Expectation-Focused Psychotherapy to Improve Clinical Outcomes.

Placebo research has shown that patients' expectations are among the strongest predictors of treatment outcome regarding various medical conditions. Therefore, interventions focusing on the change of such expectations might be most effective. This could be of relevance not only for outcome expectations but also for disease-specific, problem-specific, and treatment-specific expectations. A theoretical model is introduced to illustrate the conditions for expectation change and persistence. Strategies for patients regarding how to devalue learning effects in expectation violation situations are exemplified, and ways to optimize expectation-violating effects are highlighted. Data from a large randomized controlled trial serve as a practical example and demonstrate the effect of a presurgery optimization of expectations in patients scheduled for heart surgery (coronary artery bypass grafting). Disability scores that were obtained 6 months postsurgery confirmed that patients who participated in preoperative psychological interventions, which aimed at optimizing expectations, demonstrate the best outcome after heart surgery. Practical aspects of the intervention are presented, and suggestions on implementing these procedures to optimize outcome in medical interventions are discussed. Psychotherapy is conceptualized as an intervention that should target expectation violation of disorder- and treatment-specific expectations.