Pretreatment Expectations Research Articles

Expectancy Effect in Three Mind-Body Clinical Trials.

Expectancy, arguably the prime component of the placebo effect, has been shown to significantly modify the effects of many treatments. Furthermore, various forms of mind-body interventions have demonstrated effective improvements in outcomes. The aim of this study was to examine the relationship between pretreatment expectations and symptom reduction in a secondary analysis of 3 mind-body intervention programs. An adjusted correlation and regression analysis compared data from a 6-question expectancy questionnaire to a self-reported clinical impression of change score. Only 1 of the 6 expectancy questions in 1 of the 3 studies reached significance (B = 0.087; P = .025). The combined data from all 3 studies did not reveal significant expectancy effects. The positive effects of mindfulness meditation appear to be independent of an expectancy effect.

Patient Pre-Treatment Expectations Do Not Predict Cocaine Use Outcomes: Data From Four Clinical Trials

ABSTRACTBackground: There are very few data regarding the extent to which patients' initial expectations regarding treatment are associated with substance use treatment outcomes. Objective: This study sought to determine how patients' treatment expectations were associated with treatment outcomes. Methods: This study explored patient pre-treatment expectations and substance use treatment outcomes for 387 individuals participating in treatment for cocaine use within the United States (68.2% male, mean age 36 years old, 54.8% Caucasian). Results: Participants' expectations regarding abstinence were not strongly associated with post-treatment or follow-up cocaine use outcome measures. There was a significant association between the expected timeframe of receiving a positive treatment effect (i.e., outcome efficiency expectations) and days of cocaine use at the 1-month follow-up point (F = 3.45, p =.009). Post-hoc comparisons revealed that participants that expected positive effects of treatment within 0–1 week reported fewer days of cocaine use than those that expected results in 1–2 months. Also, those that expected positive effects of treatment in 1–2 months reported more cocaine use than those who expected positive results within two weeks to one month. Further, there was a significant effect of outcome efficiency expectations on a proxy measure of achieving a good treatment outcome at the three-month follow-up point (F = 11.13, p =.025). Conclusions/Importance: Results suggest that treatment outcomes are not associated with patients' treatment outcome expectations, but that some outcomes are associated with treatment outcome efficiency expectations.

An Empirical Examination of the Role of Common Factors of Therapy During a Mindfulness-based Cognitive Therapy Intervention for Headache Pain.

It is often assumed that psychosocial pain treatments work because of specific active components of the intervention. The degree to which common factors may contribute to improved pain outcomes is not well researched. The purpose of this study was to examine patient-related and therapist-related common factors during a Mindfulness-Based Cognitive Therapy (MBCT) for headache pain trial. This study was a secondary analysis of a parallel group, unblinded, randomized controlled trial in which MBCT was compared with a control. A series of linear regression models and 1 bootstrap mediation model were conducted with the sample of participants that completed MBCT (N=21). In-session participant engagement was positively associated with treatment dose indicators of session attendance (P=0.038) and at-home meditation practice (P=0.027). Therapist adherence and quality were both significant predictors of posttreatment client satisfaction (P=0.038 and 0.034, respectively). Therapist appropriateness was not significantly associated with any of the variables of interest (P>0.05). Baseline pain intensity was positively associated with pretreatment expectations and motivations (P=0.049) and working alliance (P=0.048), and working alliance significantly predicted posttreatment patient satisfaction (P<0.001). Higher pretreatment expectations and motivation significantly predicted greater improvement in pretreatment to posttreatment change in pain interference (P=0.016); however, this relation was fully mediated by baseline pain intensity (P<0.05). Common factors play an important role in improving pain outcomes and patient satisfaction during a MBCT for headache pain intervention. Stimulating positive pretreatment expectations and patient motivation, as well as building strong rapport is an important component of treatment success.

Expectations of recovery: A prognostic factor in patients with neck pain undergoing manual therapy treatment.

Expectations have been investigated in populations seeking care for neck pain, however not considering potential confounding factors. The aim of this study was to investigate if pretreatment expectations of recovery is a prognostic factor for recovery from neck pain at 7weeks follow-up in patients seeking manual therapy treatment. The study was based on the Stockholm Manual Intervention Trial, a randomized controlled trial investigating efficiency of three combinations of manual therapy. The patients with neck pain were included in this study (n=716). Expectations of recovery was measured at baseline; 'How likely is it, according to your judgment, that you are completely recovered from your neck/back problems in 7weeks'. Patients answered on a 11-point scale, further categorized into low, moderate and high expectations. The outcome was measured at 7weeks follow-up by a modified version of the Global Perceived Recovery Question. Potential effect measure modifiers and confounders were measured at baseline. Multivariable log binomial regression models were used to analyse the association between expectations and recovery, presented as relative risks and 95% confidence intervals (CI). High expectations of recovery yielded a 47% increased probability of being recovered at 7weeks follow-up. High expectations of recovery yielded improved recovery in both men and women separately, but moderate expectations yielded improved recovery only among men. Our results suggest that expectations of recovery is a prognostic factor for recovery in patients with neck pain seeking manual therapy treatment. WHAT DOES THIS STUDY ADD?: We found that high expectations of recovery yielded a higher probability of recovery compared to having low expectations, also when considering potential confounding factors. Expectations seemed to have a more distinct influence on recovery among men.

Understanding the Attitudes of Patients with Cancer Toward Complementary and Alternative Therapies

The high prevalence of complementary and alternative medicine (CAM) use among patients with cancer can be explained by reasons such as growing scientific evidence and improved regulation. However, subjective considerations are also relevant for practicing CAM and perceiving its effectiveness. The current study aimed at qualitatively estimating patients' prior beliefs and expectations, as well as their level of satisfaction after the treatment. Patients with cancer who received six weekly sessions of CAM during their oncologic treatments participated in the study. They detailed their prior expectations and their level of posttreatment satisfaction. The open-ended answers were analyzed using interpretative phenomenological analysis. In addition, the contents before and after the intervention were compared. Over a 2-year period, 163 patients entered the study, 135 of whom completed all six CAM sessions. The content analysis of the pretreatment expectations revealed four main categories: emotional, physical, external, and aspects related to the practice of CAM. After the intervention, patients referred to the therapeutic encounter as a significant aspect, in addition to the emotional and physical ones. CAM sessions encouraged emotional and relational aspects in patients' perspectives, which may be highly relevant for their coping process. Encouraging personal motives may increase treatment efficacy and ensure optimal use of health care resources.

Expectations predict chronic pain treatment outcomes.

Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment.

A Comparative and a Qualitative Analysis of Patient's Motivations, Expectations and Satisfaction with Dental Implants.

Dental Implants are the norm of today's prosthetic and restorative dentistry but, is it the answer for edentulism that can affect both individual's appearance and functioning, therefore having an impact on the psychological and the social well being of the person is an ongoing quest. Also, patient's beliefs and personal expectations for dental implants vary, which may influence the treatment outcome, thus emphasizing the importance of a good clinician-patient communication. Hence in this study a qualitative analysis was carried out with an earnest attempt to gain an insight into patient's motivations, personal expectations, satisfaction and impact of clinician's motivation for implant maintenance. To learn about patient's expectations and their level of satisfaction from dental implants. To know the impact of clinician's instructions and motivation for implant maintenance, with the patient's level of understanding and compare the level of motivation for implant maintenance and care provided by a dentist with Bachelor's degree to a dentist with a Master's degree. A 30 systemically healthy patients who had undergone implant treatment (aged 25-65 years) were considered and divided into two groups: Group A: 15 patients in whom implant placement was done by a dentist with Bachelor's degree (24 years, 18 years in general and implant practice respectively) and Group B: 15 patients in whom implant placement was done by a dentist with a Master's degree (Periodontics; 20 years,17 years in general and implant practice respectively). A qualitative analysis with the help of appropriate questionnaires comprising of multiple choice questions specifically designed for this purpose and few open ended questions was carried out with an earnest attempt to gain an insight into patient's motivations, personal expectations, satisfaction and impact of clinician's motivation for implant maintenance. Patients motivations for seeking implants and their expectations of treatment differed. Dental implants had met the patient's pre-treatment expectations and they were satisfied. Variations in the knowledge on the maintenance of the implants by the patients and the kind of maintenance care provided by the dentists varied between the two groups. In regard to the patient's compliance towards dental implants, a clinician must ensure that patient's understand the different demands.

Patient pre-treatment expectations and substance use treatment outcomes

Drug and Alcohol Dependence 156 (2015) e183–e245 e201 conducted utilizing a subset of the NSCAW II in which the children remained in the home following a CPS investigation. A random half sample was drawn (n=1087) to conduct two separate models for female and male caregivers. Results were confirmed on the second half of the sample. PDU was measured continuously with the 20-itemDrugAbuse Screening Test. Caregiver depressionwasmeasuredwith the Composite InternationalDiagnostic Interview-Short Form. CIB was measured continuously with the internalizing subscale of the Child Behavior Checklist. Control variables were child age, child gender, and familypoverty. Analyses accounting for stratification, clustering, andweightingwere conductedwithMplus 7.0. Standardized estimates and asymmetrical confidence intervals are reported. Results: Female caregivers’ depressionwas found to fullymediate the relationship from PDU to CIB ( = .048, ⌠= .015, 95% CI .021–.081). Among male caregivers, depression was not a significantmediator in the relationship fromPDU toCIB ( = .007, ⌠= .039, 95% CI−.068 to .099). Fit for the female caregivermodel was strong (RMSEA= .000, p= .99; CFI = 1.00). Conclusions: Among families reported to CPS where a female caregiver is engaged in PDU, thepresence of comorbiddepression is an important indicator of need for intervention. Addressing these comorbid disorders may lead to decreases in CIB. Unavailable in this dataset, future research should examine anxiety as another potential mediator. Financial support: F31DA034442; T32DA015035; Doris Duke Fellow; Fahs-Beck Scholar. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.540 Patient pre-treatment expectations and substance use treatment outcomes Kelly Serafini2,∗, Suzanne Decker2,3, Brian D. Kiluk1, Luis Anez2, Manuel Paris2, Tami Frankforter2, Kathleen M. Carroll 2 1 Psychiatry, Yale School of Medicine, West Haven, CT, United States 2 Department of Psychiatry, Yale University School of Medicine, West Haven, CT, United States 3 West Haven VA, West Haven, CT, United States Aims: To determine if expectations at pre-treatment are associated with substance use treatment outcomes. Methods: Treatment expectations were examined in two randomized controlled trials (RCTs) utilizing Motivational Enhancement Therapy (MET) for the treatment of substance use conducted in the CTN. One RCT was delivered in English (MET-E) and one was delivered in Spanish (MET-S). There were 461 participants MET-E sample and 405 participants MET-S. Participants responded to the following item at pre-treatment: “Do you think you will reduce or stop your use of drugs or alcohol as a result of this treatment?” ANOVAs and chi-square tests were used to examine the relationship between treatment expectations and treatment outcomes in the two samples. Results: Treatment expectations were not associated with any of the treatment outcomes in MET-E. However, in MET-S, expectationswere significantly associatedwithmost of the post-treatment outcomes. Among these, treatment expectationswere significantly associated with the percentage of drug positive urines within the treatment period, F (1, 1,163) =18.83, p= .000, and the percentage of days abstinent from primary drug use while in treatment and through follow-up, F (1, 1,364) =23.78, p= .000. Conclusions: There are several possible interpretations to the divergent findings between samples. The first is that the MET-S sample had fewer previous treatments, and that when a treatment is novel, expectations may have more of an influence. The second interpretation is that there may be cultural components that may affect how an individual relates to the treatment process. These findings are preliminary and future research should examine treatment expectations across cultures. Financial support: This research was supported in part through a National Institute on Drug Abuse (NIDA) T-32 grant, 5T32DA007238-23 (Petrakis), anduseddata fromstudies thatwere funded by the Clinical Trials Network. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.541 Does craving intensity influence cue exposure reports? An ecological momentary assessment study in patients with alcohol, tobacco, cannabis and heroin use disorder F. Serre1,∗, M. Fatseas1, J. Swendsen2, Marc Auriacombe1 1 Addiction Psychiatry (CNRS USR 3413), Universite Bordeaux, Bordeaux, France 2 CNRS UMR 5284 INCIA University Bordeaux,

Evaluation of Expectations and Expectation Fulfillment in Patients Treated for Trapeziometacarpal Osteoarthritis

To determine the main reasons why patients with trapeziometacarpal osteoarthritis (TMC OA) seek treatment, their pretreatment expectations for the final outcome, fulfillment after one year, and predictors of fulfillment of the expectation. We included 163 patients with TMC OA. They filled out questionnaires assessing expectations and functional status before and at 3, 6, and 12 months after treatment. Pain reduction was the most important reason why 65% of all patients sought treatment, whereas 17% and 13% requested treatment to improve hand function and activities of daily living, respectively. No patients considered improved appearance of the hand to be the main reason for undertaking treatment. Expectations before treatment were anticipated to be totally or mostly fulfilled by 93% of surgically treated patients and 59% of patients treated with corticosteroid injection. After one year, 77% of surgically treated patients rated their expectations as completely or mostly fulfilled, compared with 24% of patients treated with corticosteroid injections. Including all variables before treatment in a best-fit regression model, fulfillment of patients' expectations could not be sufficiently predicted. However, with addition to the model of the outcome of pain at one year, 48% of the variance of fulfilled expectations could be accounted for. Patients with TMC OA predominantly visit hand surgeons seeking treatment to reduce pain, whereas function and aesthetics have minor roles. Based on variables before treatment, no prediction can be made regarding whether expectations will be fulfilled after treatment because residual pain at one year contributes considerably to the variance in fulfilled expectations. Clinicians should assess patients' expectations before treatment and explain realistic treatment outcomes to obtain best treatment results. Therapeutic II.

Patient-Reported Outcomes 5-8 Years After Ultrasound-Guided Foam Sclerotherapy for Varicose Veins

BACKGROUND The aim was to determine the long-term (5-8 years) outcomes of ultrasound-guided foam sclerotherapy (UGFS) for varicose veins using health-related quality of life (HRQL), patient-reported outcomes (PROMs), patient satisfaction and retreatment rates. METHODS Consecutive patients undergoing UGFS between April 2004 and May 2007 were invited for review at least 5 years after treatment. Patients completed generic (Short Form 12) and disease-specific (Aberdeen Varicose Vein Symptom Severity Score, AVSS) HRQL instruments, and questionnaires enquiring about lower limb symptoms, lifestyle factors and satisfaction with treatment. Data on retreatments were recorded prospectively. RESULTS A total of 391 limbs in 285 patients were included (81·2 per cent response rate) at a median of 71 (i.q.r. 67-78) months following first UGFS treatment. Originally 72·1 per cent had symptomatic, uncomplicated varicose veins, 21·9 per cent had undergone surgery previously, 87·2 per cent had treatment of great saphenous veins and 19·9 per cent treatment of short saphenous veins. Disease-specific HRQL scores improved significantly at long-term follow-up, with 88·5 per cent having an improved AVSS compared with baseline. Regarding lower limb symptoms and lifestyle improvement, 62·7-93·8 per cent of patients had their pretreatment expectations met or exceeded. Overall, 82·0 per cent were very satisfied with their treatment and only 3·3 per cent were dissatisfied; 91·0 per cent would recommend the treatment to others. Some 15·3 per cent of limbs required retreatment by 5 years (Kaplan-Meier analysis). CONCLUSION UGFS has durable results as reported by PROMs to at least 5 years. Only 15·3 per cent of limbs required retreatment for recurrence during follow-up.

Patient-reported outcomes 5-8 years after ultrasound-guided foam sclerotherapy for varicose veins.

The aim was to determine the long-term (5-8 years) outcomes of ultrasound-guided foam sclerotherapy (UGFS) for varicose veins using health-related quality of life (HRQL), patient-reported outcomes (PROMs), patient satisfaction and retreatment rates. Consecutive patients undergoing UGFS between April 2004 and May 2007 were invited for review at least 5 years after treatment. Patients completed generic (Short Form 12) and disease-specific (Aberdeen Varicose Vein Symptom Severity Score, AVSS) HRQL instruments, and questionnaires enquiring about lower limb symptoms, lifestyle factors and satisfaction with treatment. Data on retreatments were recorded prospectively. A total of 391 limbs in 285 patients were included (81·2 per cent response rate) at a median of 71 (i.q.r. 67-78) months following first UGFS treatment. Originally 72·1 per cent had symptomatic, uncomplicated varicose veins, 21·9 per cent had undergone surgery previously, 87·2 per cent had treatment of great saphenous veins and 19·9 per cent treatment of short saphenous veins. Disease-specific HRQL scores improved significantly at long-term follow-up, with 88·5 per cent having an improved AVSS compared with baseline. Regarding lower limb symptoms and lifestyle improvement, 62·7-93·8 per cent of patients had their pretreatment expectations met or exceeded. Overall, 82·0 per cent were very satisfied with their treatment and only 3·3 per cent were dissatisfied; 91·0 per cent would recommend the treatment to others. Some 15·3 per cent of limbs required retreatment by 5 years (Kaplan-Meier analysis). UGFS has durable results as reported by PROMs to at least 5 years. Only 15·3 per cent of limbs required retreatment for recurrence during follow-up.

Treatment expectations and quality of life outcomes of patients with laryngeal cancer based on different treatment methods.

The treatment expectations of patients with laryngeal carcinoma and their quality of life after treatment were evaluated. We enrolled patients who were receiving treatment for epidermoid carcinoma of the larynx between January 2011 and January 2012. Their expectations from the treatment were evaluated using the visual analog scale (VAS) prior to and at the end of the treatment. Quality of life was assessed using the EORTC QLQ C 30 and EORTC H&N 35 questionnaires 3 months after completion of the treatment. In addition, the Beck Depression Inventory was used for mood assessment of the patients after treatment. As per the VAS scores pre-treatment, no differences were found between treatment expectations of early and advanced-stage tumors groups in pre-treatment expectations, but post-treatment evaluation statistically found difference between two groups in terms of average VAS score. Emotional, cognitive, and social functions of the EORTC QLQ C 30 questionnaire were the most affected items in the advanced-stage tumor group. Sense and speech problems in the symptom scales of the EORTC H&N 35 questionnaire were found to be significantly higher in patients with advanced-stage tumors than in those with early stage tumors. The present study is the first to assess the treatment expectations of patients with laryngeal carcinoma by using the VAS. Although the treatment expectations of the patients with early and advanced-stage tumors did not differ according to VAS scores in pre-treatment evaluation, early stage groups had better score than advanced-stage group. VAS was an easy and a simple applicable method for evaluating treatment expectations.

Introducing the association of psychology training clinics’ collaborative research network: A study on client expectancies.

A nationwide collaborative research network has been developed by the Association of Psychology Training Clinics (APTC) to carry out research with the potential to improve services provided in training clinic settings. Six APTC member clinics participated in this inaugural study. In addition to demonstrating that the APTC research network can recruit clients for participation in multisite research and randomize enrolled participants to conditions effectively across the network, findings from this study also contribute to our growing understanding of the problem of premature termination within psychology training clinics. More specifically, the results confirm earlier single-site reports in the literature that a high rate of premature termination is a common problem within psychology training clinics (multisite M 69.4%) and that the most typical client outcome at the end of treatment is no reliable change in symptomatic distress. Findings indicate that clients’ pretreatment expectations of treatment duration are positively correlated with the number of treatment sessions subsequently attended and are predictive of clients’ symptom severity at termination. However, expectancy education was not associated with a reduction in premature termination. Notably, there is a positive correlation between prior treatment exposure and current, prospective treatment expectations. Implications for training and policy are discussed with future directions for research suggested.

Exploring Pretreatment Expectancies in a Campus Mental Health Setting: The Validation of a Novel Expectancies Measure

Treatment expectancies and outcome have been robustly associated, although these constructs are understudied within college mental health populations. This is partially because of the lack of psychometrically sound expectancy measures for campus clinics. This study examined the validity, reliability, and clinical utility of a novel expectancy measure developed for use in campus clinics. The measure was found to have sound psychometric properties and may prospectively identify pretreatment expectancies that adversely affect treatment outcomes.

The Benefits of Acupuncture: What you think is what you Get, or is It?

As a complex treatment, with many contextual aspects of the visit being potentially therapeutic, acupuncture has long been assumed to be more effective among those patients who believe that it will help them. A number of studies have indeed shown that acupuncture is more effective among such patients.1–3 However, not all rigorously conducted studies have found this to be true. For example, in a large 638 person trial we conducted of acupuncture for chronic back pain with acupuncture-naive participants, we found that those with high pretreatment expectations for acupuncture showed greater expectations of improvement in general and showed greater preference for acupuncture.4 They were more likely to have heard that acupuncture was a very effective treatment and to have a very or moderately positive impression of acupuncture. However, such favourable beliefs towards acupuncture did not predict improvement in back-related function or pain at the end of 7 weeks of treatment or at the end of a year of follow-up. …

Cognitive interviews guide design of a new CAM patient expectations questionnaire

BackgroundNo consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive interviews as part of a process to develop and validate such a questionnaire.MethodsWe reviewed questions about expectations of benefits of acupuncture, chiropractic, massage, or yoga for pain. Components of the questions – verbs, nouns, response options, terms and phrases describing back pain – were identified. Using seven different cognitive interview scripts, we conducted 39 interviews to evaluate how individuals with chronic low back pain understood these individual components in the context of expectancy questions for a therapy they had not yet received. Chosen items were those with the greatest agreement and least confusion among participants, and were closest to the meanings intended by the investigators.ResultsThe questionnaire drafted for psychometric evaluation had 18 items covering various domains of expectancy. “Back pain” was the most consistently interpreted descriptor for this condition. The most understandable response options were 0-10 scales, a structure used throughout the questionnaire, with 0 always indicating no change, and 10 anchored with an absolute descriptor such as “complete relief”. The use of words to describe midpoints was found to be confusing. The word “expect” held different and shifting meanings for participants. Thus paired items comparing “hope” and “realistically expect” were chosen to evaluate 5 different aspects of treatment expectations (back pain; back dysfunction and global effects; impact of back pain on specific areas of life; sleep, mood, and energy; coping). “Impact of back pain” on various areas of life was found to be a consistently meaningful concept, and more global than “interference”.ConclusionsCognitive interviews identified wordings with considerable agreement among both participants and investigators. Some items widely used in clinical studies had different meanings to participants than investigators, or were confusing to participants. The final 18-item questionnaire is undergoing psychometric evaluation with goals of streamlining as well as identifying best items for use when questionnaire length is constrained.

The associations among improvement and alliance expectations, alliance during treatment, and treatment outcome for major depressive disorder

Objective: To examine the associations between treatment/outcome expectations, alliance before and during treatment, and the impact of alliance on symptomatic improvement. Methods: One hundred and fifty-three depressed patients randomized to dynamic supportive-expressive psychotherapy (SET), antidepressant medication (ADM) or placebo (PBO) + clinical management completed ratings of treatment expectations, therapeutic alliance (CALPAS, WAI-S), and depressive symptoms (HAM-D). Results: Pretreatment expectations of the therapeutic alliance were significantly related to alliance later in therapy but did not differ across treatments and did not predict outcome. Alliance development over time differed between treatments; it increased more in SET than in PBO. After controlling for prior symptom improvement, early alliance predicted subsequent depression change. Conclusions: Expectations of alliance and of treatment outcome/improvement, measured prior to treatment onset, predicted subsequent alliance.

Treatment expectations and satisfaction of treatment‐refractory opioid‐dependent patients in RIOTT, the Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics

The study investigates patients' pre-treatment expectations of, and post-treatment satisfaction with, supervised injectable opiate treatment delivered within UK's first such clinics within the Randomised Injectable Opiate Treatment Trial (RIOTT) (ISRCTN0133807). Data were collected from 127 chronic heroin addicts recruited to RIOTT and randomised to receive supervised injectable (heroin or methadone) treatment or optimised oral maintenance treatment at supervised injectable maintenance clinics in London, Darlington and Brighton. Of 127 RIOTT patients, 113 (89%) provided responses to structured enquiry about treatment expectations, and 94 (74%) subsequent responses about treatment satisfaction (at six months). Patients were hoping that injectable heroin treatment would: reduce substance misuse (81%); help achieve normality, routine and structure (16%); and increase education and work prospects (15%). At six months, an area of treatment satisfaction most commonly reported by all three trial groups was reduced substance misuse (supervised injectable heroin 59%, supervised injectable methadone 56%, optimised oral methadone 54%). Most found supervision acceptable, but some desired modifications were also identified. Patients previously considered non-responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment. Supervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. This raised the challenging issue of the extent to which opinions of patients need to be taken into consideration in shaping future treatment provision. Future research may need to examine the extent of expectations 'fit' and the relationship between treatment sought and received.

The Role of Patients' Expectation of Appropriate Initial Manual Therapy Treatment in Outcomes for Patients With Low Back Pain

ObjectivesThe purpose of this study was to compare the outcomes of patients with low back pain who had a matched, unmatched, or were indifferent with their pretreatment expectation/preference to the manual therapy thrust or nonthrust intervention. A secondary purpose was to explore baseline patient characteristics affiliated with a preference of manual therapy treatment type (thrust or nonthrust manipulation). MethodsThe study is a secondary analysis of a prospective randomized controlled trial that enrolled 149 patients with low back pain, from 16 distinct outpatient physical therapy practices within the United States. Patient's pretreatment expectations were identified before randomization. The intervention included manual therapy (thrust or nonthrust manipulation) with a standardized exercise program, which was carried out for 2 treatment sessions. Six outcomes captured the constructs of (a) disability, (b) pain perception, (c) care intensity, (d) fear avoidance behaviors, and (e) perception of extent of recovery. Descriptive statistics, analysis of variance (and Tukey, a post hoc test), Fisher exact test, and a multivariate logistic regression analysis were used for analysis. ResultsThere were no statistical differences in any of the 6 dedicated outcomes measures between the matched, unmatched, and no preference groups. Therapist-determined patient “irritability” was associated with patient preference of nonthrust treatment, and higher body mass index was associated with patient preference of thrust treatment. ConclusionsThis study shows that patients demonstrated no statistical difference in disability or pain outcome measures when matched, unmatched, or indifferent to the intervention.

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

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.