Expectancies are assumed to play an essential role in the maintenance and treatment of anxiety disorders. The present review aimed to systematically summarize studies examining the effects of expectancies as suggested by the match-mismatch model of fear (Rachman, 1994). A total of 50 articles were included. The findings largely supported core assumptions of the match-mismatch theory. The majority of studies verified the existence of an overprediction bias in anxiety disorders and a reduction of both expected and actually experienced level of fear with repeated exposures. There was some evidence, that an increasingly accurate prediction of fear was associated with reductions in real fear. New research directions and clinical implications are proposed to further develop treatment strategies for anxiety disorders.
Public Health Significance StatementExposure therapy is highly effective as a treatment of anxiety disorders. However, mechanisms of change remain unclear. Cognitive processes, such as expectancies, might be one important factor for treatment success. The manuscript summarizes findings on fear-related expectancies and their violation within the context of exposure therapy. Patients with anxiety disorders tend to overpredict fear in situations, and this overprediction subsides with repeated exposure. There is a possible connection between a more accurate prediction of fear and exposure therapy outcome. This manuscript underlines the importance of incorporating expectancies in the evaluation of the therapy process.