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TRR 289:  Treatment Expectation - The impact of expectation on health outcome

Subject Area Social and Behavioural Sciences
Medicine
Term since 2020
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Project identifier Deutsche Forschungsgemeinschaft (DFG) - Project number 422744262
 
Patients’ expectations about treatments are important modulators of health outcomes. An individual’s expectation can substantially shape symptoms and disease progression and influence the efficacy and tolerability of treatments. The ultimate goal of this CRC is to provide a knowledge base for the systematic utilization of patient expectations to optimize therapeutic strategies and improve health outcomes. To achieve this goal, we set out to characterize the mechanisms underlying the generation and dynamics of positive and negative expectations and their impact on treatment outcomes, and to elucidate how expectation effects interact with ‘actual’ (e.g., pharmacological) treatment effects. Our research program is structured to reflect the long-term goals of the CRC, in which the focus of the three funding periods will gradually shift from characterizing the mechanisms underlying treatment expectation to translating the knowledge gained into clinical practice. Using a highly interdisciplinary and translational approach and guided by a unified theoretical framework, we conduct basic experimental studies in animals and healthy volunteers, as well as clinical proof-of-concept studies in patients, to investigate the mechanisms and effects of treatment expectation alone and, importantly, in combination with gold-standard treatments. During the 1st funding period, we focused on the psychological and neurobiological mechanisms (objective #1) and interindividual differences (objective #2) in the effects of expectation on health outcomes in healthy volunteers and patients. To ensure rapid translation into the clinical context, these mechanistic studies were complemented by small-scale translational clinical proof-of-concept studies (objective #3) testing approaches to modulate treatment expectation in patient populations with chronic pain or depression. In the 2nd funding period, we will maintain the focus on these three major objectives but will place a particular emphasis on the temporal dynamics of expectation. We will investigate how expectations are formed, revised, and updated based on patients’ treatment experiences, how these modifications are influenced by individual and contextual characteristics, and how expectations and their effects generalize to other health and treatment outcomes. We will also broaden our investigations beyond pain and depression to test for commonalities and differences in the mechanisms and effects of treatment expectation in disorders with more physiological and objective rather than subjective and patient-reported treatment outcomes. This will allow us to strategically target expectation tailored to context, the individual patient, and disease-specific aspects in the 3rd funding period. Across all funding periods, the success of our efforts relies on the synergy of effective science communication and dynamic collaboration, including co-production with patients and other stakeholders.
DFG Programme CRC/Transregios

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Applicant Institution Universität Duisburg-Essen
 
 

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