2 - (OP18) Assessing Expectancy Violations in Exposure and Response Prevention: A Multidimensional Perspective

Assessing Expectancy Violations in Exposure and Response Prevention: A Multidimensional Perspective

Background: Exposure and Response Prevention (ERP) is the treatment of choice for obsessive–compulsive disorder (OCD) and one of the most effective interventions in cognitive behavioral therapy. However, a substantial proportion of patients do not benefit sufficiently, highlighting the need to optimize treatment by gaining a more precise understanding of therapeutic change mechanisms. Expectancy violation - the disconfirmation of prior expectations during exposure - has been proposed as one of several therapeutic change mechanisms in ERP. Empirical research on expectancy violation has predominantly focused on the non-occurrence of feared outcomes and has rarely examined how expectancy violation may also be reflected in other experiential domains during exposure. To address this broader perspective, we propose a multidimensional conceptualization of expectancy violation in ERP and introduce the Questionnaire on Exposure Experience (QEE), which operationalizes expectations prior to exposure and expectancy-related experiences during exposure across five theoretically derived dimensions: emotional intensity, change in emotional intensity, emotion tolerance, adherence, and harm events. The present study provides an initial validation of the proposed dimensional model of the QEE and examines how expectancy violations are associated with theoretically relevant conclusions drawn from the exposure experience.

Methods: The QEE was administered before and after therapist-guided exposure sessions in routine clinical settings. The planned sample comprises patients with a primary diagnosis of OCD (N > 100); preliminary analyses are based on a subsample of n = 70 participants. The dimensional structure of the questionnaire was examined using confirmatory factor analyses and indices of internal consistency. To examine the theoretical relevance of expectancy violations, regression analyses tested whether violations in specific dimensions were associated with conclusions drawn from the exposure experience that are assumed to foster self-efficacy expectations.

Results: The proposed multidimensional structure showed predominantly good model fit and very good to moderate internal consistency across dimensions. Expectancy violations related to emotion tolerance were particularly relevant: stronger violations in this dimension were associated with a higher level of self-efficacy–enhancing conclusions.

Conclusions: These findings support a multidimensional understanding of expectancy violation as one component within a broader set of therapeutic change mechanisms in ERP. Violations of tolerance-related expectations may be especially important for facilitating mastery experiences that strengthen self-efficacy expectations, a process consistently linked to adaptive coping and sustained behavior change. By enabling a differentiated assessment of expectancy-related experiences during exposure, the QEE provides a theoretically informed tool that may help refine mechanistic models of exposure and inform future efforts to optimize ERP for patients who do not yet benefit sufficiently.