Expectation-focused psychological interventions for depression: a treatment manual

Abstract

Background: Cognitive behavioral therapy (CBT) is effective for depression also in the long term; however, there is still a need for improvement. In research on the placebo effect and neuroscience, the central importance of expectations is becoming increasingly clearer. Recent therapeutic approaches for modification of dysfunctional expectations (expectation-focused psychotherapeutic interventions, EFPI) seem to be a promising element for improvement of classical CBT. Objective: The essential components of an EFPI treatment manual for depression are presented. Material and methods: The manual is designed for 24 sessions (short-term therapy). It contains five sessions of psychoeducation on the formulation, review and violation of expectations as well as on cognitive immunization (retrospective re-evaluation of experiences that violate prior expectations). The psychoeducation is followed by a phase in which one behavioral experiment is carried out or planned in each session. The behavioral experiments aim to challenge central disease-sustaining expectations (expectation violation). In addition, cognitive immunization strategies are discussed and if possible prevented. In the last session, what has been learned is summarized and consolidated for relapse prevention. The manual was tested in a small pilot study (n = 5). Results: The EFPI therapy was well-received. A comprehensive evaluation is in progress. Discussion: The EFPI manual represents the focus of CBT on as many salient expectation violations as possible and additionally addresses cognitive immunization. Persistent, dysfunctional expectations of persons with depression can be targeted and directly treated.