From Expectation to Learning: A Mediational Model of Exposure Therapy Outcome in Anxiety Disorders.

IF 17.4 1区医学 Q1 PSYCHIATRY

Psychotherapy and Psychosomatics Pub Date : 2026-04-14 DOI:10.1159/000551966

Benjamin Straube,Lukas Kirchner,Gina L Haccou,Isabelle C Ridderbusch,Ingmar Heinig,Jan Richter,Ulrike Lueken,Paul Pauli,Jürgen Deckert,Katharina Domschke,Peter Neudeck,Katja Koelkebeck,Udo Dannlowski,Volker Arolt,Thomas Fydrich,Andreas Ströhle,Jürgen Margraf,Silvia Schneider,Jürgen Hoyer,Alfons O Hamm,Hans-Ulrich Wittchen,Tilo Kircher,Winfried Rief,Andre Pittig

{"title":"From Expectation to Learning: A Mediational Model of Exposure Therapy Outcome in Anxiety Disorders.","authors":"Benjamin Straube,Lukas Kirchner,Gina L Haccou,Isabelle C Ridderbusch,Ingmar Heinig,Jan Richter,Ulrike Lueken,Paul Pauli,Jürgen Deckert,Katharina Domschke,Peter Neudeck,Katja Koelkebeck,Udo Dannlowski,Volker Arolt,Thomas Fydrich,Andreas Ströhle,Jürgen Margraf,Silvia Schneider,Jürgen Hoyer,Alfons O Hamm,Hans-Ulrich Wittchen,Tilo Kircher,Winfried Rief,Andre Pittig","doi":"10.1159/000551966","DOIUrl":null,"url":null,"abstract":"INTRODUCTION\r\nNegative expectations about treatment outcomes are associated with poorer recovery in anxiety disorders. However, it remains unclear whether (1) patients' expectations about how effective the treatment will be (treatment-specific expectations) mediate the link between generalized negative expectations (i.e. unspecific pessimistic beliefs) and treatment outcomes, and (2) these expectations affect outcomes via the learning rate during exposure therapy, that is, the extent to which patients update their fear-related beliefs based on corrective experiences. Since treatment-specific expectations may be more modifiable, clarifying these mechanisms could improve interventions. This study investigated whether treatment-specific expectations and learning rate mediate the effect of generalized negative expectations on treatment outcomes.\r\n\r\nMETHODS\r\nData from 605 patients with various anxiety disorders undergoing 12 sessions of manualized exposure therapy were analyzed. Generalized negative expectations at baseline (session 0) were hypothesized to predict treatment outcomes (i.e., symptom severity at post treatment) via expectations about treatment success measured at session 4 and learning rate during exposure. Depression and anxiety at baseline were covariates. Mediation analyses were conducted using the PROCESS macro with bootstrap confidence intervals.\r\n\r\nRESULTS\r\nGeneralized negative expectations predicted poorer treatment outcomes (higher symptom severity), mediated by lower expectations about treatment success (β = 0.0375; 95% CI: 0.0088-0.0730). A sequential mediation via these treatment-specific expectations and learning rate was also significant (β = 0.0059; 95% CI: 0.0008-0.0134), even after accounting for baseline symptom levels (R² = 0.3375).\r\n\r\nCONCLUSION\r\nTargeting both generalized and treatment-specific expectations early in treatment may enhance exposure-based learning and improve clinical outcomes in anxiety disorders.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"68 1","pages":"1-25"},"PeriodicalIF":17.4000,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psychotherapy and Psychosomatics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000551966","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 0

Abstract

INTRODUCTION Negative expectations about treatment outcomes are associated with poorer recovery in anxiety disorders. However, it remains unclear whether (1) patients' expectations about how effective the treatment will be (treatment-specific expectations) mediate the link between generalized negative expectations (i.e. unspecific pessimistic beliefs) and treatment outcomes, and (2) these expectations affect outcomes via the learning rate during exposure therapy, that is, the extent to which patients update their fear-related beliefs based on corrective experiences. Since treatment-specific expectations may be more modifiable, clarifying these mechanisms could improve interventions. This study investigated whether treatment-specific expectations and learning rate mediate the effect of generalized negative expectations on treatment outcomes. METHODS Data from 605 patients with various anxiety disorders undergoing 12 sessions of manualized exposure therapy were analyzed. Generalized negative expectations at baseline (session 0) were hypothesized to predict treatment outcomes (i.e., symptom severity at post treatment) via expectations about treatment success measured at session 4 and learning rate during exposure. Depression and anxiety at baseline were covariates. Mediation analyses were conducted using the PROCESS macro with bootstrap confidence intervals. RESULTS Generalized negative expectations predicted poorer treatment outcomes (higher symptom severity), mediated by lower expectations about treatment success (β = 0.0375; 95% CI: 0.0088-0.0730). A sequential mediation via these treatment-specific expectations and learning rate was also significant (β = 0.0059; 95% CI: 0.0008-0.0134), even after accounting for baseline symptom levels (R² = 0.3375). CONCLUSION Targeting both generalized and treatment-specific expectations early in treatment may enhance exposure-based learning and improve clinical outcomes in anxiety disorders.

查看原文本刊更多论文

从期望到学习：焦虑障碍暴露治疗结果的中介模型。

对治疗结果的负面预期与焦虑症较差的康复有关。然而，目前尚不清楚(1)患者对治疗效果的期望（治疗特异性期望）是否介导了广义负面期望（即非特异性悲观信念）与治疗结果之间的联系，以及(2)这些期望是否通过暴露治疗期间的学习率影响结果，即患者基于纠正经验更新恐惧相关信念的程度。由于治疗特异性期望可能更容易改变，因此澄清这些机制可以改善干预措施。本研究探讨了治疗特异性期望和学习率是否介导广义负面期望对治疗结果的影响。方法对605例不同类型焦虑症患者进行12次暴露治疗的数据进行分析。假设基线（第0阶段）的广义负面预期可以通过第4阶段测量的治疗成功预期和暴露期间的学习率来预测治疗结果（即治疗后的症状严重程度）。基线时的抑郁和焦虑为协变量。使用带有自举置信区间的PROCESS宏进行中介分析。结果广义负面期望预测较差的治疗结果（较高的症状严重程度），其中介作用是对治疗成功的较低期望（β = 0.0375; 95% CI: 0.0088-0.0730）。即使在考虑了基线症状水平（R²= 0.3375）之后，通过这些治疗特异性期望和学习率进行的顺序中介也很显著（β = 0.0059; 95% CI: 0.0008-0.0134）。结论在治疗早期同时针对广义期望和治疗特异性期望，可增强焦虑症患者基于暴露的学习，改善临床预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.