Promoting Flexibility in Expectations: A Randomized-Controlled Online-Intervention Study for Mild Psychopathological Symptoms

Abstract

Background: Research demonstrates that mental disorders are associated with specific dysfunctional expectations and a reduced ability to adjust them, even after expectation-violating experiences. The ViolEx (violated expectation) model offers a framework to explain why expectations persist or change, introducing the concept of cognitive immunization as a potential explanation for differences in information processes. Expectation-focused psychological interventions (EFPI) aim to promote expectation adaptation. Method: This study examines the effectiveness of an online EFPI platform for individuals with mild depressive and/or anxiety symptoms. A total of 128 participants, screened with the PHQ-9 (scores 5-9) and/or BAI (scores 8-25), were randomly assigned to one of three groups. The EFPI group and the active control group (ACG) received a psychoeducational video about expectations and their influence on behavior. Over four weeks, the EFPI group completed behavioral experiments to test their personal expectations, while the ACG used only cognitive strategies to challenge personal expectations. A third group (control group; CG) received no intervention. Surveys were administered at baseline, four weeks, and eight weeks after the initial assessment. Results: A significant reduction in cognitive immunization was observed over measurement timepoints, with a significant difference to the CG at the follow-up. Anxiety symptoms appear to moderate this effect, whereas EFPI did not influence depressive symptoms, nor did depressive symptoms moderate changes in cognitive immunization. Conclusion: This study is the first to evaluate online EFPI for mild depression and/or anxiety symptoms, suggesting that EFPI may reduce cognitive immunization. Future studies should investigate therapist-delivered EFPI in clinical populations with more severe symptoms.