Impact of patient expectation, motivation, and satisfaction on outcomes of neurosurgical deep brain stimulation in treatment-resistant depression and obsessive–compulsive disorder

Abstract

Background

Treatment-resistant major depressive disorder (MDD) and treatment-resistant obsessive–compulsive disorder (OCD) are the two main application areas of Deep Brain Stimulation (DBS) in psychiatry. DBS in treatment-resistant OCD patients is part of the guidelines, while this procedure in treatment-resistant depressive patients, is still being regarded as being under development.

Objectives

This study aimed to explore the role of patient-related factors—specifically, expectation, motivation, and satisfaction—in the context of DBS outcomes in patients with treatment-resistant depression and OCD. The focus was on descriptively examining how these factors present before and after the surgery, and how they may relate to patients’ perception of treatment efficacy.

Methods

A total of 58 patients participated in the study. Three measurement instruments were used for the investigation − the Client Motivation for Therapy Scale, the Stanford Expectancy Treatment Scale and the Credibility/Expectancy Questionnaire.

Results

Negative expectations decreased significantly, and realistic expectations increased postoperatively in both groups. Correlations between expectation levels and perceived treatment efficacy were observed at various time points. No significant differences in motivational behavior were found between the groups. Overall satisfaction with DBS was high across groups, with 81 % indicating they would choose the treatment again.

Conclusions

The findings highlight the relevance of patient factors such as motivation, expectation, and satisfaction in the treatment of psychiatric patients undergoing DBS. These aspects, while not predictive in a causal sense, offer valuable insights into patient engagement and perceived benefit. Managing patient expectations, as in many invasive therapies, remains a key component of therapeutic success.