Objective While 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 post-traumatic stress disorder.

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We hypothesized that increases in SE and OE would predict reductions in anxiety and depression as well as improvement in functioning. Method Participants (mean age = 43.3, SD=13.2, 71.1% female, 55.5% white) were recruited from primary care centers throughout the US and were randomized to receive either Coordinated Anxiety Learning and Management (CALM) treatment, comprised of cognitive-behavioral therapy, psychotropic medication, or both, or to 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, and Sheehan Disability Scale outcomes at 6, 12, and 18 months after baseline. Self-efficacy and outcome-expectancy have been written about extensively over decades. Outcome-expectancy is the degree to which one believes that a particular outcome will occur, whereas self-efficacy is the degree of conviction that one can successfully execute the behavior required to produce an outcome (). In terms of treatment, outcome-expectancy is the belief that a particular treatment will reduce symptom levels or improve functioning (), whereas self-efficacy is one’s judgment of capability for successfully participating in and completing treatment (). While these are clearly related concepts, they are differentiated because individuals can believe that they are capable of completing treatment, and yet not believe that the treatment will be effective at reducing their distress, and vice versa ().

Outcome-expectancy and self-efficacy are both theorized to enhance task motivation and intention to complete a behavior, as well as to determine the degree of effort expended and persistence in the face of obstacles or aversive experiences (, ). A number of studies have found that initial outcome expectancies, usually measured at completion of the first therapy session, predict treatment outcome. Truck Driver Nepali Movie Song Download How To Crack Pdc Files. on this page. This is the case for various psychosocial treatment approaches, including cognitive behavioral therapy (CBT), non-directive therapy and applied relaxation for generalized anxiety disorder (), cognitive-behavioral group therapy for social anxiety disorder (, ), in vivo exposure therapy and virtual reality therapy for specific phobia (), and CBT and interpersonal therapy for depression (). In addition, expectation for medication to work consistently predicts actual response to drug treatments (). Similarly, self-efficacy has been shown to predict outcome across a variety of treatments and disorders.

Results are similar for treatment-related self-efficacy (i.e., belief in an ability to complete the necessary steps of treatment) () and disorder-related self-efficacy (i.e., belief in ability to engage or not engage in a disorder-specific behavior) (–). Higher initial self-efficacy predicted better post-treatment outcomes from either CBT or a 12-step facilitation treatment for substance abuse with comorbid depression (), six-month outcomes from ‘treatment as usual’ for substance abusers (), and six-month outcomes from CBT and supportive therapy for depressed adolescents (). Also, initial self-efficacy significantly predicted response to medication () and better maintenance of fear reduction following medication treatment (). Therefore, baseline values of both self-efficacy and outcome-expectancy are robust predictors of outcome across a wide array of conditions and treatments. Gm2 Drivers License more. Despite the extensive research on initial levels of self-efficacy and outcome-expectancy, little research has examined whether change in self-efficacy and outcome-expectancy throughout the course of treatment explains outcome, even though these expectancies are theorized to change over time and subsequently result in symptom improvement (, ).

In the only study of change over time in outcome-expectancy, Newman and Fisher () found that rate of change in outcome-expectancy across multiple treatment sessions predicted reductions in generalized anxiety disorder severity at post-CBT. However, they neither examined self-efficacy nor did they evaluate long-term outcomes. Pre- to post-treatment changes in self-efficacy have been shown to precede symptom reduction () or to predict symptomatic improvement at post-treatment (, ). In the one study that conducted a true mediational analysis, changes in self-efficacy (measured at three time-points) did not predict changes in outcome) (). Therefore, very little is known about the degree to which changes in expectancies predict treatment outcomes. Greater understanding of these predictive pathways has the potential to inform treatment strategies and in turn augment outcomes. In the current investigation, we evaluated the directional relationship between session ratings of self-efficacy, outcome-expectancy, and symptoms/functioning using a cross-lagged panel analysis.