Kooistra Marike J, Schoorl Maartje, Oprel Danielle A C, van der Does Willem, de Kleine Rianne A
Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.
Parnassia Groep, PsyQ, The Hague, The Netherlands.
Eur J Psychotraumatol. 2025 Dec;16(1):2447183. doi: 10.1080/20008066.2024.2447183. Epub 2025 Jan 7.
It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD. We aimed to test whether explicitly focusing on expectancy violation leads to superior exposure outcomes. Adult treatment-seeking patients with PTSD ( = 60) were randomly assigned to one 90-minute exposure session focusing on either expectancy violation or a control condition without an expectancy focus. Assessments occurred before the session and one week later, measuring changes in fear responses during a script-driven imagery task, and PTSD symptoms. Using multilevel analyses, we found no between-condition differences. On average, fear responses to the imagery and PTSD symptoms decreased over time. The expectancy violation condition exhibited a greater decrease in threat appraisal, which appeared to mediate symptom reduction. We found no evidence that explicitly focusing on expectancy violation led to superior immediate effects. However, it may lead to more changes in expectancies which could affect symptom improvement over an extended period. Further research is needed to determine whether emphasizing expectancy violation in exposure therapy for PTSD is advantageous.
有人提出，将预期违背最大化可提高暴露疗法的疗效。预期违背的临床效用仍不明确，且尚未在创伤后应激障碍（PTSD）中进行研究。我们旨在测试明确关注预期违背是否会带来更好的暴露结果。60名寻求治疗的成年PTSD患者被随机分配到一个90分钟的暴露环节，该环节要么聚焦于预期违背，要么为不聚焦预期的对照条件。在环节开始前和一周后进行评估，测量在脚本驱动的意象任务中恐惧反应的变化以及PTSD症状。使用多水平分析，我们未发现组间差异。平均而言，对意象的恐惧反应和PTSD症状随时间减少。预期违背组在威胁评估方面的下降幅度更大，这似乎介导了症状减轻。我们没有发现证据表明明确关注预期违背会带来更好的即时效果。然而，它可能会导致预期发生更多变化，这可能会在较长时期内影响症状改善。需要进一步研究以确定在PTSD暴露疗法中强调预期违背是否有益。
