Abstract

This article examined patients’ change in outcome expectation across cognitive-behavior therapy for generalized anxiety disorder, as well as participant factors that are associated with both pretreatment outcome expectation and expectation change. Findings: On average, patients’ outcome expectation becomes more positive over time. Moreover, the degree of such change is influenced by several baseline and early treatment patient factors and by the therapist themselves. Meaning: Therapists should consider assessing outcome expectation throughout cognitive-behavior therapy for generalized anxiety disorder and pay attention to baseline patient characteristics (i.e., demographic and clinical variables) and their early change in general self-efficacy, as these might be important clinical indicators of both patients’ pretreatment outcome expectation level and expectation change. In addition, therapists should “know thyself,” as they may differ in their ability to foster positive expectancy change for their average patient (which could bear on clinical practices and training needs). Next Steps: Future research needs to replicate the current findings and extend them by investigating therapist-level characteristics and/or actions that might explain why some therapists do a significantly better job than others of facilitating positive patients’ outcome expectation. This latter focus would contribute to developing more effective evidence-based therapist trainings.

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