Expectation framing in psychotherapy: effects of approach- and avoidance-oriented video interventions on help-seeking...

Treatment expectations play an important role in psychotherapy initiation and early treatment engagement may influence whether individuals decide to seek help. Negative expectations, concerns about burden, and anticipated risks may be particularly relevant for individuals with social anxiety. However, little is known about how different ways of framing treatment expectations influence help-seeking intentions. This study examined whether brief, role-model-based video interventions can modify treatment expectations and increase the subjective likelihood of seeking psychotherapy.

Participants (N = 123) were randomly assigned to one of three conditions: (1) avoidance-oriented framing, emphasizing the reduction of negative treatment expectations; (2) approach-oriented framing, highlighting potential positive treatment outcomes or (3) a minimal-intervention control condition. Treatment expectations (TEX-Q) and self-reported likelihood of seeking psychotherapy were assessed before and after the intervention.

Both video conditions increased subjective treatment-seeking probability compared to the control group, with a stronger increase observed for avoidance-oriented framing. This pattern was replicated in a subsample with higher self-reported social anxiety. Effects on treatment expectations were less consistent.

These findings suggest that expectation-focused communication may help address expectation-related barriers before psychotherapy begins. Avoidance-oriented framing may be particularly relevant in the early phase of treatment engagement, especially for individuals with higher self-reported social anxiety.

The trial was registered at ClinicalTrials.gov: NCT06022432.