Comments on: What did you expect?

By: Steve Kamper

Steve Kamper — Tue, 27 Jul 2010 01:58:28 +0000

It’s an excellent question Nickster, in short; I’m not really sure, but in the spirit of the Federal election campaign underway here in Australia I will bang on for a bit on somewhat related issues and hope it passes for an answer. I don’t think that expectation is the only factor at play but probably acts as an adjunct to whatever the biological (in the sense of the ‘bio’ part of the biopsychosocial model) processes are going on (in the treatment and in the condition). So to your example; maybe the cheese-burger believer will lose a little more weight on the cheese-burger diet than a non-believer, but in all likelihood still end up pretty tubby. Related to this, perhaps the potential for effect of expectation with respect to any condition (or treatment) is in some way proportional to the size of the biological part of a condition. To the example again; maybe cheese-burgers along with cheese-burger belief will be less successful for obesity, than for fibromyalgia. I’d recognise here that I have no idea of how, or in fact even if it is possible, to divide a condition up in this way. Another complicating issue here is choice of outcome – it seems plausible to me that some outcomes would be more sensitive to expectation effects than others. To the example a final time then; maybe cheese-burgers will improve your quality of life but not be so good for shifting the spare tyre.

I’m hungry.

By: Nicksterdam

Nicksterdam — Mon, 26 Jul 2010 09:36:11 +0000

Steve, you raise some very interesting questions, which made me think of one (only one, it is Monday morning) of my own… Which treatments do you think these expectations influence?

I can imagine that positive expectations about prognosis or treatment strategies can be helpful for many different patients and conditions, but what if they have positive expectations about harmful treatments? I’ve been conversing with a few nutritionists lately, who seem to battle daily with patients who seem to have misguided expectations about which weight loss strategies work (for instance). What I mean is, even if you have positive expectations that eating only cheeseburgers will help you shed the kilos, it probably still wouldn’t work, right? Do these expectations mostly pertain, then, to treatments where there is a minimal “active”/”biological” component (e.g. physiotherapy)?

Any thoughts on this?

Another great post (by Steve, not me), I’m loving the variety of contributors and articles provided by this blog. Keep up the good work!

By: Steve Kamper

Steve Kamper — Mon, 26 Jul 2010 01:56:56 +0000

Thanks for your interest Darcia, glad you liked the piece. I have a question about the patients in whom you see such a strong relationship between expectation and outcome. Some of the research that has been done in the area makes the distinction between expectation related to outcome, and expectation that is specific to a certain treatment, a sort of interaction effect. So the question becomes; does it matter what treatment people with postive expectations get, if their expectation is driving their outcome? In your opinion do the patients you mention expect to get better before they see you (almost regardless of what you are going to do), or is the expectation generated by your explanation of the treatment? The obvious answer is that it is a bit of both, but I wonder if you think one or other is more important.

Cheers,
steve

By: Richmond Stace

Richmond Stace — Fri, 23 Jul 2010 21:04:39 +0000

Good piece. I think anyone considering the patient’s experience will think about and ask about their expectations. We all hold beliefs based on our past experiences, understanding of our place in the world and a host of other influences.These beliefs will surely impact upon any expectation that we may have about treatment and life in general.
As I sit here watching the cricket highlights, I expect that the Aussies will put up a bit of a fight. If they don’t I’ll be disappointed. This expectation comes from 30 odd years of watching Australian cricket.
Expectation is inherent and part of processing thoughts unless you are in a state of mindfulness. This is a wonderful state of non-judgement, holding oneself in the present moment. There is some great writing on this including Thich Nhat Hahn (http://www.amazon.co.uk/Peace-Every-Step-Mindfulness-Everyday/dp/0712674063/ref=sr_1_1?ie=UTF8&s=books&qid=1279918680&sr=8-1) and Eckart Tolle. From a clinical standpoint I do not find it surprising that mindfulness is gaining acceptance, especially in chronic pain treatment programmes. Attention on the painful area and mindful ‘non-judgement’ means that the signals are being acknowledged but not valued, hence threat reduction. I have no empirical evidence only case studies!
Asking about patient expectations is routine. Reducing the threat is routine. How do we individualise it? Perhaps recognise belief and see expectation as an ally that can help us determine the best course of action.
Mmm, could get waffly now so signing off… I now expect Pakistan to win.

By: Darcia Dexter

Darcia Dexter — Thu, 22 Jul 2010 15:24:51 +0000

Great post. As a Feldenkrais Practitioner going into my 15th year, I’ve seen many a chronic pain client where the expectation is exactly correlative to the outcome and willingness to participate in their own wellness. You had me at your bio…one of the best I’ve seen. Thanks! DD