Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: an investigation of mediation

Patients’ outcome expectancies and the working alliance are two psychotherapy process variables that researchers have found to be associated with treatment outcome, irrespective of treatment approach and problem area. Despite this, little is known about the mechanisms accounting for this association, and whether contextual factors (e.g., psychotherapy type) impact the strength of these relationships. The primary aim of this study was to examine whether patient-rated working alliance quality mediates the relationship between outcome expectancies and pre- to post-treatment change in anxiety symptoms using data from a recent randomized clinical trial comparing a transdiagnostic treatment (the Unified Protocol [UP]; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook, Oxford University Press, New York, 2011a; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Patient workbook. New York: Oxford University Press, 2017b) to single diagnosis protocols (SDPs) for patients with a principal heterogeneous anxiety disorder (n = 179). The second aim was to explore whether cognitive-behavioral treatment condition (UP vs. SDP) moderated this indirect relationship. Results from mediation and moderated mediation models indicated that, when collapsing across the two treatment conditions, the relationship between expectancies and outcome was partially mediated by the working alliance [B = 0.037, SE = 0.05, 95% CI (.005, 0.096)]. Interestingly, within-condition analyses showed that this conditional indirect effect was only present for SDP patients, whereas in the UP condition, working alliance did not account for the association between expectancies and outcome. These findings suggest that outcome expectancies and working alliance quality may interact to influence treatment outcomes, and that the nature and strength of the relationships among these constructs may differ as a function of the specific cognitive-behavioral treatment approach utilized.This study was funded by grant R01 MH090053 from the National Institutes of Health. (R01 MH090053 - National Institutes of Health)First author draf

Which outcome expectancies are important in determining young adults intentions to use condoms with casual sexual partners?: A cross-sectional study

Background: The prevalence of unwanted pregnancy and sexually transmitted infection amongst young adults represents an important public health problem in the UK. Individuals attitude towards the use of condoms has been identified as an important determinant of behavioural intentions and action. The Theory of Planned Behaviour has been widely used to explain and predict health behaviour. This posits that the degree to which an individual positively or negatively values a behaviour (termed direct attitude) is based upon consideration of the likelihood of a number of outcomes occurring (outcome expectancy) weighted by the perceived desirability of those outcomes (outcome evaluation). Outcome expectancy and outcome evaluation when multiplied form indirect attitude. The study aimed to assess whether positive outcome expectancies of unprotected sex were more important for young adults with lower safe sex intentions, than those with safer sex intentions, and to isolate optimal outcomes for targeting through health promotion campaigns. Methods: A cross-sectional survey design was used. Data was collected from 1051 school and university students aged 16-24 years. Measures of intention, direct attitude and indirect attitude were taken. Participants were asked to select outcome expectancies which were most important in determining whether they would use condoms with casual sexual partners. Results: People with lower safe sex intentions were more likely than those with safer sex intentions to select all positive outcome expectancies for unprotected sex as salient, and less likely to select all negative outcome expectancies as salient. Outcome expectancies for which the greatest proportion of participants in the less safe sex group held an unfavourable position were: showing that I am a caring person, making sexual experiences less enjoyable, and protecting against pregnancy. Conclusions: The findings point to ways in which the attitudes of those with less safe sex intentions could be altered in order to motivate positive behavioural change. They suggest that it would be advantageous to highlight the potential for condom use to demonstrate a caring attitude, to challenge the potential for protected sex to reduce sexual pleasure, and to target young adults risk appraisals for pregnancy as a consequence of unprotected sex with casual sexual partners

The Contribution Of Outcome Expectancies To Drinking Behaviour

The present dissertation was conducted to gain a better theoretical understanding of the contribution of outcome expectancies to male undergraduate drinking behaviour. Two assumptions important to the construct validity of outcome expectancies were investigated: (1) outcome expectancies are situation-specific and (2) outcome expectancies are different from attitudes toward drinking.;In each of the four studies conducted in the first series of studies, environmental setting (i.e., bar vs. lab) was manipulated and a second variable was manipulated through instructional set. Specifically, expected beverage content (i.e., beer vs. soda pop), social context (i.e., alone, with friends, no explicit instructions), and level of intoxication (i.e., early vs. latter) was manipulated in Experiments 1, 2, and 3 respectively. In Experiments 1 through 3, weighted outcome expectancies (i.e., likelihood x valence ratings) were assessed using a modified version of the Alcohol Effects Questionnaire, REQ-Revised (Rohsenow, 1983). Experiment 4 was a partial replication of Experiment 3, however, a modified version of the Alcohol Effects Scale, AES-Revised (Southwick, Steele, Marlatt, & Lindell, 1981) was administered. Evidence for the situational-specificity hypothesis was obtained only in Experiment 4 in which the AES-Revised was employed.;In Experiment 5, the contribution of outcome expectancies (as assessed by both the REQ-Revised and the AES-Revised) to the Theory of Reasoned Action-TRA (Ajzen & Fishbein, 1980) and the Theory of Planned Behaviour-TPB (Ajzen, 1988) was investigated. Overall, the TPB was superior to the TRA in predicting self-report excessive consumption episodes among male undergraduates. Outcome expectancies, as assessed by the AES-Revised, did not make a unique contribution to the TPB. In contrast, weighted expectancies for Enhanced Sexual Functioning (as assessed by the REQ-Revised) improved the prediction of self-report excessive monthly drinking episodes, over and above components of the TPB.;Three tentative conclusions are drawn. First, two types of outcome expectancies may exist: generalized and situation-specific. Secondly, investigations that examine the sole contribution of outcome expectancies to drinking behaviour may be too narrow in their approach. Finally, the TPB is a useful theoretical framework to explore both the construct validity of outcome expectancies and how these processes contribute to drinking behaviour

Social Anxiety and Drinking Behaviors in College Students: Mediated by Alcohol Outcome Expectancies Specific to Social Situations?

Understanding the relationship between social anxiety and problematic drinking is a difficult task. Studies examining this relationship have commonly found a positive correlation between social anxiety and drinking behaviors, although the literature is marked by mixed results. If social anxiety does positively predict alcohol use, then what accounts for this relationship? Some researchers posit that alcohol outcome expectancies may be a mediator for this relationship. Alcohol outcome expectancies specific to the context of social evaluative situations may be a stronger mediator than general alcohol outcome expectancies. A study to test this mediation was conducted with xxx undergraduate students. Results showed that alcohol outcome expectancies specific to socially evaluative situations significantly mediated the relationship between social anxiety and problematic drinking. Also, alcohol outcome expectancies specific to socially evaluative situations was a stronger mediator in the relationship between social anxiety and problematic drinking than general positive alcohol outcome expectancies. Regression analyses showed that after controlling for social anxiety and demographic variables, fear of negative and fear of positive evaluation were not significant predictors of problematic drinking, though alcohol outcomes expectancies specific to socially evaluative situations remained a significant predictor

Worse or even better than expected? Outcome expectancies and behavioral experiences in the context of physical activity among cancer patients

Expectancies of cancer patients regarding their physical activity before they took part in a behavior change intervention were compared with their experiences during the intervention period. A total of 66 cancer patients completed either a randomly assigned 4-week physical activity or a stress-management counseling intervention. On average, participants had positive expectancies toward physical activity. Outcome expectancies predicted outcomes (e.g. physical activity) at a 10-week follow-up. Outcome realization (discrepancy between expectancies and experiences) further increased explained variance in self-efficacy and physical activity enjoyment. In conclusion, not only initial outcome expectancies but also their realizations seem to be important for subsequent behavior and cognitions

CONSTRUCTION AND VALIDATION OF A NON-MEDICAL USE OF PRESCRIPTION OPIOIDS OUTCOME EXPECTANCIES SCALE AMONG COLLEGE STUDENTS IN CHINA

Background:Non-medical use of prescription opioids (NMUPO) has become a clear threat to public health. Young adults (aged 18 to 25) have a high risk of NMUPO. My prior work on Chinese undergraduates indicates a high prevalence of lifetime NMUPO (49.2%). Health behavior theories propose that outcome expectancies are robust psychosocial determinants of substance use. Literature has identified the influence of outcome expectancies on alcohol and drug use. However, the role of outcome expectancies in NMUPO in China is unknown, and a scarcity of a valid measures for NMUPO outcome expectancies may be a barrier. Our previous research also found an association of cultural orientation with NMUPD in Chinese college students, implying that cultural orientation may affect NMUPD-related perceptions, such as outcome expectancies. The purposes of this study were to (1) conduct initial work to develop and validate an NMUPO outcome expectancies scale (NMUPOES) for Chinese college students; (2) examine the association of cultural orientation with factors identified in NMUPOES. Method: Partial data (n = 202) derived from a bigger online dataset collected from 849 undergraduates (average age = 19.65) at two universities in Beijing and Macau in Jan-April 2017 was used in this study. Participants completed the NMUPOES and reported their past-3-month NMUPO and cultural orientation. Exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were employed to test the study hypotheses. Results: Findings suggested four subscales in the 50-item NMUPOES (i.e., social enhancement and tension reduction, academic enhancement, physiological discomfort, and guilt and dependence) and two higher-order factors (i.e., positive expectancies and negative expectancies). All subscales were positively correlated and had good internal consistency. The negative expectancies scale was negatively associated with past-3-month NMUPO. No significant association was found between cultural orientation and the two expectancy factors. Conclusion:NMUPOES is a psychometrically appropriate measure of NMUPO expectancies for Chinese college students. Future research may validate the NMUPOES using a large sample size in both clinical and non-clinical populations in China. An intervention program tailored to outcome expectancies may be beneficial to reduce the risk of NMUPO in Chinese college students

Examining the Relationship Between Outcome Expectancies and Anxiety Severity in Patients Using Medical Marijuana

Many states have legalized marijuana for medical and recreational use despite it being classified as a Schedule I controlled substance. Although research regarding its efficacy is limited, one of the most common medical marijuana referral reasons is anxiety and patients often report experiencing reductions in anxiety. Many patients have beliefs about the effects of medical marijuana, called outcome expectancies, which may differ based on previous recreational marijuana use. These beliefs may influence anxiety outcomes, but this relationship is still unclear. The purpose of this study is to examine the relationship between patients’ medical marijuana outcome expectancies, previous recreational marijuana use, and levels of anxiety in adults using medical marijuana for anxiety over the first three months of use. It was hypothesized that (a) participants with more years of previous recreational marijuana use will report significantly higher positive medical marijuana outcome expectancies at baseline, (b) higher positive medical marijuana outcome expectancies at baseline will be associated with lower levels of anxiety at the 3- month follow-up, and (c) previous recreational marijuana use will moderate the relationship between positive medical marijuana outcome expectancies and levels of anxiety at the 3-month follow-up. This study used archival data from a larger study being conducted at the Philadelphia College of Osteopathic Medicine and funded by Organic Remedies. Participants included 73 adults who are new to medical marijuana treatment and have a medical marijuana referral for anxiety only. Study hypotheses were not supported suggesting that a placebo-like effect may not be occurring for positive medical marijuana outcome expectancies on anxiety outcomes. Future research should capitalize on these limitations to further understand the effects of outcome expectancies on anxiety

What Happens in Therapy? Adolescents' Expectations and Perceptions of Psychotherapy

An empirically based measure of adolescent pre-treatment expectations and perceptions of psychotherapy is provided with supporting literature from service-use models, common factors research, evidence-based practice principles, and expectancies. The development of the Psychotherapy Expectations and Perceptions Inventory (PEPI) is described with initial psychometric properties reported based on data from 546 adolescents (age 14-18). Results indicate adequate internal consistency and a 3 factor structure measuring negative expectancies, process/outcome expectancies, and expectancies for a positive therapeutic relationship. Boys reported greater negative expectancies, but also greater expectancies for a positive therapeutic relationship. Girls reported greater therapy process/outcome expectancies. Level of contact with mental illness was not a significant predictor for any factors. An item response report is provided. Clinical and educational implications are discussed. Clinicians might be advised assess adolescent expectancies in treatment to facilitate greater rapport and engagement in the therapeutic process in order to foster more therapeutic change

Work and Mental Complaints: Are Response Outcome Expectancies More Important Than Work Conditions and Number of Subjective Health Complaints?

Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees’ response outcome expectancies

The Influence of Positive and Negative Affect on the Processing of Outcome Expectancies Related to Risky Sexual Practices

The current study is a continuation on a line of research examining the effects of affective states on cognitions related to risky sexual behavior and is based on the Prototype/Willingness Model (Gibbons, Gerrard, & Lane, 2003). Past research (Pomery, 2004) found that mood states had a greater influence on behavioral willingness (BW) to engage in risky sexual behavior than on behavioral intentions/expectations (BI/BE) to engage in risky sexual behavior. Negative affective states were associated with greater levels of willingness and positive affective states were associated with lower levels of willingness. The current study investigated the effects of happy, sad, and neutral mood states on positive and negative outcome expectancies and other risk cognitions (willingness, intentions/expectations, prototype images, perceived vulnerability). College students (N = 110), who were pre-selected based on their prior high levels of willingness and either low or high levels of intentions, were randomly assigned to one of the three mood conditions (happy, sad, neutral). After the mood induction, participants were exposed to eight positive and eight negative outcome expectancies and their endorsements of these expectancies were measured, along with their response times. This was followed by the other risk cognition measures. It was hypothesized that those in the negative mood condition would more strongly endorse the positive outcome expectancies, as they would be motivated to improve their current mood state. In contrast, participants in the happy mood condition were expected to have lower levels of endorsement for the positive outcome expectancies. In addition, it was hypothesized that the effects of the induced mood states would be moderated by prior level of BW and BI, with those at risk (high BW/low BI) showing stronger mood effects than those more committed to the risky behavior (high BW/high BI). Contrary to expectations, no effects of mood were found on the endorsement of outcome expectancies in any of the repeated-measures analyses. When examining only the negative outcome expectancies, there were significant effects of mood on the Would this be important to you? item, though not as predicted. The negative outcome expectancies received the highest importance ratings from those who were in the happy mood condition and were higher in mass-testing BI/BE. There were few effects of mood on the positive outcome expectancy items. Not surprisingly, those in the high BW/high BI group (the intenders ) showed greater endorsement of the positive outcome expectancies and lower endorsement of the negative outcome expectancies; these effects may be due to dissonance reduction. Contrary to predictions, however, when interactions were found, it was the high BW/high BI group that showed the stronger mood effects ( the intenders ). With respect to the response time measures, those in the happy mood condition with higher levels of prior BI/BE were quicker at reading the negative outcome expectancies; those in the sad condition took longer to report whether these expectancies either came to mind or were important to them. Those in the sad mood condition reported the highest levels of BW and BI/BE during the experimental session