The Effect of Video-based Testimonials About Psychotherapy on Treatment Expectations and a Short Online Intervention

Study Overview
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Brief Summary
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Research has shown that treatment expectations play a major role in the course of mental disorders and that positive expectations have a beneficial impact on treatment outcomes. Expectations can develop in different ways and an emerging body of research shows that social learning plays a significant role in this process. To date, most studies have investigated the impact of social learning on treatment expectations in the context of pain relief. Little is known about the impact of social learning in the psychotherapeutic treatment of depression. Therefore, this study investigates whether treatment expectations about depression therapy and treatment effects of a short online intervention can be modulated via social learning, i.e., showing positive treatment testimonials.

Official Title
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Social Learning in Depression Therapy: The Effect of Video-based Testimonials About Psychotherapy on a Treatment Expectations and a Short Online Intervention

Conditions
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Health Care Utilization

Intervention / Treatment
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* Behavioral: Emotional Writing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: at least 18 years old be able understand German (at least B1 level) have access to a computer device with internet access Exclusion Criteria: age below 18 years old non correctable hearing or visual impairment diagnosis of borderline-personality disorder diagnosis of post-traumatic-stress-disorder self-reported suicidality

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control video<br>Video of a woman describing basic information about psychotherapy and how it is embedded in the insurance system in Germany. Personal experience with therapy are not provided. 'Emotional writing' is introduced as a type of intervention used in depression treatment and basic information about it is provided. | Behavioral: Emotional Writing<br>* Participants complete four 20-minute sessions of emotional writing (at home) on four consecutive days. Instructions are provided online before each writing session.<br>* Other names: Expressive Writing;|
| Experimental: Testimonials<br>Video of a patient and a therapist, who both describe their personal experience of depression therapy in a positive but realistic way. Emphasis is on the personal experience protagonist. 'Emotional writing' is described as a helpful technique from a first person perspective. | Behavioral: Emotional Writing<br>* Participants complete four 20-minute sessions of emotional writing (at home) on four consecutive days. Instructions are provided online before each writing session.<br>* Other names: Expressive Writing;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in scores on the Credibility and Expectancy Questionnaire (CEQ) scale | German version of the Credibility and Expectancy Questionnaire (CEQ), 6-item scale.The CEQ consists of two subscales with four items measuring cognitive-focused credibility (e.g., At this point, how logical does the therapy offered to you seem?) and two items measuring affect-focused expectations (e.g., By the end of the therapy period, how much improvement in your symptoms do you really feel will occur?). The CEQ applies different rating scales; a 9-point scale ranging from 1 (not at all) to 9 (very much) and a percentage rating scale ranging from 0% (not at all) to 100% (very much) with higher sum scores indicating greater treatment credibility and expectations. | Baseline; after viewing the videos (1 day after baseline); after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in scores on self-report measure for the Assessment of Emotion Regulation Skills (Fragebogen zur standardisierten Selbsteinschätzung emotionaler Kompetenzen; SEK-27) | The German SEK-27 is a 27-item scale measuring 9 domains (attention, clarity, body awareness, understanding, acceptance, resilience, self-support, readiness for confrontation, and regulation) of emotion regulation skills. Higher scores on the overall score indicate better emotion regulation skills. | Baseline; after completion of the writing intervention (5 days after baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in scores on the Patient Health Questionnaire (PHQ-9) | Depressive symptoms via the German version of the Patient Health Questionnaire (PHQ-9), 9-item scale. With each item, the PHQ-9 captures one of the nine criteria for major depression posted in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using a 4-point Likert-scale ranging from 0 (not at all) to 3 (almost every day). The total score ranges of 0 to 27, whereby a score of 0 to 4 indicates minimal depressive symptomatology, a score of 5 to 9 mild, a score of 10 to 14 moderate, a score of 15 to 19 moderate to severe, and a total score of 20 to 27 severe depressive symptomatology. | Baseline; after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in subjective stress scores on the 'Perceived Stress Scale' (PSS-10) | Self-report questionnaire to assess subjective stress experience; 10 items; each item is rated on a 5-point scale from 0(never) to 4(very often); total scores range between 0 and 40 (higher scores indicate more subjective stress). | Baseline; after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in scores on Regulatory Emotional Self-Efficacy Scale (RESE) | The German version of the RESE is a 10-item instrument measuring self-efficacy for emotion regulation. Items are scored on a Likert Scale ranging from 1 (not well at all) to 5 (very well). Higher scores indicate better regulatory emotional self-efficacy. | Baseline; after completion of the writing intervention (5 days after baseline) | 
| Change from baseline on the state-anxiety subscale of the 'State-Trait-Anxiety- Depression-Inventory' (STADI) | Self-report questionnaire to assess state and trait anxiety and depression; 40 (20 state scale; 20 trait scale) items; each item is rated on a 4-point scale from 1(not at all) to 4(very much); total scores per scale range between 20 and 80 (higher scores indicate more anxiety) | Baseline; after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in scores on specific emotion regulation items | Because we felt that the existing emotion regulation scales used in this study did not capture the some of the specific skills that the emotional writing intervention targets, we created a set of five specific items about allowing, accepting, experiencing and managing negative emotions. Items are scored on a Likert Scale ranging from 1 (do not agree at all) to 5 (agree completely). Higher scores indicate better emotion regulation abilities. | Baseline; after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in scores on the treatment expectations subscale of the the generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE) | Treatment expectations are measured via the generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE), subscale for previous treatment experiences and subscale for treatment expectations. Answers are provided on a numeric rating scale ranging from 0 to 10 (each item has specific anchors with lower anchors always indicating no expected effects) | Baseline; after viewing the videos (1 day after baseline); after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in scores on perceived uncertainty and perceived barriers to psychotherapy | The items used by Kushner and Sher (1989), to assess perceived barriers were translated to German and modified to state I am uncertain instead of I am anxious. The scale consists of 3 subscales: therapist responsiveness (5 items), image concerns (4 items), coercion concerns (4 items). Answers are provided on a 5-point scale ranging from 1 (not at all) to 5 (completely) with high scores indicating greater uncertainty. Five items to reflect specific uncertainties (financial concerns, time restrictions, therapist relatability, the therapeutic process, personal ability to complete therapy), that were not covered by the original article, were added. Answers are provided on a 5-point scale ranging from 1 (do not agree) to 5 (agree) with high scores indicating greater uncertainty. | Baseline; after viewing the videos (1 day after baseline) | 
| Change from baseline in scores on the Credibility and Personal Reaction Scale | Credibility of and personal reactions to psychotherapy are measured via a self-translated German version of the Credibility & Personal Reaction Scale. This scale also measures intentions to seek therapy. Credibility scale: 7 items, answers are provided on a 7-point Likert scale from 1 (not at all) to 7 (extremely). Personal Reactions to the Rationales (PRR): 5 items, answers are provided on a 7-point Likert scale from 1 (not at all) to 7 (extremely). The total score of the credibility scale ranges from 7 to 49 with higher scores indicating higher credibility ratings, the total PRR score ranges from 5 to 35 with higher scores indicating more positive reactions and higher credibility. | Baseline; after viewing the videos (1 day after baseline); after completion of the writing intervention (5 days after baseline) | 
| Change from baseline in D-Scores on the Single-Category Implicit Associations Test (SC-IAT) | Single-Category Implicit Associations Test (SC-IAT), measuring implicit associations with psychotherapy. It is a reaction-time task facing the target dimension 'psychotherapy' and the evaluative dimensions 'effective' and 'ineffective'. The strength of the association (D-score) between the target dimension and the evaluative dimension is calculated based on the reaction times. Shorter reaction times indicate a greater associative strength. | Baseline; after viewing the videos (1 day after baseline) | 
| Change from baseline in scores on the Self-Stigma of Depressions Scale (SSDS) | German version of the Self-Stigma of Depressions Scale (SSDS), 16 items measuring anticipated self-stigma for the hypothetical case that one would be suffering from depression. The SSDS consists of 3 subscales: self-blame, help-seeking inhibition, social inadequacy Answers on all items are given on a 5-point Likert-scale ranging from 1 (completely disagree) to 5 (completely agree); higher scores indicate higher self-stigma. | Baseline; after viewing the videos (1 day after baseline) | 
| Change from baseline in the items assessing expectations about dealing with negative emotions of the Depressive Expectations Scale (DES) | Part A (6 items) of the Depressive Expectations Scale (DES). Items are scored on a Likert Scale ranging from 1 (do not agree) to 5 (agree). Higher scores indicate stronger negative expectations about dealing with negative emotions. | Baseline; after completion of the writing intervention (5 days after baseline) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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treatment expectations, social learning, psychotherapy, depression, testimonials