An Investigation of Outcome Expectancies as a Predictor of Treatment Response for Combat Veterans With Ptsd: Comparison of Clinician, Self-Report, and Biological Measures

Abstract

Background Outcome expectancy, or the degree to which a client believes that therapy will result in improvement, is related to improved treatment outcomes for multiple disorders. There is a paucity of research investigating this relation in regards to PTSD. Additionally, the bulk of the research on outcome expectancy and treatment outcomes has relied mostly on self-report outcome measures. Methods The relation between outcome expectancy on self-report measures, clinician-rated measures, and two biological indices (fear potentiated startle and cortisol reactivity) of PTSD symptoms was explored. The sample included combat veterans (N= 116) treated with virtual reality exposure therapy for PTSD. Results Results supported a negative association between outcome expectancy and both self-report and clinician-rated symptoms at the conclusion of treatment, but outcome expectancy was related to the magnitude of change during treatment for self-report measures only. Outcome expectancy was unrelated to biological measures of treatment response. Conclusions These findings suggest that outcome expectancy may be related to patient and clinician perceptions of outcomes but not biological indices of outcome for PTSD.

Differential Estimation of Treatment Effect Between Clinician‐Administered and Self‐Reported PTSD Assessments

“…This method is justifiable among adults samples, wherein researchers have detected statistically significant convergence between C-A and S-R assessments for estimating PTSD outcomes (Cody, Jones, Woodward, Simmons, & Beck, 2017;Lenz & Williams, 2014). These findings appear to remain consistent across some important characteristics, such as gender (Irish et al, 2011), participants' expectations for treatment (Price et al, 2015), and factor structure used to depict PTSD scores (Scher, McCreary, Asmundson, & Resick, 2008). By contrast, evidence has begun to emerge calling into question the concordance between C-A and S-R measures of PTSD and related traumatic responses among children and adolescents.…”

Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy

“…Many therapeutic resources and clinical supervision efforts are focused on better enabling clinicians to increase the emotional and physiological responses of clients/ patients early in the exposure therapy process (Foa, 2011). Although the theory is widely supported as evidenced by clinically significant effect sizes for exposure therapy in PTSD, investigations of the specific empirical links between psychophysiological indices of patient engagement in exposure therapy and positive treatment outcomes have only recently been initiated (Price et al, 2015). There is evidence from the literature supporting a link between biological reactivity pre-treatment with positive (Foa, Riggs, Massie, & Yarczower, 1995; Rauch et al, 2015) and negative (Yehuda et al, 2009) treatment outcomes.…”

Virtual Reality for Anxiety and Stress-Related Disorders: A SWOT Analysis

“…In another study, mediational analyses revealed that the reduction of posttraumatic symptoms leads to the change of depressive symptoms and not the other way around [52]. Likewise, Maples-Keller and colleagues [46] investigated the role of reexperiencing symptoms in VRET for PTSD, showing its importance in line with Emotional Processing Theory. Finally, a further research line explored the role of cognitive mechanisms in spider phobia VRET.…”

“…A spark of interest was also shown in the predictors of outcome. In total, four studies explored the role of expectations as a predictor of outcome in VRET [44][45] [46] [47], indicating that it constitutes a relevant non technical aspect that plays a relevant role in VRET. Likewise, some studies were conducted to look into the levels of engagement as a key process in VR outcomes, with mixed findings [48,49].…”