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There is some evidence that internet-delivered treatment can be effective in treating some common mental health problems, including major depressive disorder (MDD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD). Research also suggests that these treatments are more effective when they involve clinician support (vs fully automated) and that clinician-supported internet-delivered CBT can produce similar effects as face-to-face CBT. Given the growth of and interest in internet-delivered treatment, researchers are considering what predicts outcomes, engagement, and dropout. Two factors that may be important are patients’ experience of credibility and treatment expectancy. Credibility refers to a patient’s belief about the logic and suitability of the treatment. Expectancy refers to the extent to which a patient believes that the treatment will be of benefit to them. Both are considered one of the “common factors” of psychotherapy. In meta-analyses of face-to-face psychotherapy, credibility and expectancy are each associated with better treatment outcomes. In this study, Dear combined data from four large studies of internet-delivered treatment for depression (n = 445), generalized anxiety (n = 454), social anxiety (n = 486), and panic disorder (n = 292). Treatment credibility and outcome expectations were relatively high overall, with 65% to 85% of patients scoring in the upper ranges of the scales. Being male, single, and having previous mental health treatment was associated with lower credibility and expectancy scores, although the effects were small. There was a significant association between credibility and expectancy with symptom reduction for MDD, GAD, SAD and PD, and the effects were moderately large. Only 11% dropped out of treatment. Those who reported high credibility and expectancy were significantly less likely to drop out than those with low levels of credibility (8% vs. 20%, p = .007) and expectancy (7% vs. 16%, p = .005). Among those in the study, 70% of the participants were highly engaged (utilized most of the online content). Those with high credibility and high expectancy were significantly more likely to engage with the content compared to those categorized as low in credibility (73% vs. 59%, p = .030) and low expectancy (75% vs. 64%, p = .012). |
As with face-to-face psychotherapy, patients’ experience of internet-delivered treatment as credible and their expectation that the treatment will be effective are both associated with better outcomes, lower drop-out, and greater engagement. Treatment providers would do well to give a rationale for treatment that is acceptable to patients and that will enhance the credibility of the interventions. When the provider and patient come to an agreement on the tasks and goals of therapy (key elements of the therapeutic alliance) and continually evaluate these throughout treatment, this will significantly enhance the effectiveness of the intervention.
Dear, B. F. (2025). Credibility and expectations: Important factors for understanding clinical response, treatment completion, and dropout in internet-delivered psychological interventions. Journal of Consulting and Clinical Psychology. Advance online publication. https://doi.org/10.1037/ccp0000969