From the Department of Clinical Psychology and Psychotherapy (Kube, Glombiewski, Rief), Philipps-University of Marburg, Marburg, Germany.
Psychosom Med. 2018 Jul/Aug;80(6):535-543. doi: 10.1097/PSY.0000000000000596.
Patients' expectations have been shown to predict the course and treatment success of a variety of medical conditions. Therefore, expectation-focused psychological interventions (EFPIs) have been developed to use these expectation effects clinically. Importantly, EFPI differ with regard to the particular expectation mechanism being addressed, i.e., expectation optimization or expectation violation. The aims of this systematic review were to give an overview of the application of these expectation interventions and to evaluate their effectiveness.
Several databases were searched to identify clinical trials or experimental studies that conducted EFPI among participants with various medical conditions. Risk of bias was evaluated using the Cochrane Risk of Bias tool.
Eleven studies (N = 944) investigating different medical conditions (coronary heart disease, cancer, chronic pain) were included. Qualitative synthesis revealed positive effects of EFPI on clinical outcome variables in all studies. Expectation optimization approaches yielded particularly promising results. Because of the large heterogeneity of outcome measures, quantitative synthesis was not possible.
This review highlights the potential of EFPI for optimizing treatment of patients with medical conditions. However, it seems that different expectation mechanisms might have different application possibilities. Therefore, we provide suggestions for further developing EFPI to tailor treatment and develop personalized psychological interventions. We argue that for this purpose, it is important to consider both disease-specific aspects and patients' personality traits. In addition, we discuss future challenges such as implementing EFPI into routine medical care.
研究表明，患者的期望可以预测多种医疗状况的病程和治疗效果。因此，已经开发了以期望为重点的心理干预措施（EFPI），以便在临床上利用这些期望效应。重要的是，EFPI 在针对的特定期望机制方面存在差异，即期望优化或期望违背。本系统评价的目的是概述这些期望干预措施的应用，并评估其效果。
通过搜索多个数据库，确定了针对各种医疗状况的参与者进行 EFPI 的临床试验或实验研究。使用 Cochrane 偏倚风险工具评估偏倚风险。
纳入了 11 项研究（N=944），涉及不同的医疗状况（冠心病、癌症、慢性疼痛）。定性综合分析显示，所有研究中 EFPI 对临床结局变量均有积极影响。期望优化方法尤其取得了有希望的结果。由于结果测量指标的高度异质性，因此无法进行定量综合。
本综述强调了 EFPI 优化治疗患有医疗状况的患者的潜力。然而，不同的期望机制似乎具有不同的应用可能性。因此，我们为进一步开发 EFPI 以调整治疗和开发个性化心理干预措施提供了建议。我们认为，为此目的，考虑疾病特异性方面和患者的个性特征很重要。此外，我们还讨论了实施 EFPI 纳入常规医疗护理等未来挑战。
