Outcome Expectations

Abstract

Outcome expectations are a person's beliefs about what a behaviour or a treatment will lead to: the expected benefits and costs of acting, as distinct from the belief that one can perform the act at all. MeSH classifies them under behavior and behavior mechanisms. This article covers their place in social cognitive theory and the dispute over their relation to self-efficacy, their place in expectancy-value and response-expectancy accounts, their links to health behaviour, drinking and psychotherapy outcome, their role in placebo and nocebo effects, and what trials of changing them have found. The central question is whether expected outcomes cause behaviour or only accompany it. Three interactive demos separate efficacy from outcome expectations, combine expectancy with value, and show how an expectation is updated or kept after a violation.

Keywords: outcome expectations, outcome expectancy, self-efficacy, expectancy-value, placebo

The relation between expected outcomes and self-efficacy has been debated in the psychology of motivation, although the debate has subsided in recent years (Williams, 2010). In self-efficacy theory, self-efficacy, defined as perceived capability to perform a behaviour, causally influences expected outcomes of behaviour, but not vice versa; research has nonetheless shown that expected outcomes causally influence self-efficacy judgements (Williams, 2010). The same review argues that inattention to this contradiction has led to a disproportionate focus on self-efficacy as a causal determinant of behaviour at the expense of expected outcomes (Williams, 2010). This article is an account of the expected outcomes.

What Outcome Expectations Are

Outcome expectations are beliefs about what a behaviour will bring. Social learning and social cognitive theories distinguish two main concepts of expectations: behaviour outcome expectancies express the subjective likelihood that a specific outcome will follow a given action, while self-efficacy expresses an individual's expectation of being capable of executing that action (Laferton et al., 2017). According to self-efficacy theory, self-efficacy causally influences expected outcomes of behaviour, but not vice versa (Williams, 2010). In social cognitive theory, self-efficacy beliefs operate together with goals, outcome expectations and perceived environmental impediments and facilitators in the regulation of human motivation, behaviour and well-being (Bandura, 2004). In physical-activity research, outcome expectancy is a central construct of social cognitive models of health behaviour, and self-efficacy theory, the transtheoretical model, the theory of planned behaviour and protection motivation theory differ in their labelling and conceptualisation of outcome expectancy but unanimously include expected outcomes of behaviour (Williams et al., 2005). The same review found that preliminary empirical investigation of the role of outcome expectancy in understanding physical activity had yielded mixed results (Williams et al., 2005). The terms outcome expectations and outcome expectancies are used interchangeably in this literature, and both are split by valence.

Positive outcome expectations and negative outcome expectations behave differently. In physical activity, positive outcome expectancy appears to be more predictive in older adults than in young to middle-aged adults, and personal barriers appear to be the most predictive subtype of negative outcome expectancy (Williams et al., 2005). In the alcohol literature, the same split recurs: two studies found that more positive outcome expectancies held at treatment predicted poorer outcome, five others failed to find this, and three related studies found that more negative outcome expectancies held at treatment predicted better outcome (Jones et al., 2001).

Generalised outcome expectancies form a trait. The idea of generalised expectancies predates the optimism literature: Rotter's monograph set out generalized expectancies for internal versus external control of reinforcement (Rotter, 1966). Dispositional optimism has been defined in terms of generalized outcome expectancies, and in a longitudinal study of undergraduates those who initially reported being highly optimistic were subsequently less likely to report being bothered by physical symptoms, even after correcting for initial symptom reports (Scheier & Carver, 1985); the trait is treated on the optimism page.

Types of Outcome Expectations

MeSH places outcome expectations under behavior and behavior mechanisms and lists one narrower descriptor. The subtypes in such a list need not be mutually exclusive, and MeSH is an indexing classification for the literature, not a theory of how expectations are organised in the mind.

Self-Efficacy and Outcome Expectations

The modern construct was sharpened against self-efficacy. Bandura's theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy, and hypothesises that expectations of personal efficacy determine whether coping behaviour will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles (Bandura, 1977). In the same model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion and physiological states (Bandura, 1977).

The dispute is about causal direction. Bandura has rebutted arguments that self-efficacy judgements are invalidated when influenced by expected outcomes, and a theoretical analysis argues that his rebuttal contains a contradiction: expected outcomes are said not to influence self-efficacy causally, yet self-efficacy judgements are said to remain valid when causally influenced by expected outcomes (Williams, 2010). The original exchange includes a critique of theoretical and methodological difficulties in Bandura's self-efficacy theory (Eastman & Marzillier, 1984), Bandura's reply on recycled misconceptions of perceived self-efficacy (Bandura, 1984), and the argument that self-efficacy and expectancy are old wine with new labels (Kirsch, 1985b). Experimental evidence on the other side is indirect: across 204 experimental tests, inducing changes in attitudes, norms and self-efficacy led to medium-sized changes in intention and small to medium-sized changes in health behaviour (Sheeran et al., 2016).

Expectancy-Value and Response Expectancy

Two other traditions treat expectancies as central. A review of developmental and educational research groups motivation theories into those focused on expectancies for success, those focused on task value, those that integrate expectancies and values, including the expectancy-value models of Eccles and colleagues, Feather and Heckhausen, and those integrating motivation and cognition (Eccles & Wigfield, 2002). Kirsch's response expectancy theory extends expectancy to experience itself, treating expectations about one's own responses as determinants of experience and behaviour (Kirsch, 1985a).

Figure 1

Three Accounts That Give Expectancies a Causal Role

Positive thinking about the future is not always helpful. Positive thinking can be detrimental to effort and success if it takes the form of fantasies, free thoughts and images about the desired future, rather than beliefs, that is, expectations; fantasy realisation theory holds that mentally contrasting future and reality produces active goal pursuit or active goal disengagement depending on whether expectations of success are high or low (Oettingen, 2012).

Outcome Expectations and Behaviour

Large-scale correlational evidence comes from psychotherapy. In patients receiving a therapist-delivered treatment of at least three sessions, an updated meta-analysis of 81 independent samples with 12,722 patients found an overall weighted effect of r = .18, or d = .36, between more optimistic early treatment outcome expectation and better posttreatment outcomes, with high heterogeneity (I² = 76%) and no evidence of publication bias (Constantino et al., 2018). The earlier meta-analysis of 46 samples had found r = .12 (Constantino et al., 2018).

Vocational psychology carries the construct into careers: social cognitive career theory was proposed as a unifying social cognitive theory of career and academic interest, choice and performance (Lent et al., 1994). Drinking is the test case for whether expectancies cause behaviour. A review concluded that research has still to be done that securely links expectancy manipulations with subsequent changes in consumption, noting that in seven prevention projects targeting positive expectancies only two reported an expectancy-change analysis and in neither did expectancy change relate to later consumption (Jones et al., 2001). A later meta-analysis of 14 studies with 19 expectancy challenge interventions in 1,415 college students found that, compared with controls, participants reported lower positive alcohol expectancies, reduced alcohol use and reduced frequency of heavy drinking at first follow-up (d+ from 0.23 to 0.28); the short-term effects on drinking were not maintained at follow-ups greater than four weeks (Scott-Sheldon et al., 2012).

Treatment Expectations and Placebo

Expectations about treatment are the clinical face of the construct, treated in detail on the treatment expectations page. An integrative model of patients' expectations includes treatment and behaviour outcome expectations, which can relate to benefits and side effects and to internal and external outcomes, alongside timeline, structural and process expectations and generalised expectations such as optimism (Laferton et al., 2017). A review describes placebo effects as a major part of treatment success and the nocebo effect as accounting for a significant proportion of reported side effects, with expectations the central mechanism examined in both (Petrie & Rief, 2019). The size of placebo effects is disputed: a systematic review of 130 trials that randomly assigned patients to placebo or no treatment found little evidence in general that placebos had powerful clinical effects, with no significant effects on objective or binary outcomes and possible small benefits in studies with continuous subjective outcomes and for the treatment of pain (Hróbjartsson & Gøtzsche, 2001).

The placebo literature long set expectancy against conditioning. A review of the two models suggests that classical conditioning procedures are one factor shaping placebo effects and verbal information is another, and that conditioning procedures and other sources of information sometimes shape conscious expectancies that mediate some placebo effects, while in other cases conditioning appears to shape placebo effects not mediated by conscious cognition (Stewart-Williams & Podd, 2004). In the brain, expectancies shape pain-intensity processing, with strong effects on nociceptive portions of the insula, cingulate and thalamus, and their effects on subjective pain also involve the dorsolateral prefrontal and orbitofrontal cortex (Atlas & Wager, 2012), the link to pain.

Changing Expectations

Expectations do not always update. In major depression, dysfunctional expectations are proposed to be maintained despite contrary experiences through immunization, a cognitive reappraisal of the contradictory experience such that expectations need not change (Kube et al., 2017). Psychological immunization and assimilation, implicit self-confirming processes and the stability of biological processes are offered as reasons expectancies persist despite expectation violations, and the authors argue that interventions should optimise expectation violation (Rief et al., 2015). A predictive-processing account of depression adds that people with depression tend to negatively reappraise or disregard positive information that disconfirms negative expectations (Kube et al., 2020).

Expectations can be targeted directly. In a three-arm randomized trial of 124 patients scheduled for coronary artery bypass surgery, a brief pre-surgery intervention to optimise outcome expectations produced significantly larger improvements in disability at 6 months than standard medical care (-12.6 against -1.9), while against an emotional-support control matched for dose it showed only a trend in favour (P = 0.09), with specific advantages for mental quality of life and fitness for work; the authors call for replication in larger multicenter trials, and report that manipulation checks confirmed effects on control expectations while specific effects on outcome expectations remained unclear (Rief et al., 2017).

Worked Example

The psychotherapy correlation can be converted to variance. An r of .18 (Constantino et al., 2018) corresponds to r² = .032, so early outcome expectation shares about 3% of its variance with posttreatment outcome; the earlier estimate of r = .12 corresponds to about 1.4%. The updated meta-analysis pooled 12,722 patients from 81 samples, an average of about 157 per sample.

The heart-surgery trial can be read the same way. The expectation intervention improved disability by 12.6 points and standard care by 1.9 (Rief et al., 2017), a difference of 10.7 points; the trial randomized 124 patients across three arms, about 41 per arm.

Discussion

Three lessons follow for cognitive psychology. First, outcome expectations are a construct that the major social cognitive models of health behaviour all include under different labels (Williams et al., 2005), yet self-efficacy theory subordinates them to self-efficacy, and a theoretical analysis argues that the case for that ordering contains an unresolved contradiction (Williams, 2010).

Second, manipulations of expectations have had short-lived or uncertain effects. Early outcome expectation predicts psychotherapy outcome reliably but modestly (Constantino et al., 2018), and expectancy challenge reduced drinking only briefly (Scott-Sheldon et al., 2012), while an earlier review found that laboratory evidence that expectancy manipulations change consumption was limited by measuring consumption changes over only 1-2 hours, and concluded that research had still to be done that securely links expectancy manipulations with subsequent changes in consumption (Jones et al., 2001).

Third, the clinical frontier treats expectations as something to violate rather than simply to raise. The immunization and assimilation accounts (Rief et al., 2015; Kube et al., 2017) predict that an expectation can survive a disconfirming experience if the experience is reappraised, which is a cognitive claim about how people learn from outcomes.

Current Directions

The research front is integrative. The ViolEx 2.0 model offers a framework for interdisciplinary research on the cognitive and behavioural mechanisms of expectation update and maintenance after expectation violations, with three model levels of increasing specificity (Panitz et al., 2021). A predictive-processing reformulation of the cognitive model of depression proposes that too much precision afforded to negative prior beliefs, with attenuated positive prediction errors, is the main candidate pathology (Kube et al., 2020). In clinical research, attention has turned to optimising placebo effects and minimising nocebo effects to improve outcomes (Petrie & Rief, 2019), and a review has recommended standardised, psychometrically evaluated measures of multidimensional patient expectations (Laferton et al., 2017).

Common Misconceptions

“Outcome expectations and self-efficacy are the same thing.”

In self-efficacy theory, self-efficacy is the perceived capability to perform a behaviour and is held to influence expected outcomes of that behaviour; outcome expectations are the expected outcomes themselves (Williams, 2010).

“Positive thinking about the future always helps.”

Positive thinking can be detrimental to effort and success when it comes as fantasies about the desired future rather than as expectations (Oettingen, 2012).

“Changing what people expect from drinking durably changes how much they drink.”

In college students, expectancy challenge interventions reduced drinking at first follow-up, but the effects on drinking were not maintained beyond four weeks (Scott-Sheldon et al., 2012).

Glossary

Expectancy challenge.

An intervention that challenges alcohol expectancies with the aim of reducing alcohol consumption.

Expectancy-value model.

A theory of motivation that integrates expectancies for success with the value placed on a task.

Expectation violation.

An experience that contradicts an expectation, after which the expectation may be updated or maintained.

Fantasy realisation theory.

A theory of how fantasies about the future can be used to self-regulate goal pursuit through mental contrasting.

Generalized outcome expectancies.

Broad expectations about outcomes, in terms of which dispositional optimism has been defined.

Immunization.

The proposed cognitive reappraisal of an expectation-violating experience so that the expectation need not change.

Mental contrasting.

Contrasting a desired future with present reality, producing goal pursuit or disengagement depending on expectations of success.

Negative outcome expectancies.

Expected outcomes of a behaviour that are negative in value; in physical activity, personal barriers appear to be the most predictive subtype.

Nocebo effect.

An effect that accounts for a significant proportion of the reported side effects of many treatments, of which expectations are a central mechanism.

Outcome expectancies.

A synonym of outcome expectations: expected outcomes of a behaviour.

Placebo effect.

An effect of placebo treatment that one review describes as a major part of treatment success in medical interventions, though its size is disputed; expectations are a central mechanism.

Positive outcome expectancies.

Expected outcomes of a behaviour that are positive in value; in physical activity they appear more predictive in older than in young to middle-aged adults.

Response expectancy.

An expectation about one's own responses, treated as a determinant of experience and behaviour.

Self-efficacy.

Perceived capability to perform a behaviour, distinct from expectations about the behaviour's outcomes.

Treatment expectations.

Expectations about the benefits and side effects of a treatment, the narrower MeSH descriptor under outcome expectations.

Key Researchers

Albert Bandura

(1925–2021). Psychologist at Stanford University; proposed self-efficacy theory and the social cognitive account in which self-efficacy operates with outcome expectations, goals and environmental factors. Wikipedia - Wikidata

Michael J. Constantino

Professor in the Department of Psychological and Brain Sciences at the University of Massachusetts Amherst; led the meta-analysis of patients' early treatment outcome expectation and posttreatment outcomes. Google Scholar - Faculty Page

Jacquelynne S. Eccles

Psychologist at the University of California, Irvine; co-authored the review of motivational beliefs, values and goals and developed an expectancy-value model of motivation. ORCID - Wikipedia - Wikidata - Google Scholar

Gabriele Oettingen

Professor of Psychology at New York University and the University of Hamburg; developed fantasy realisation theory and the strategy of mental contrasting. ORCID - Wikipedia

Winfried Rief

Professor of Clinical Psychology and Psychotherapy at Philipps-Universität Marburg; co-authored the model of expectation persistence in mental disorders and led the trial optimising patient expectations before heart surgery. Wikipedia - Faculty Page

Frequently Asked Questions

What are outcome expectations?

They are expected outcomes of a behaviour, a construct that widely used social cognitive models of health behaviour label and conceptualise differently but unanimously include (Williams et al., 2005).

How do outcome expectations differ from self-efficacy?

In self-efficacy theory, self-efficacy is the perceived capability to perform a behaviour and is held to influence expected outcomes but not the reverse, although research has shown that expected outcomes also influence self-efficacy judgements (Williams, 2010).

Do outcome expectations predict psychotherapy outcome?

Across 81 samples with 12,722 patients, more optimistic early outcome expectation was associated with better posttreatment outcome, with a weighted effect of r = .18 (Constantino et al., 2018).

What are positive and negative outcome expectations?

They are expected outcomes of a behaviour that are positive or negative in value; in physical activity, positive outcome expectancy appears more predictive in older adults and personal barriers appear to be the most predictive negative subtype (Williams et al., 2005).

How do expectations produce placebo effects?

Conditioning procedures and other sources of information sometimes shape conscious expectancies that mediate some placebo effects, while other placebo effects shaped by conditioning appear not to be mediated by conscious cognition (Stewart-Williams & Podd, 2004).

Can changing alcohol expectancies reduce drinking?

Expectancy challenge interventions reduced drinking at first follow-up in college students, but the effects on drinking were not maintained at follow-ups greater than four weeks (Scott-Sheldon et al., 2012).

Why do negative expectations persist in depression?

One proposal is immunization: people with depressive symptoms may reappraise an experience that contradicts their expectations so that the expectations do not need to change (Kube et al., 2017).

Can a brief intervention improve outcomes by changing expectations?

Before heart surgery, a brief intervention to optimise outcome expectations improved disability at 6 months more than standard care, though against a matched support intervention the difference in disability was only a non-significant trend, and manipulation checks confirmed effects on control expectations while specific effects on outcome expectations remained unclear (Rief et al., 2017).

References