Rief Winfried, Sperl Matthias F J, Braun-Koch Kristina, Khosrowtaj Zahra, Kirchner Lukas, Schäfer Leonora, Schwarting Rainer K W, Teige-Mocigemba Sarah, Panitz Christian
Department of Psychology, University of Marburg, Marburg, Germany.
Department of Psychology, University of Marburg, Marburg, Germany; Department of Psychology, University of Giessen, Giessen, Germany.
Clin Psychol Rev. 2022 Dec;98:102212. doi: 10.1016/j.cpr.2022.102212. Epub 2022 Oct 15.
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.
期望是精神障碍的一种核心维持机制，大多数心理治疗旨在直接或间接地改变具有临床相关性的期望。因此，至关重要的是要探究为什么精神障碍患者即使面对反证仍维持功能失调的期望，以及在治疗环境中应如何制造违反期望的情境，以优化治疗效果并降低治疗失败的风险。不同的心理学子学科提供了各种理解期望形成、持续和改变的潜在机制的方法。在此，我们基于这些不同视角传达关于如何改进心理治疗的建议。基于我们的期望违背模型，我们认为期望违背的结果取决于几个特征：违背期望情境的特征；期望违背程度与认知免疫过程之间的动态关系；在期望改变期间及之后应对不确定性；控制性和自动性注意过程；以及期望改变的成本。人格因素进一步增加了预测结果的能力，并可能为个性化治疗计划提供基础。我们最后列出一系列源自基础心理学的建议，这些建议可能有助于改善治疗效果并降低治疗失败的风险。
