Maximizing expectancy violation and exposure outcomes in patients with PTSD
Background: It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD.Objective: We aimed to test whether explicitly focusing on expectancy violation leads...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2025-12-01
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| Series: | European Journal of Psychotraumatology |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/20008066.2024.2447183 |
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| author | Marike J. Kooistra Maartje Schoorl Danielle A. C. Oprel Willem van der Does Rianne A. de Kleine |
| author_facet | Marike J. Kooistra Maartje Schoorl Danielle A. C. Oprel Willem van der Does Rianne A. de Kleine |
| author_sort | Marike J. Kooistra |
| collection | DOAJ |
| description | Background: It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD.Objective: We aimed to test whether explicitly focusing on expectancy violation leads to superior exposure outcomes.Method: Adult treatment-seeking patients with PTSD (N = 60) were randomly assigned to one 90-minute exposure session focusing on either expectancy violation or a control condition without an expectancy focus. Assessments occurred before the session and one week later, measuring changes in fear responses during a script-driven imagery task, and PTSD symptoms.Results: Using multilevel analyses, we found no between-condition differences. On average, fear responses to the imagery and PTSD symptoms decreased over time. The expectancy violation condition exhibited a greater decrease in threat appraisal, which appeared to mediate symptom reduction.Conclusions: We found no evidence that explicitly focusing on expectancy violation led to superior immediate effects. However, it may lead to more changes in expectancies which could affect symptom improvement over an extended period. Further research is needed to determine whether emphasizing expectancy violation in exposure therapy for PTSD is advantageous. |
| format | Article |
| id | doaj-art-54bb243a9a084d1ba25d5bbc239df08c |
| institution | Kabale University |
| issn | 2000-8066 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | European Journal of Psychotraumatology |
| spelling | doaj-art-54bb243a9a084d1ba25d5bbc239df08c2025-01-07T13:45:11ZengTaylor & Francis GroupEuropean Journal of Psychotraumatology2000-80662025-12-0116110.1080/20008066.2024.2447183Maximizing expectancy violation and exposure outcomes in patients with PTSDMarike J. Kooistra0Maartje Schoorl1Danielle A. C. Oprel2Willem van der Does3Rianne A. de Kleine4Department of Clinical Psychology, Leiden University, Leiden, The NetherlandsDepartment of Clinical Psychology, Leiden University, Leiden, The NetherlandsDepartment of Clinical Psychology, Leiden University, Leiden, The NetherlandsDepartment of Clinical Psychology, Leiden University, Leiden, The NetherlandsDepartment of Clinical Psychology, Leiden University, Leiden, The NetherlandsBackground: It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD.Objective: We aimed to test whether explicitly focusing on expectancy violation leads to superior exposure outcomes.Method: Adult treatment-seeking patients with PTSD (N = 60) were randomly assigned to one 90-minute exposure session focusing on either expectancy violation or a control condition without an expectancy focus. Assessments occurred before the session and one week later, measuring changes in fear responses during a script-driven imagery task, and PTSD symptoms.Results: Using multilevel analyses, we found no between-condition differences. On average, fear responses to the imagery and PTSD symptoms decreased over time. The expectancy violation condition exhibited a greater decrease in threat appraisal, which appeared to mediate symptom reduction.Conclusions: We found no evidence that explicitly focusing on expectancy violation led to superior immediate effects. However, it may lead to more changes in expectancies which could affect symptom improvement over an extended period. Further research is needed to determine whether emphasizing expectancy violation in exposure therapy for PTSD is advantageous.https://www.tandfonline.com/doi/10.1080/20008066.2024.2447183Posttraumatic stress disorderexposure therapyexpectancy violationinhibitory learningmechanisms of changeTrastorno de estrés postraumático |
| spellingShingle | Marike J. Kooistra Maartje Schoorl Danielle A. C. Oprel Willem van der Does Rianne A. de Kleine Maximizing expectancy violation and exposure outcomes in patients with PTSD European Journal of Psychotraumatology Posttraumatic stress disorder exposure therapy expectancy violation inhibitory learning mechanisms of change Trastorno de estrés postraumático |
| title | Maximizing expectancy violation and exposure outcomes in patients with PTSD |
| title_full | Maximizing expectancy violation and exposure outcomes in patients with PTSD |
| title_fullStr | Maximizing expectancy violation and exposure outcomes in patients with PTSD |
| title_full_unstemmed | Maximizing expectancy violation and exposure outcomes in patients with PTSD |
| title_short | Maximizing expectancy violation and exposure outcomes in patients with PTSD |
| title_sort | maximizing expectancy violation and exposure outcomes in patients with ptsd |
| topic | Posttraumatic stress disorder exposure therapy expectancy violation inhibitory learning mechanisms of change Trastorno de estrés postraumático |
| url | https://www.tandfonline.com/doi/10.1080/20008066.2024.2447183 |
| work_keys_str_mv | AT marikejkooistra maximizingexpectancyviolationandexposureoutcomesinpatientswithptsd AT maartjeschoorl maximizingexpectancyviolationandexposureoutcomesinpatientswithptsd AT danielleacoprel maximizingexpectancyviolationandexposureoutcomesinpatientswithptsd AT willemvanderdoes maximizingexpectancyviolationandexposureoutcomesinpatientswithptsd AT rianneadekleine maximizingexpectancyviolationandexposureoutcomesinpatientswithptsd |