therapy for generalized anxiety disorder, as well as participant factors that are associated with both pretreatment outcome expectation and expectation change. Findings: On average, patients' outcome expectation becomes more positive over time. Moreover, the degree of such change is influenced by several baseline and early treatment patient factors and by the therapist themselves. Meaning: Therapists should consider assessing outcome expectation throughout cognitive-behavior therapy for generalized anxiety disorder and pay attention