Background: Medication side effects are strongly determined by non-pharmacological, nocebo mechanisms, particularly patients’ expectations. Optimizing expectations could minimize side effect burden. This study evaluated whether brief psychological expectation management training (EXPECT) optimizes medication-related expectations in women starting adjuvant endocrine therapy (AET) for breast cancer.
Method: In a multisite randomized controlled design, 197 women were randomized to EXPECT, supportive therapy (SUPPORT), or treatment as usual (TAU). The three-session cognitive-behavioral EXPECT employs psychoeducation, guided imagery, and side effect management training. Outcomes were necessity-concern beliefs about AET, expected side effects, expected coping ability, treatment control expectations, and adherence intention.
Results: Both interventions were well accepted and feasible. Patients’ necessity-concern beliefs were optimized in EXPECT compared to both TAU and SUPPORT, d = .41, p < .001; d = .40, p < .001. Expected coping ability and treatment control expectations were optimized compared to TAU, d = .35, p = .02; d = .42, p < 001, but not to SUPPORT. Adherence intention was optimized compared to SUPPORT, d = .29, p = .02, but not to TAU. Expected side effects did not change significantly.
Conclusion: Expectation management effectively and partly specifically (compared to SUPPORT) modified medication-related expectations in women starting AET. Given the influence of expectations on long-term treatment outcome, psychological interventions like EXPECT might provide potential pathways to reduce side effect burden and improve quality of life during medication intake.
Most read articles by the same author(s)
- Tobias Kube, Philipp Herzog, Charlotte M. Michalak, Julia A. Glombiewski, Bettina K. Doering, Winfried Rief, Further Specifying the Cognitive Model of Depression: Situational Expectations and Global Cognitions as Predictors of Depressive Symptoms , Clinical Psychology in Europe: Vol. 1 No. 4 (2019)
- Lisa D'Astolfo, Lukas Kirchner, Winfried Rief, No1LikesU! – A Pilot Study on an Ecologically Valid and Highly Standardised Experimental Paradigm to Investigate Social Rejection Expectations and Their Modification , Clinical Psychology in Europe: Vol. 2 No. 2 (2020)