Expectation-Focused Psychological Interventions (EFPI)

Research on placebo mechanisms has shown that expectations of patients about treatment outcome are a crucial predictor of treatment success. This holds true for both physical and mental conditions. However, in the field of mental disorders, further expectations beyond treatment outcome also play a significant role. These are disorder-related expectations (e.g., catastrophizing by patients with anxiety disorders), but also expectations about one self and others (e.g., others will reject me if they discover my real personality). We postulate that treatment failures are frequently associated with not adequately addressing expectation modification. The ViolEx model offers a framework to better understand how expectations develop and how they change, but also why expectations frequently persist despite contradictory experiences. Based on this model, we offer a treatment approach and case examples to illustrate how focusing on a patient's expectations can help to optimize psychological interventions (expectation-focused psychological interventions; EFPI). Although many other psychological interventions also address issues of expectation modification, EFPI offers a framework for a more focused approach that helps to better identify reasons for lack of treatment success.