Evidence map›Paper›PMID 41980009›Full record

ArticlePsychotherapy and psychosomatics2026

From Expectation to Learning: A Mediational Model of Exposure Therapy Outcome in Anxiety Disorders.

Benjamin Straube, Lukas Kirchner, Gina L Haccou, Isabelle C Ridderbusch, Ingmar Heinig, Jan Richter, Ulrike Lueken, Paul Pauli, Jürgen Deckert, Katharina Domschke and 14 more

Abstract read
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In one paragraph

Article in Psychotherapy and psychosomatics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Benjamin StraubeDepartment of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior - CMBB, Philipps- University Marburg, Marburg, Germany, straubeb@staff.uni-marburg.de.
Lukas KirchnerDepartment of Clinical Psychology and Psychotherapy, Justus-Liebig-University, Giessen, Germany.
Gina L HaccouDepartment of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior - CMBB, Philipps- University Marburg, Marburg, Germany.
Isabelle C RidderbuschDepartment of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior - CMBB, Philipps- University Marburg, Marburg, Germany.
Ingmar HeinigInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Jan RichterDepartment of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
Ulrike LuekenGerman Center for Mental Health (DZPG), Partner Site Berlin/Potsdam, Berlin, Germany.
Paul PauliDepartment of Psychology, University of Würzburg, Würzburg, Germany.
Jürgen DeckertCenter for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
Katharina DomschkeGerman Center for Mental Health (DZPG), Partner Site Berlin/Potsdam, Berlin, Germany.
Peter NeudeckProtect-AD Study Site Cologne, Cologne, Germany.
Katja KoelkebeckDepartment of Psychiatry and Psychotherapy, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Bielefeld University, Bielefeld, Germany.
Udo DannlowskiDepartment of Psychiatry and Psychotherapy, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Bielefeld University, Bielefeld, Germany.
Volker AroltInstitute for Translational Psychiatry, University of Münster, Münster, Germany.
Thomas FydrichDepartment of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
Andreas StröhleDepartment of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Jürgen MargrafMental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
Silvia SchneiderFaculty of Psychology, Clinical Child and Adolescent Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
Jürgen HoyerInstitute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
Alfons O HammDepartment of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany.
Hans-Ulrich WittchenPsychiatric University Hospital, Ludwig-Maximilians-University München, Munich, Germany.
Tilo KircherDepartment of Psychiatry and Psychotherapy and Center for Mind Brain and Behavior - CMBB, Philipps- University Marburg, Marburg, Germany.
Winfried RiefDepartment of Clinical Psychology and Psychotherapy, Faculty of Psychology and Center for Mind, Brain and Behavior - CMBB, Philipps-University of Marburg, Marburg, Germany.
Andre PittigTranslational Psychotherapy, Institute of Psychology, University of Göttingen, Göttingen, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionNegative expectations about treatment outcomes are associated with poorer recovery in anxiety disorders. However, it remains unclear whether patients' expectations about how effective the treatment will be (treatment-specific expectations) mediate the link between generalized negative expectations (i.e., unspecific pessimistic beliefs) and treatment outcomes, and whether these expectations affect outcomes via the learning rate during exposure therapy that is, the extent to which patients update their fear-related beliefs based on corrective experiences. Since treatment-specific expectations may be more modifiable, clarifying these mechanisms could improve interventions. This study therefore investigated whether treatment-specific expectations and learning rate mediate the effect of generalized negative expectations on treatment outcomes.

methodsData from 605 patients with various anxiety disorders undergoing 12 sessions of manualized exposure therapy were analyzed. Generalized negative expectations at baseline (session 0) were hypothesized to predict treatment outcomes (i.e., symptom severity at posttreatment) via expectations about treatment success measured at session 4 and learning rate during exposure. Depression and anxiety at baseline were covariates. Mediation analyses were conducted using the PROCESS macro with bootstrap confidence intervals.

resultsGeneralized negative expectations predicted poorer treatment outcomes (higher symptom severity), mediated by lower expectations about treatment success (β = 0.0375; 95% CI: 0.0088-0.0730). A sequential mediation via these treatment-specific expectations and learning rate was also significant (β = 0.0059; 95% CI: 0.0008-0.0134), even after accounting for baseline symptom levels (R2 = 0.3375).

conclusionTargeting both generalized and treatment-specific expectations early in treatment may enhance exposure-based learning and improve clinical outcomes in anxiety disorders.

Indexed as

Anxiety disordersExposureLearning rateMediationNegative expectationsPsychotherapyTreatment outcome

Identifiers

PMID41980009
PMCPMC13293588

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.