The role of pretreatment outcome expectancies and cognitive–behavioral skills in symptom improvement in an acute psychiatric setting

Abstract

BackgroundPrior research has found that pretreatment expectations of symptom improvement are positively correlated with depressive symptom change. The current investigation extends previous research by examining whether pretreatment outcome expectancies predict symptom change across several diagnostic categories within the context of an acute, naturalistic psychiatric setting. MethodsAnalyses were conducted to examine whether pretreatment outcome expectancies (credibility/expectancy questionnaire [CEQ]) predicted symptom improvement within major depression (N=420), bipolar disorder (N=120) and psychosis (N=36). Bootstrap mediation analyses were conducted to examine whether acquisition of cognitive behavioral therapy (CBT) skills (cognitive behavior therapy skills questionnaire [CBTSQ]) may mediate expectancy–outcome relations. ResultsResults indicated a differential pattern of associations across diagnoses. Patient CBT skills emerged as a significant mediator of expectancy–outcome relations, but only in the major depression group. Both behavioral and cognitive skills were significantly, and independently, associated with symptom improvement. LimitationsSample sizes were small in the bipolar manic subgroup and psychosis group. CBT skills and symptom measures were assessed at concurrent time points. ConclusionsThe present findings suggest that patient expectancies and CBT skills may have a differential impact on symptom change as a function of diagnostic category. The implication of these results and directions for future research are discussed.