Using expectation violation models to improve the outcome of psychological treatments

• Published in: Clinical psychology review Vol. 98; p. 102212
• Main Authors: Rief, Winfried, Sperl, Matthias F.J., Braun-Koch, Kristina, Khosrowtaj, Zahra, Kirchner, Lukas, Schäfer, Leonora, Schwarting, Rainer K.W., Teige-Mocigemba, Sarah, Panitz, Christian
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.12.2022
• Subjects: Anxiety; Attention; Depression; Expectation; Expectation violation; Humans; Mental Disorders - therapy; Motivation; Predictive coding; Treatment outcome; Predictive coding; Treatment outcome; Depression; Anxiety; Expectation violation; Expectation
• ISSN: 0272-7358; 1873-7811; 1873-7811
• DOI: 10.1016/j.cpr.2022.102212

Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures. •Many clinically relevant expectations persist even after contradicting experiences.•Most psychological treatments do not consider the basic psychological concepts of expectation change.•Different psychological perspectives can help to better understand how expectations are changed.•We provide recommendations for how to improve the efficacy of psychological treatments that aim to change expectations.