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Kirchner L, Kube T, D'Astolfo L, Strahler J, Herbstreit R, Rief W. How to modify expectations of social rejection? An experimental study using a false-feedback paradigm. J Behav Ther Exp Psychiatry 2023; 81:101859. [PMID: 37182428 DOI: 10.1016/j.jbtep.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Negative expectations (NEs) are fundamental to various mental disorders. Finding ways to modulate NEs would help to improve clinical treatment. The present study investigated how previously formed expectations of social rejection are revised in the context of novel positive social experiences, and whether their revision can be modulated by differentially shifting participants' attentional focus. METHODS Our sample of 124 healthy participants was randomly assigned to four experimental conditions and received manipulated social feedback in multiple alleged webcam conferences. All groups went through three experimental phases that began with predominantly negative social feedback, then either transitioned to predominantly positive social feedback or continued to predominantly negative social feedback, and ultimately transitioning to a phase with no explicit social feedback. The experimental conditions differed in what they were instructed to focus on when receiving positive social feedback. RESULTS Receiving novel positive social feedback led to substantial changes in social expectations, but this effect was not modulated by the instructions the participants were given. Descriptive trends revealed that both instructions improved NE modification, although this effect was not robust to extinction in one condition. LIMITATIONS To prevent our cover story from being compromised, we could not perform an immediate manipulation check of the instructions given. Nevertheless, some of the sample seemed suspicious about the cover story. CONCLUSION Our results suggest that established expectations of social rejection can be revised when unexpectedly experiencing social acceptance. Nevertheless, more research is needed on potential instructions that could be used to optimize the modification of NEs.
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Affiliation(s)
- Lukas Kirchner
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Tobias Kube
- University of Koblenz-Landau, Ostbahnstraße 10, 76829, Landau, Germany
| | - Lisa D'Astolfo
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jana Strahler
- Albert-Ludwigs-University of Freiburg, Sandfangweg 4, 79102, Freiburg, Germany
| | - René Herbstreit
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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2
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Kube T. Biased belief updating in depression. Clin Psychol Rev 2023; 103:102298. [PMID: 37290245 DOI: 10.1016/j.cpr.2023.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
Cognitive approaches to depression have benefitted from recent research on belief updating, examining how new information is used to alter beliefs. This review presents recent advances in understanding various sources of bias in belief updating in depression. Specifically, research has demonstrated that people with depression have difficulty revising negative beliefs in response to novel positive information, whereas belief updating in depression is not related to an enhanced integration of negative information. In terms of mechanisms underlying the deficient processing of positive information, research has shown that people with depression use defensive cognitive strategies to devalue novel positive information. Furthermore, the disregard of novel positive information can be amplified by the presence of state negative affect, and the resulting persistence of negative beliefs in turn perpetuates chronically low mood, contributing to a self-reinforcing negative feedback loop of beliefs and affect. Synthesising previous research, this review proposes a coherent framework of when belief change is likely to occur, and argues that future research also needs to elucidate why people with depression hesitate to abandon negative beliefs. Recent insights from belief updating have not only improved the understanding of the psychopathology of depression, but also have the potential to improve its cognitive-behavioural treatment.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
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Kube T, Kirchner L, Gärtner T, Glombiewski JA. How negative mood hinders belief updating in depression: results from two experimental studies. Psychol Med 2023; 53:1288-1301. [PMID: 34247664 DOI: 10.1017/s0033291721002798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In two experimental studies, we tested the hypothesis that negative mood would hinder the revision of negative beliefs in response to unexpectedly positive information in depression, whereas positive mood was expected to enhance belief updating. METHODS In study 1 (N = 101), we used a subclinical sample to compare the film-based induction of sad v. happy mood with a distraction control group. Subsequently, participants underwent a well-established paradigm to examine intra-individual changes in performance-related expectations after unexpectedly positive performance feedback. In study 2, we applied the belief-updating task from study 1 to an inpatient sample (N = 81) and induced sad v. happy mood via film-clips v. recall of autobiographic events. RESULTS The results of study 1 showed no significant group differences in belief updating; the severity of depressive symptoms was a negative predictor of belief revision, though, and there was a non-significant trend suggesting that the presence of sad mood hindered belief updating in the subgroup of participants with a diagnosed depressive episode. Study 2 revealed that participants updated their expectations significantly less in line with positive feedback when they underwent the induction of negative mood prior to feedback, relative to positive mood. CONCLUSIONS By indicating that the presence of negative mood can hinder the revision of negative beliefs in clinically depressed people, our findings suggest that learning from new experiences can be hampered if state negative mood is activated. Thus, interventions relying on learning from novel positive experiences should aim at reducing state negative mood in depression.
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Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Lukas Kirchner
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Thomas Gärtner
- Schön Klinik Bad Arolsen, Hofgarten 10, 34454 Bad Arolsen, Germany
| | - Julia Anna Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
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4
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Lüdtke T, Westermann S. Negative expectations regarding interpersonal interactions in daily life are associated with subclinical depressive symptoms in a student sample: A prospective experience sampling study. MOTIVATION AND EMOTION 2022. [DOI: 10.1007/s11031-022-09985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractDysfunctional expectations and interpersonal problems are associated with depression, so we measured expected emotions towards interaction partners and compared them with actual emotions. We hypothesized that, between persons, individuals with higher subclinical depression would display stronger, more stable, and less accurate negative expectations. Within persons, we hypothesized that momentary negative expectations would predict subsequent negative affect. Fifty-three students completed 6 days of Experience Sampling, consisting of one morning expectation-assessment (9 am), three assessments on actual interpersonal emotions (1 pm, 5 pm, 9 pm), and six random affect-assessments. We regressed expected emotions, experienced emotions, expectation fluctuations, and expectation violations on subclinical depression. Using mixed model analyses, we further examined whether negative expectations preceded negative affect, and whether expectation violations preceded adjustments of expectations. Higher subclinical depression predicted more negative expectations. Within persons, worse-than-expected interpersonal interactions preceded negative affect whereas better-than-expected interactions preceded reductions of negative expectations. Despite problems with skewed data, our approach appears well-suited to examine interpersonal expectations in vivo.
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Feldmann M, Kube T, Rief W, Brakemeier EL. Testing Bayesian models of belief updating in the context of depressive symptomatology. Int J Methods Psychiatr Res 2022:e1946. [PMID: 36114811 DOI: 10.1002/mpr.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/08/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Predictive processing approaches to belief updating in depression propose that depression is related to more negative and more precise priors. Also, belief updating is assumed be negatively biased in comparison to normative Bayesian updating. There is a lack of efficient methods to mathematically model belief updating in depression. METHODS We validated a novel performance belief updating paradigm in a nonclinical sample (N = 133). Participants repeatedly participated in a non-self-related emotion recognition task and received false feedback. Effects of the feedback manipulation and differences in depressive symptoms on belief updating were analysed in Bayesian multilevel analyses. RESULTS Beliefs were successfully manipulated through the feedback provided. Depressive symptoms were associated with more negative updating than normative Bayesian updating but results were influenced by few cases. No evidence of biased change in beliefs or overly precise priors was found. Depressive symptoms were associated with more negative updating of generalised performance beliefs. CONCLUSIONS There was cautious support for negatively biased belief updating associated with depressive symptoms, especially for generalised beliefs. The content of the task may not be self-relevant enough to cause strong biases. Further explication of Bayesian models of depression and replication in clinical samples is needed.
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Affiliation(s)
- Matthias Feldmann
- Department for Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany.,Department for Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Winfried Rief
- Department for Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany.,Department for Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
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Groth RM, Rief W. You Were Better Than Expected-An Experimental Study to Examine Expectation Change in a Non-clinical Sample. Front Psychol 2022; 13:862946. [PMID: 35898994 PMCID: PMC9311683 DOI: 10.3389/fpsyg.2022.862946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 12/13/2022] Open
Abstract
Background Reduced sensitivity to rewards as well as the tendency to maintain dysfunctional expectations despite expectation-disconfirming evidence (cognitive immunization) are considered core features of various mental disorders. It is therefore important for clinical research to have paradigms that are suitable to study these phenomena. We developed a new experimental paradigm to study explicit expectation change after prior expectation induction and violation. Its validity is tested by applying the paradigm to healthy individuals. Materials and Methods In the main part of the study (experiment 1) we examined whether it is possible to change healthy individuals' (Sample size 56) task-specific and generalized performance expectations through expectation-disconfirming experiences. We used a high-difficulty performance task to induce initially negative expectations regarding participants' ability to successfully work on that unknown task. In the second part of the study, the difficulty of the test was lowered in one experimental condition, in order to disconfirm the negative expectations of the first part, while the other group continued with high test difficulty to confirm the negative expectations. We measured the participant's explicit performance expectations before and after completing the tests. In experiment 2 (Sample size 57), we investigated the impact of different test instructions on expectation change. Using the same paradigm as in experiment 1, we added an "immunization-inhibiting" manipulation for one group and an "immunization-enhancing" manipulation for the other group. Results In experiment 1, we were able to show that individuals changed their expectations according to variations of task difficulty. Adding instructions to manipulate cognitive immunization inhibited expectation change regardless of condition (experiment 2). Conclusion Our approach allowed us to examine the effects of implicitly acquired performance expectations on explicit, verbalized expectation change. The new experimental paradigm used in this study is suitable to induce performance expectations, and to examine expectation-change among healthy individuals (experiment 1). Instructions to enhance or inhibit cognitive immunization processes both inhibited expectation change (experiment 2). The results are discussed within the context of current models of expectation change, cognitive immunization, and reward sensitivity.
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No Evidence for the Involvement of Cognitive Immunisation in Updating Beliefs About the Self in Three Non-Clinical Samples. COGNITIVE THERAPY AND RESEARCH 2022; 46:43-61. [PMID: 34345057 PMCID: PMC8323093 DOI: 10.1007/s10608-021-10256-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cognitive immunisation against disconfirmatory evidence (i.e., devaluing expectation-disconfirming information through cognitive mechanisms) has recently been discussed as an obstacle to the revision of dysfunctional beliefs in mental disorders such as depression. Yet, it is unclear whether cognitive immunisation is also involved in belief updating in non-clinical samples. METHODS Using a three-group modulation protocol (promotion vs. inhibition of cognitive immunisation vs. control group), we examined how cognitive immunisation influences belief updating in response to performance feedback in three non-clinical samples. In Experiments 1 (N = 99) and 2 (N = 93), participants received unexpectedly negative feedback, whereas participants from Experiment 3 (N = 118) received unexpectedly positive feedback. Depressive symptoms and dispositional optimism were examined as additional predictors of belief updating. RESULTS In all experiments, participants adjusted their expectations in line with the feedback received, but this effect was not influenced by the cognitive immunisation manipulation. In Experiment 3, expectation change remained stable over 2 weeks. Depressive symptoms were associated with a reduced integration of positive feedback, but not with an increased sensitivity to negative feedback. CONCLUSIONS Whereas previous research has shown that cognitive immunisation contributes to persistent beliefs in clinical populations, the present findings suggest that it does not affect belief updating in non-clinical samples. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10608-021-10256-y.
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van der Oest MJW, Hoogendam L, Wouters RM, Vermeulen GM, Slijper HP, Selles RW, Vranceanu AM, Porsius JT. Associations between positive treatment outcome expectations, illness understanding, and outcomes: a cohort study on non-operative treatment of first carpometacarpal osteoarthritis. Disabil Rehabil 2021; 44:5487-5494. [PMID: 34232069 DOI: 10.1080/09638288.2021.1936661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE More positive outcome expectations and illness perceptions are associated with better outcomes for patients with several osteoarthritic orthopedic conditions. However, it is unknown whether these factors also influence outcomes of non-operative treatment for first carpometacarpal osteoarthritis (CMC-1 OA). Therefore, we assess the role of pre-treatment outcome expectations and illness perceptions in reports of pain and hand function 3 months after non-operative treatment for CMC-1 OA. MATERIALS AND METHODS We conducted a cohort study with 219 patients treated non-operatively for CMC-1 OA between September 2017 and October 2018. Patients were included in the study if they completed measures of pain and hand function, illness perceptions (scale: 0-10), and expectations (scale: 3-27) as part of routine outcome measurements. Pain and hand function were measured before treatment and 3 months after starting treatment using the Dutch version of the Michigan Hand Outcomes Questionnaire. Multivariable linear regression analysis was used to assess the influence of outcome expectations and illness perceptions on pain and hand function. RESULTS Both positive outcome expectations (B = 0.64; 95% CI [0.1-1.2]) and a better illness understanding (an illness perception subdomain; B = 1.53; 95% CI [0.2-2.9]) at baseline were associated with less pain at 3 months. For hand function, similar estimates were found. CONCLUSIONS We found that positive outcome expectations and a better illness understanding, were associated with a better outcome of non-operative treatment for CMC-1 OA.IMPLICATIONS FOR REHABILITATIONNon-operative treatment can often be successful for patients with arthritis of the thumb.Outcome expectations and illness perceptions are associated with pain and hand function 3 months after non-operative treatment for thumb base osteoarthritis.Improving the outcome expectations and illness perceptions of patients through better education could improve the outcome of non-operative treatment.
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Affiliation(s)
- Mark J W van der Oest
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands
| | - Guus M Vermeulen
- Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Harm P Slijper
- Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Jarry T Porsius
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Erasmus MC, Rotterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands.,Department of Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Netherlands.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10191-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background
People with depression maintain negative expectations despite disconfirming positive experiences by reappraising or discarding novel positive information, referred to as “cognitive immunisation”. A second body of literature suggests that negative mood can negatively affect information processing. Bridging these two lines of research, the present study examined the interplay of cognitive immunisation and negative mood in the context of expectation modification.
Methods
In a student sample (N = 152), we used a well-established experimental paradigm to examine the adjustment of performance expectations in response to positive performance feedback, and its relation to depressive symptoms. In a 2 × 2 design, participants received either a negative mood induction, a cognitive immunisation manipulation, both, or no further manipulation.
Results
Participants from all experimental groups revised their previous expectations significantly in line with positive performance feedback. However, depressive symptoms were a negative predictor of expectation adjustment, and a moderation analysis indicated that this effect was particularly pronounced if participants underwent the negative mood induction.
Conclusions
Consistent with previous work, depressive symptoms were associated with a reduced ability to integrate positive information. Furthermore, our results suggest that the activation of negative mood in people with elevated levels of depression may hamper learning from new positive experience.
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10
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Can theory of mind be improved? Positive expectations cause better theory of mind performance in a community sample. J Behav Ther Exp Psychiatry 2020; 69:101577. [PMID: 32559656 DOI: 10.1016/j.jbtep.2020.101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/03/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Theory of Mind (ToM) deficits are present in several mental disorders and closely related to problems in social functioning and lower quality of life. While several trainings are aimed at improving ToM performance, it is unknown whether positive expectations on a persons' ToM performance might cause better ToM achievement. METHODS Participants (n = 131) first completed a mock ToM test and were then randomly assigned to either receive standardized positive, negative or no feedback on their ToM performance. Secondly, their expectations on their own ToM performance were assessed. Thirdly, ToM was assessed using the Movie Task for the Assessment of Social Cognition (MASC). RESULTS Participants who received positive feedback resulted in positive expectations on their ToM performance and showed enhanced ToM performance, whereas negative feedback did not lead to negative expectations and negative expectations did not affect a change in ToM performance. LIMITATIONS In the present exploratory study, the effect of positive expectations on ToM performance was assessed in a community sample. Thus, the study should be replicated in a clinical sample for more in-depth results. CONCLUSIONS ToM performance could be enhanced by inducing positive expectations on one's ToM performance, whereas negative feedback had no effect. The present study suggest that interventions that focus on strengthening positive expectations on one's ToM performance could enhance the efficacy of present ToM training methods.
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No1LikesU! – A pilot study on an ecologically valid and highly standardised experimental paradigm to investigate social rejection expectations and their modification. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2997. [DOI: 10.32872/cpe.v2i2.2997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 04/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background
Dysfunctional expectations have been suggested as core features in the development and maintenance of mental disorders. Thus, preventing development and promoting modification of dysfunctional expectations through intervention might improve clinical treatment. While there are well-established experimental procedures to investigate the acquisition and modification of dysfunctional performance expectations in major depression, paradigms for investigating other important types of dysfunctional expectations (e.g. social rejection expectations) are currently lacking. We introduce an innovative associative learning paradigm, which can be used to investigate the development, maintenance, and modification of social rejection expectations.
Method
A pilot sample of 28 healthy participants experienced manipulated social feedback after answering personal questions in supposed webcam conferences. While participants repeatedly received social rejection feedback in a first phase, differential feedback was given in a second phase (social rejection vs. social appreciation). In a third phase, explicit social feedback was omitted.
Results
Participants developed social rejection expectations in the first phase. For the second phase, we found an interaction effect of experimental condition; i.e. participants adjusted their expectations according to the differential social feedback. In the third phase, learned social expectations remained stable in accordance to the social feedback in the second phase.
Conclusion
Results indicate that the paradigm can be used to investigate the development, maintenance, and modification of social rejection expectations in healthy participants. This offers broad applications to explore the differential acquisition and modification of social rejection expectations in healthy vs. clinical samples. Further, the paradigm might be used to investigate therapeutic strategies to facilitate expectation change.
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Optimizing expectations about endocrine treatment for breast cancer: Results of the randomized controlled psy-breast trial. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e2695. [DOI: 10.32872/cpe.v2i1.2695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background
Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients’ expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
Method
In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Results
Both interventions were well accepted and feasible. Patients’ necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Conclusion
Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.
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Pinquart M, Koß JC, Block H. How Do Students React When Their Performance Is Worse or Better Than Expected? ZEITSCHRIFT FUR ENTWICKLUNGSPSYCHOLOGIE UND PADAGOGISCHE PSYCHOLOGIE 2020. [DOI: 10.1026/0049-8637/a000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. We analyzed grade level and sex differences for changes in expectations and coping with expectation violations, based on the ViolEx model. A sample of 114 third to sixth graders (male, n = 44, 38.6 %; female, n = 70, 61.4 %) reported their expected achievement in trials with no feedback, worse-than-expected achievement feedback, and better-than-expected feedback. Expectations improved across the no-feedback and better-than-expected feedback trials, and deteriorated across worse-than-expected trials. While expectation change did not vary by grade level or sex, reported coping with expectation violation did vary, and pupils of younger years reported higher attempts to fulfill their expectations (assimilative behavior). Immunization against worse-than-expected feedback was associated with higher expectations in the negative-feedback condition, but protective effects of immunization were lost with an increasing number of expectation violations. In addition, higher willingness to reduce one’s expectations (accommodation) inhibited the update of expectations after receiving better-than-expected feedback. Conclusions for future research are drawn.
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Affiliation(s)
| | - Julia C. Koß
- Department of Psychology, Philipps-University of Marburg
| | - Helena Block
- Department of Psychology, Philipps-University of Marburg
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14
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Kube T, Kirchner L, Rief W, Gärtner T, Glombiewski JA. Belief updating in depression is not related to increased sensitivity to unexpectedly negative information. Behav Res Ther 2019; 123:103509. [PMID: 31715323 DOI: 10.1016/j.brat.2019.103509] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/25/2019] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND People with depression differ from healthy people in the extent to which they use novel positive information to adjust negative expectations. In this study, we examined whether the two groups also differ in updating positive expectations after receiving unexpectedly negative information. METHODS Examining 76 people with depressive symptoms and 81 healthy controls, we used an adapted version of a previously validated paradigm. After the initial establishment of positive performance expectations, participants worked on the TEMINT performance test, whereupon half of the participants received standardized feedback that confirmed previous positive expectations while the other half received disconfirming negative feedback. Subsequently, participants' performance expectations were assessed again. Additionally, we assessed participants' appraisal of the feedback, particularly whether they tended to disregard it. RESULTS Results indicated that healthy subjects had overall more positive expectations than people with depressive symptoms, but the two samples did not differ in updating their expectations: both groups changed their expectations in a negative direction after receiving negative feedback; similarly, there were no differences between the two samples after receiving confirmatory positive feedback. Both people with and without depressive symptoms were more likely to disregard the feedback received if the feedback was negative, and such a negative appraisal of the feedback was associated with smaller expectation update. CONCLUSIONS In combination with prior work, the current findings suggest that people with depressive symptoms do not over-sensitively react to unexpectedly negative information; rather, the main problem of depression seems to be the integration of novel positive information, as shown previously.
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Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032, Marburg, Germany; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstraße 10, 76829, Landau, Germany.
| | - Lukas Kirchner
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Thomas Gärtner
- Schön Klinik Bad Arolsen, Hofgarten 10, 34454, Bad Arolsen, Germany
| | - Julia Anna Glombiewski
- University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstraße 10, 76829, Landau, Germany
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Kube T, Rief W, Gollwitzer M, Gärtner T, Glombiewski JA. Why dysfunctional expectations in depression persist - Results from two experimental studies investigating cognitive immunization. Psychol Med 2019; 49:1532-1544. [PMID: 30131084 DOI: 10.1017/s0033291718002106] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Research has revealed that negative expectations impact depressive symptoms. However, research on the change of dysfunctional expectations in depression is lacking so far. Therefore, the present research aimed to fill this gap by testing the hypothesis that people with the major depressive disorder (MDD), contrary to healthy individuals, maintain their expectations despite experiences that positively disconfirm expectations. Further, it was hypothesized that cognitive immunization (a cognitive reappraisal of the disconfirming evidence) is a mechanism underlying the persistence of expectations. METHOD In Study 1, we compared individuals with MDD (N = 58) to healthy individuals (N = 59). Participants worked on the same performance test and received standardized feedback that either confirmed or disconfirmed their initial performance expectations. In Study 2, we investigated the effects of cognitive immunization on expectation change among 59 individuals reporting elevated levels of depression by varying the appraisal of expectation-disconfirming feedback. RESULTS Results from Study 1 show that in the expectation-disconfirming condition, healthy individuals changed their expectations, whereas individuals with MDD did not. No such difference between the two groups was found for expectation-confirming feedback. Results from Study 2 indicated that varying cognitive immunization impacted expectation change, thus suggesting a crucial role of cognitive immunization in expectation change. CONCLUSIONS These two studies indicated that individuals suffering from depression have more difficulties in changing their expectations after disconfirming experiences than do healthy individuals, and cognitive immunization might be a core mechanism underlying expectation persistence. Therefore, psychotherapeutic interventions should aim to inhibit cognitive immunization processes to enhance expectation change.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
| | - Mario Gollwitzer
- Department of Psychological Methodology and Social Psychology,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
| | - Thomas Gärtner
- Schön Klinik Bad Arolsen,Hofgarten 10, D-34454 Bad Arolsen,Germany
| | - Julia Anna Glombiewski
- Department of Clinical Psychology and Psychotherapy,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
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How to modify persisting negative expectations in major depression? An experimental study comparing three strategies to inhibit cognitive immunization against novel positive experiences. J Affect Disord 2019; 250:231-240. [PMID: 30870773 DOI: 10.1016/j.jad.2019.03.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research has shown that negative expectations in major depressive disorder (MDD) often persist despite positive disconfirming experiences. To explain this phenomenon, the concept of cognitive immunization has been introduced: that is, individuals with MDD reappraise disconfirming positive evidence in such a way that negative expectations are maintained. In this study, we examined whether it is possible to inhibit cognitive immunization to facilitate expectation update. METHODS We examined 113 people with MDD being treated in an inpatient psychosomatic hospital. Using a previously validated paradigm, participants worked on a standardized performance test; we examined changes in negative performance-related expectations after positive expectation-disconfirming feedback. One experimental group received additional information increasing the value of the positive feedback ('INFORMATION'). Another group was instructed to recall the feedback after completing the task ('RECALL'). In a third group, participants' attention was shifted to potential expectation-disconfirming feedback ('ATTENTION'). In addition, a control group underwent the standard procedure of the paradigm. RESULTS The results showed significant group differences in the change in generalized performance expectations, with the largest changes in participants from the INFORMATION group. All experimental groups had lower values for cognitive immunization than the control group. LIMITATIONS Given that this proof-of-concept study was the first to examine strategies to inhibit cognitive immunization, the findings need to be replicated in future studies. CONCLUSIONS The present study confirms that cognitive immunization in MDD can be inhibited, thus facilitating adjusting negative expectations. The most promising results were found for the INFORMATION group, providing information to emphasize the relevance of expectation-disconfirming information.
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Abstract
The cognitive model of depression was highly stimulating for a better understanding and development of treatment for depression. However, the concept of “cognition” is rather broad and unspecific, and we suggest to focus on the cognitive subset of expectation.
We conducted a narrative review on the role of expectations, and present an expectation-focused model of explaining why depression tends to persist despite the occurrence of positive events.
Several results from basic neuroscience to effects in clinical interventions indicate that expectations play a special role not only for the understanding of the development of mental disorders and the effects of treatment approaches, but especially for an improved understanding of the persistence of mental disorders. If expectations are a major mechanism of depression, the treatment of depression must maximize the violation of dysfunctional expectations. We also introduce the concept of immunization that describes any cognitive or behavioral strategies to reduce the effect of expectation violation experiences, and hereby contributing to expectation maintenance despite expectation contradicting events. We postulate that the development of immunization strategies could help to better understand the transition from episodic to chronic depression.
While in early periods of depression development, a focus on expectation change might be sufficient in treatment, the treatment of patients with chronic depression requires addressing these cognitive and behavioral immunization strategies more intensively. Further implications for treatment and research are outlined that are derived from this balance between expectation violation and cognitive immunization in depression.
A focus on “expectations” helps to better understand the maintenance of depression
We offer a model that explains why depression persists even in the presence of positive experiences.
Many psychological treatments focus on the violation of negative expectations, but cognitive immunization can hinder treatment success.
We suggest strategies on how to improve psychological treatments for depression by maximizing expectation violation, and minimizing cognitive immunization.
A focus on “expectations” helps to better understand the maintenance of depression
We offer a model that explains why depression persists even in the presence of positive experiences.
Many psychological treatments focus on the violation of negative expectations, but cognitive immunization can hinder treatment success.
We suggest strategies on how to improve psychological treatments for depression by maximizing expectation violation, and minimizing cognitive immunization.
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