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Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study.

ABSTRACT: Although self-efficacy (SE) and outcome expectancy (OE) have been well researched as predictors of outcome, few studies have investigated changes in these variables across treatments. We evaluated changes in OE and SE throughout treatment as predictors of outcomes in a large sample with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder. We hypothesized that increases in SE and OE would predict reductions in anxiety and depression as well as improvement in functioning.Participants (mean age = 43.3 years, SD = 13.2, 71.1% female, 55.5% white) were recruited from primary care centers throughout the United States and were randomized to receive either Coordinated Anxiety Learning and Management (CALM) treatment - composed of cognitive behavioral therapy, psychotropic medication, or both - or usual care. SE and OE ratings were collected at each session for participants in the CALM treatment (n = 482) and were entered into a structural equation model as predictors of changes in Brief Symptom Inventory, Anxiety Sensitivity Index, Patient Health Questionnaire (PHQ), and Sheehan Disability Scale outcomes at 6, 12, and 18 months after baseline.The best-fitting models predict symptom levels from OE and SE and not vice versa. The slopes and intercept of OE significantly predicted change in each outcome variable except PHQ-8. The slope and intercept of SE significantly predicted change in each outcome variable.Over and above absolute level, increases in SE and OE were significant predictors of decreases in symptoms and increases in functioning. Implications for treatment are discussed, as well as future directions of research.

SUBMITTER: Brown LA

PROVIDER: S-EPMC4244230 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study.

Brown Lily A LA Wiley Joshua F JF Wolitzky-Taylor Kate K Roy-Byrne Peter P Sherbourne Cathy C Stein Murray B MB Sullivan Greer G Rose Raphael D RD Bystritsky Alexander A Craske Michelle G MG

Depression and anxiety 20140311 8

<h4>Background</h4>Although self-efficacy (SE) and outcome expectancy (OE) have been well researched as predictors of outcome, few studies have investigated changes in these variables across treatments. We evaluated changes in OE and SE throughout treatment as predictors of outcomes in a large sample with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder. We hypothesized that increases in SE and OE would predict reductions in anxiety and depr ...[more]

PMID: 24619599

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Project description:BackgroundCognitive bias modification for interpretation (CBM-I) trainings have shown positive effects on interpretation bias in both active interpretation bias training conditions and structurally similar control conditions. Outcome expectations have been suggested to contribute to these placebo effects. The goal of this pilot experimental study was to test the feasibility of positive expectancy induction, to gain preliminary insight into whether this has implications for the efficacy of CBM-I training, and to assess the feasibility of recruitment and the overall study design.MethodsSocially anxious individuals aged 18 years and older received a single session (approx. 45 min) of either CBM-I or placebo training preceded by either a positive expectancy induction or no expectancy induction. We first tested whether the expectancy induction had modified participants' expectations of training. We then explored the effects of CBM-I training and expectancy induction on interpretation bias. Finally, we assessed the feasibility of recruitment and further study procedures.ResultsDue to pandemic-related difficulties, fewer participants were recruited than initially planned. Thirty-four (22 females and 12 males) participants were randomly assigned to one of four conditions (interpretation bias training + high expectancy = 10, interpretation bias training + no expectancy = 8, placebo training + high expectancy = 11, placebo training + no expectancy = 5). Participants in the positive expectancy condition had more positive expectations of the training (CBM-I or placebo) than participants in the no expectancy condition. We were unable to conduct the planned 2 × 2 × 2 analysis of interpretation bias due to the small sample size. When looking at these groups individually, we found that participants in the active training condition and participants in the high expectancy condition showed increases in positive interpretation bias and decreases in negative interpretation bias from pre- to post-training, while participants in the placebo and no expectancy conditions showed no change.ConclusionsThese findings suggest that the expectancy manipulation utilized in this study may be adopted by future studies which investigate outcome expectations as an unspecific mechanism of CBM-I. Preliminary analyses suggest that participants' expectations are likely to play a role in the effect of CBM-I training, although these effects require replication in a larger sample. Several observations about the study feasibility were made which could inform future trials.Trial registrationRetrospectively registered on the August 23, 2022, through the German Clinical Trials Register ( DRKS00029768 ).

Project description:Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed?Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes.Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS.The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.

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Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study.

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Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the CALM study.

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