Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease

Introduction/Objective Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. Methods A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health–related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. Results In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to −7.34; −2.22, p < .001). Conclusions The present study shows that, next to pre-treatment functioning, patients’ pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). Trial registration ClinicalTrials.gov, NCT01207739 (Registration date: 23–09-2010) Key Points• As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response.• Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment.• Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).

Incorporating a Usual Care Comparator into a Study of Meditation and Music Listening for Older Adults with Subjective Cognitive Decline: A Randomized Feasibility Trial

Background: Recent studies suggest meditation and music listening (ML) may improve cognitive and psychosocial outcomes in adults with subjective cognitive decline (SCD). However, lack of a usual care group has limited conclusions. Objective: To assess the: 1) feasibility of incorporating an enhanced usual care (EUC) comparator in a trial of Kirtan Kriya meditation (KK) and ML for adults experiencing SCD; and 2) preliminary effects of active treatment (KK/ML) versus an EUC program. Methods: Forty participants with SCD were randomized 1:1:2 to a 12-week KK, ML, or EUC program. KK and ML participants were asked to practice 12 minutes/day; EUC participants were given a comprehensive educational packet regarding healthy aging and strategies for improving/maintaining brain health and asked to record any activities or strategies used. Feasibility was assessed using measures of retention, adherence, treatment expectancies, and participant satisfaction, as well as information from exit questionnaires and daily practice/activity logs. Cognitive functioning, stress, mood, sleep-quality, and health-related quality of life (QOL) were measured pre- and post-intervention using well-validated instruments. Results: Thirty-two participants (80%) completed the 3-month study, with retention highest in the EUC group (p < 0.05). Active treatment participants averaged 6.0±0.4 practice sessions/week, and EUC participants, 7.5±0.6 brain health activities/week. Treatment expectancies were similar across groups. EUC participants indicated high satisfaction with the program and study. Despite limited study power, the active treatment group showed significantly greater gains in subjective memory functioning (ps≤0.025) and nonsignificant improvements in cognitive performance (TMT-B), perceived stress, QOL, and mood (ps≤0.08) compared to the EUC group. Conclusion: Findings of this pilot feasibility trial suggest incorporation of an EUC program is feasible, and that participation in a simple 12-week relaxation program may be helpful for adults with SCD versus engagement in an EUC program.

Effects of Treatment Preference on Adherence, Attrition, and Process Measures Among Older Adult Worriers

Patient preference may be related to treatment outcomes through decreased rates of attrition and higher rates of adherence and patient satisfaction. We present findings from a 2-stage randomized preference trial of cognitive-behavioral therapy (CBT) and yoga for the treatment of late-life worry. We examine rates of preference for CBT and yoga, as well as the stability of these preferences over time. We also examine the impact of preference on adherence, attrition, and process measures (satisfaction, treatment expectancies, and working alliance). Five hundred participants were randomized to either the randomized controlled trial (RCT; N=250) or the preference trial (participants chose the treatment; N=250). All participants received 10 weeks of an intervention. Among those in the preference trial, 48% chose CBT and 52% chose yoga (p&gt;.05). Strength of preference was similar between the groups; 73.3% and 76.2% reported a strong preference for CBT and yoga, respectively (p&gt;.05). Fourteen percent of those who preferred CBT at baseline preferred yoga upon completion of the intervention, while 12.2% of those who preferred yoga at baseline preferred CBT upon completion of the intervention (p&gt;.05). There were no significant differences between participants in the RCT and preference trial on intervention adherence, attrition, satisfaction, or working alliance (p’s&gt;.05). Treatment expectancies were higher for the preferred intervention (p’s&lt;.0001). Results suggest that older adults prefer CBT and yoga at similar rates, and these preferences are stable. Receiving a preferred treatment had no effect on adherence, attrition, satisfaction, or working alliance.

What Drives Symptom Reduction in Attention Bias Modification Treatment? A Randomized Controlled Experiment in Clinically Anxious Youths

Attention-bias modification (ABM) is a novel treatment for anxiety disorders. We tested the contribution of two possible factors implicated in ABM’s efficacy: training of threat-related selective spatial attention and exposure to threat. We also measured general attention control to examine its potential role in treatment effects. A four-arm randomized controlled design was used, which dissociated spatial attention and threat exposure while equating treatment expectancies. One hundred clinically anxious youths were randomized and assessed at pretreatment, midtreatment, posttreatment, and 3-month follow-up. All four groups manifested large reductions in anxiety symptoms; there were no significant between-group differences. Level of change in anxiety symptoms significantly correlated with level of change in youths’ self-rated attention control. Findings did not support the role of either dissociated spatial attention or threat exposure as underlying mechanisms. Implications of the findings are discussed including possible roles of expectations and general attention control in ABM efficacy.

A machine learning ensemble to predict treatment outcomes following an Internet intervention for depression

BackgroundSome Internet interventions are regarded as effective treatments for adult depression, but less is known about who responds to this form of treatment.MethodAn elastic net and random forest were trained to predict depression symptoms and related disability after an 8-week course of an Internet intervention, Deprexis, involving adults (N = 283) from across the USA. Candidate predictors included psychopathology, demographics, treatment expectancies, treatment usage, and environmental context obtained from population databases. Model performance was evaluated using predictive R2 $\lpar R_{{\rm pred}}^2\rpar\comma $ the expected variance explained in a new sample, estimated by 10 repetitions of 10-fold cross-validation.ResultsAn ensemble model was created by averaging the predictions of the elastic net and random forest. Model performance was compared with a benchmark linear autoregressive model that predicted each outcome using only its baseline. The ensemble predicted more variance in post-treatment depression (8.0% gain, 95% CI 0.8–15; total $R_{{\rm pred}}^2 \; $= 0.25), disability (5.0% gain, 95% CI −0.3 to 10; total $R_{{\rm pred}}^2 \; $= 0.25), and well-being (11.6% gain, 95% CI 4.9–19; total $R_{{\rm pred}}^2 \; $= 0.29) than the benchmark model. Important predictors included comorbid psychopathology, particularly total psychopathology and dysthymia, low symptom-related disability, treatment credibility, lower access to therapists, and time spent using certain Deprexis modules.ConclusionA number of variables predict symptom improvement following an Internet intervention, but each of these variables makes relatively small contributions. Machine learning ensembles may be a promising statistical approach for identifying the cumulative contribution of many weak predictors to psychosocial depression treatment response.

Mental health treatment outcome expectancies in Burundi

Best practices in global mental health stress the importance of understanding local values and beliefs. Research demonstrates that expectancies about the effectiveness of a given treatment significantly predicts outcome, beyond the treatment effect itself. To help inform the development of mental health interventions in Burundi, we studied expectancies about the effectiveness of four treatments: spiritual healing, traditional healing, medication, and selected evidence-based psychosocial treatments widely used in the US. Treatment expectancies were assessed for each of three key syndromes identified by previous research: akabonge (a set of depression-like symptoms), guhahamuka (a set of trauma-related symptoms), and ibisigo (a set of psychosis-like symptoms) . In individual interviews or written surveys in French or Kirundi with patients ( N = 198) awaiting treatment at the clinic, we described each disorder and the treatments in everyday language, asking standard efficacy expectations questions about each (“Would it work?” “Why or why not?”). Findings indicated uniformly high expectancies about the efficacy of spiritual treatment, relatively high expectancies for western evidence-based treatments (especially cognitive behavior therapy [CBT] for depression-like symptoms), lower expectancies for medicine, and especially low expectancies for traditional healing (except for traditional healing for psychosis-like symptoms). There were significant effects of gender but not of education level. Qualitative analyses of explanations provide insight into the basis of people’s beliefs, their explanations about why a given treatment would or would not work varied by type of disorder, and reflected beliefs about underlying causes. Implications for program development and future research are discussed.

Smokers’ Treatment Expectancies Predict Smoking Cessation Success

Introduction: Smokers’ treatment expectancies may influence their choice of a particular medication as well as their medication experience.Aims: This study examined the role of smokers’ treatment expectancies to their smoking cessation outcomes in a completed, randomized, placebo-controlled trial of naltrexone for smoking cessation, controlling for perceptions of treatment assignment.Methods: Treatment-seeking cigarette smokers (N = 315) were randomized to receive either naltrexone (50 mg) or placebo in combination with nicotine patch and behavioural counselling. Expectancies for naltrexone as a smoking cessation aid were assessed at baseline and four weeks after the quit date.Results: More positive baseline medication expectancies predicted higher quit rates at one month in the naltrexone group (OR = 1.45, p = 0.04) but were associated with lower quit rates in the placebo group (OR = 0.66, p = 0.03). Maintaining and/or increasing positive medication expectancies in the first month of treatment was associated with better pill adherence during this interval in the naltrexone group (ps < 0.05). Positive baseline medication expectancies were also associated with the perception of having received naltrexone over placebo among all participants.Conclusions: Positive medication expectancies in smokers may contribute to better treatment response. Assessing treatment expectancies and attempting to maintain or improve them may be important for the delivery, evaluation, and targeting of smoking cessation treatments.