Determinants of psychotherapy outcome expectations: Qualitative accounts from socially anxious college students

Aim Patients' prognostic psychotherapy outcome expectations are robustly associated with post-treatment outcomes. However, little is known about the determinants of such expectancies, especially in college students whose beliefs have yet to be influenced by prior therapy experiences. Understanding factors that relate to such truly 'baseline' predictive beliefs can have implications for addressing undergraduate students' willingness to begin a course of, engage in, and benefit from mental health treatment, beyond simply having had prior positive or negative experiences. In this qualitative study, we examined socially anxious college students' first-hand accounts of the primary determinants of their baseline treatment outcome expectations. Methods Semi-structured interviews focused on participants' personal, cultural and contextual outcome expectancy determinants were they to begin a course of psychotherapy in the future. Data were analysed according to grounded theory and consensual qualitative research principles. Results Categories including coursework, media and the experiences of important others were considered positive expectancy determinants in some cases and negative expectancy determinants in others, depending on whether the related depictions in class, on the screen, or in discussions were positively or negatively valenced. Although there was balance among most of these predictors, coursework was more commonly considered a positive versus negative expectancy determinant. More unique negative expectancy determinants were based on incorrect information regarding mental health and/or psychotherapy or stigma surrounding mental illness. Discussion Findings contribute to the currently scant literature on determinants of college students' baseline treatment beliefs.