Expectancies as core features of mental disorders

Expectancies are core features of mental disorders, and change in expectations is therefore one of the core mechanisms of treatment in psychiatry. We aim to improve our understanding of expectancies by summarizing factors that contribute to their development, persistence, and modification. We pay particular attention to the issue of persistence of expectancies despite experiences that contradict them.

Based on recent research findings, we propose a new model for expectation persistence and expectation change. When expectations are established, effects are evident in neural and other biological systems, for example, via anticipatory reactions, different biological reactions to expected versus unexpected stimuli, etc. Psychological 'immunization' and 'assimilation', implicit self-confirming processes, and stability of biological processes help us to better understand why expectancies persist even in the presence of expectation violations.

Learning theory, attentional processes, social influences, and biological determinants contribute to the development, persistence, and modification of expectancies. Psychological interventions should focus on optimizing expectation violation to achieve optimal treatment outcome and to avoid treatment failures.