The role of dysfunctional expectation persistence in psychopathology
In the literature, expectations are seen as core elements influencing and directing human behavior. There are many different models underlying this, such as the well-known expectancy–value theories. The past few decades have seen increased interest in analyzing the role of these theories in psychoth...
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|In the literature, expectations are seen as core elements influencing and directing human behavior. There are many different models underlying this, such as the well-known expectancy–value theories. The past few decades have seen increased interest in analyzing the role of these theories in psychotherapy. On one hand, scholars have found increasingly convincing evidence of the impact of expectations on treatment success (i.e., placebo-effect research). On the other hand, the question has arisen whether people with mental disorders differ in the content of their expectations as well as in their processing mechanisms. The ViolEx model is one of the first expectation models that has been applied to the mechanisms of psychopathology and psychotherapy. It appears that people with mental disorders not only show a greater amount of dysfunctional expectations but also that those expectations are more persistent than in people without a mental disorder. In addition to other mechanisms, the concept of “cognitive immunization” has been suggested as responsible for the maintenance of dysfunctional expectations. First, researchers have found evidence for the link between cognitive immunization (i.e., expectation persistence after an expectation-disconfirming experience) and psychopathology. For this dissertation, the process of cognitive immunization, as a relatively new concept, was analyzed in detail, with the goal of developing interventions and reducing cognitive immunization processes.
In the first study, the concept of cognitive immunization was analyzed in an experimental design (N = 102). Social expectations were induced and violated, and the expectation adaptation was hypothesized to differ between micro-interventions, including an expectation- focused psychological intervention (EFPI). The EFPI group showed significantly greater variability in their expectations and, thus, lower rates of cognitive immunization compared to the other groups.
Second, the complexity of the implicit operationalization of cognitive immunization through experimental designs showed the need for efficient (self-rating) instruments. Therefore, a self-rating questionnaire, the Immunization Scale (IMS), has been developed. The IMS was validated through exploratory (N = 230) and confirmatory (N = 299) factor analyses, resulting in a 23-item questionnaire.
In the third study, the EFPI was tested for its effectiveness in reducing cognitive immunization, measured with the IMS. Therefore, an online longitudinal randomized controlled design was developed for people with mild depressive and/or anxiety symptoms (N = 128). Cognitive immunization was correlated with psychopathology, and the EFPI group showed a significant reduction in the cognitive immunization level.
Lastly, and based on the third study, a protocol paper was written for a large-scale psychotherapeutic study that analyzes the effectiveness of cognitive behavioral therapy (CBT) with the integration of EFPIs in people with diagnosed depression compared to standard CBT without special focus on expectations.
This dissertation provides a validated questionnaire to analyze cognitive immunization processes and their link to psychopathology. It offers initial evidence of EFPIs’ effectiveness in reducing cognitive immunization in people with psychopathological symptoms. Practical and research implications are discussed.