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ERDÉLYI PSZICHOLÓGIAI S ZEMLE | VII. Évfolyam 1.

szám | 2006

RESPONSE EXPECTANCY VERSUS RESPONSE


HOPE IN PREDICTING DISTRESS
A BRIEF RESEARCH REPORT

DANIEL DAVID, PH.D.1,2


GUY H. MONTGOMERY, PH.D.2
TERRY DILORENZO, PH.D.3

e-mail: danieldavid@psychology.ro

Abstract: A recent line of research suggests that response expectancy [i.e., expectancy
for nonvolitional outcomes (e.g., relaxed)] and response hope [i.e., hope for nonvolitional
outcomes (e.g., relaxed)] may be two different constructs. Despite the vast literature re-
garding the impact of response expectancies on nonvolitional outcomes, little is known
about the impact of response hopes on nonvolitional outcomes. The aim of this brief re-
search report is to investigate the interrelations between response expectancy and re-
sponse hope in generating distress during an exam situation. As expected, results show
that response expectancy directly predicts distress; also, as expected, a discrepancy be-
tween response hope and response expectancy is a strong predictor of distress. Theoreti-
cal and clinical implications of these findings are discussed.
Keywords: response expectancy, response hopes, distress

Introduction

The role of cognitive factors (i.e. expectancies) in learning (e.g. Tolman &
Honzik, 1931) and the production of behavior (Rotter, 1954) has long been
recognized, but the impact of such cognitive factors on nonvolitional out-
comes is a much more recent theoretical development. Kirsch (1985) was
perhaps the first to explicitly theorize on relations between what individuals
expect and their experiences of seemingly automatic responses. He termed
such beliefs concerning nonvolitional outcomes, ‘‘response expectancies’’,
and explicitly hypothesized that response expectancies are: sufficient to
cause nonvolitional outcomes; not mediated by other psychological vari-
ables; and self-confirming while seemingly automatic. Since that time, the
literature has grown to support the strong role of response expectancies as a
psychological mechanism for producing nonvolitional outcomes in three
areas of research: (1) placebo effects (Montgomery & Kirsch, 1996, 1997;
Price, Milling, Kirsch, Duff, Montgomery, & Nicholls, 1999); (2) effects of
hypnotic suggestion (Montgomery, Weltz, Seltz, & Bovbjerg, 2002; Schoen-

1
Biobehavioral and Integrative Medicine Programs, Oncological Sciences
2
Department, Mount Sinai School of Medicine, New York, New York, USA
3
Stern College for Women, Yeshiva University, New-York, New-York, USA
2 | DANIEL DAVID, PH.D.; GUY H. MONTGOMERY, PH.D.; TERRY DILORENZO, PH.D.

berger, Kirsch, Gearan, Montgomery, & Pastyrnak, 1997); and (3) effects of
pharmacological agents (Kirsch & Rasadino, 1993; Lansky & Wilson, 1981;
Montgomery & Bovbjerg, 2000; Montgomery et al., 1998; Roscoe, Hickok, &
Morrow, 2000). Additional evidence has suggested that response expec-
tancies influence memory reports, pain perception, responses to psycho-
therapy, sexual arousal, asthmatic responses and mood (Kirsch, 1999). De-
spite this growing literature on the powerful effects of response expectan-
cies in a variety of contexts, little is known about the components of the
construct itself. Specifically, it is not known whether individuals’ hopes are
associated with their response expectancies or not.
Existing literature has also indicated that individuals’ hopes are impor-
tant determinants of the success of psychotherapy, personal achievement,
problem-solving ability, and health related concerns (Frank, 1973; Snyder,
Sympson, Michael, & Cheavens, 2001). However, it should be noted that the
focus on hope research has been brought onto the prediction of behavior
rather than on the experience of nonvolitional outcomes (e.g., side effects of
aversive medical treatments, emotional distress). Although Kirsch (1990)
has discussed patient hopes as positive response expectancies that can be
reinforced by patient gains, the relation between hopes and expectancies
has not been further developed. For example, it is possible that one might
‘‘hope’’ that an impending venipuncture will be painless, but ‘‘expect’’ it to
hurt a moderate amount. While such patients would traditionally be as-
sessed for their response expectancies concerning pain (e.g., How much
pain do you expect to feel?), it is not clear at this time whether they would
be reporting an estimate of anticipated future pain intensity or rather their
hopes in regard to their nonvolitional response to the venipuncture proce-
dure (How much pain do you hope to feel?). Although the idea has been ad-
vanced (Andrykowski & Gregg, 1992), for a long period it has not been em-
pirically established in the literature that participants can reliably distin-
guish between what they think will happen (the estimate of future intensity
that is traditionally used in response expectancy assessment) and what they
hope will happen when predicting future nonvolitional outcomes. It would
seem reasonable that individuals could achieve such discrimination, but
then the question of the magnitude of relations between expectancies and
hopes would still remain open. That is, the constructs could be closely re-
lated or orthogonal. Current theory on hope suggests that the construct is
defined by two components: agency thoughts and pathway thoughts (Sny-
der et al., 2001). Together, they are described as beliefs in one’s ability to
RESPONSE EXPECTANCY VERSUS RESPONSE HOPE… | 3

produce outcomes and one’s ability to generate strategies in order to


achieve desired outcomes. Both types of thoughts are described as expec-
tancies for behavior, rather than for nonvolitional outcomes. Indeed, the
assessment of hopes in both children (Snyder et al., 1997) and adults (Sny-
der, Sympson, Ybasco, Borders, & Babyak, 1996) seems to lack distinction
from expectancies despite face valid distinctions in common usage. For ex-
ample, examination of the leading hope scales for adults reveals that indi-
viduals are asked to report on what they think in regard to future behavioral
outcomes rather than on what they hope for (Snyder et al., 1996). While
such assessment methods have been productive for predicting behavior
(see Snyder et al., 2001), these practices may inadvertently further obfuscate
the distinction between hopes and expectancies regarding nonvolitional
outcomes.
The determination of the relationships between these two constructs is a
necessary first step to be taken before the relative contributions of hopes
and response expectancies to nonvolitional outcomes should be explored.
In a more recent study, Montgomery, David, DiLorenzo, and Erblich (2003)
addressed some of these problems. They investigated whether people can
discriminate between hope and expectancy for nonvolitional outcomes and
found that individuals can indeed discriminate between these two con-
structs. The overall pattern of the data indicated that expectancies and
hopes were independent, nevertheless/but related constructs (e.g., expec-
tancies and hopes were correlated for 9 out of 10 nonvolitional outcome
scenarios assessed). They also found that both stable individual characteris-
tics and prior experience were associated with individuals’ hopes and ex-
pectancies (Montgomery et al., 2003). Developing this line of research,
David et al. (2004) further explored the distinction between response expec-
tancy (i.e., expectancy for nonvolitional outcomes) and response hope (i.e.,
hope for nonvolitional outcome) showing that this is a robust psychological
phenomenon, generalizable across various cultures, rather than a meth-
odological artefact (e.g., Romanian vs. USA participants).
These data suggest that the pursuit of hope as a separate construct may
potentially add to predictive models of various outcomes (e.g., nonvoli-
tional outcomes). Indeed, now that we have proved that the distinction be-
tween response hopes and response expectancy is a robust phenomenon,
which often appears as obfuscated in the professional literature, we have to
further investigate the merit and the possible impact of this distinction. Re-
sponse expectancies proved to be very good predictors of both positive (re-
4 | DANIEL DAVID, PH.D.; GUY H. MONTGOMERY, PH.D.; TERRY DILORENZO, PH.D.

laxed) and negative (e.g., distressed) nonvolitonal outcomes in both clinical


and nonclinical samples (for a review see Kirsch, 1999). Although the con-
struct of hope has proved useful in the prediction of volitional outcomes
(e.g., behaviors) it has been less used to predict nonvolitional outcomes
(e.g., distress). Various authors (e.g., Ellis, 1994; David, Belloiu, & Schnur,
2002; Smith & Lazarus, 1993) have shown that a discrepancy between hopes
for positive outcomes and what actually happens is often a source of dis-
tress. As response expectancies have often proved to be expressed in the
real nonvolitional outcomes (Kirsch, 1999) it logically follows that a discrep-
ancy between response expectancies and response hopes for positive non-
volitional outcomes might also be a source of distress. On the contrary, in
case of a negative nonvolitional outcome (e.g., distress) a discrepancy be-
tween response hope for negative outcomes and what actually happens
(and/or response expectancy) may often be a source of positive feelings. For
example, in clinical work, an anxious patient may hope to be anxious (fol-
lowing the employment of a paradoxical therapeutic strategy) but expect
not to be (based on the new skills acquired). Interestingly, this situation of-
ten seems to be accompanied by low distress.
The purpose of this study was to investigate the interrelations among re-
sponse expectancies and response hopes in predicting distress levels
among students facing an important exam. Exam-related stress is a typical
situation used to investigate distress in non-clinical samples (e.g., Malouff,
et al., 1992). For example, the one-week period before an important exam is
usually considered a highly stressful period which may negatively impact on
the students’ emotional health (Malouff et al., 1992). Taking into account
the important role of the expectancy and hope constructs in the clinical
field, this study could have both theoretical and practical implications.
From a theoretical point of view, the results may add to the basic under-
standing of the distinction between hope and expectancies in accounting
for distress levels in stressful situations. Because most of the previous scales
are cross contaminated, the present study may, from a practical perspective,
provide relevant insight for the development of targeted interventions to
reduce distress, and to develop more rigorous instruments to evaluate the
two constructs.
Predictions were specifically based on the review of the literature. Thus,
based on response expectancy theory (Kirsch, 1999) we expect that re-
sponse expectancies for nonvolitional outcomes (i.e., distress and relaxa-
tion) would predict nonvolitional outcomes (i.e., relaxation and distress) in
RESPONSE EXPECTANCY VERSUS RESPONSE HOPE… | 5

stressful situation (i.e., exam). Based on the analysis of the hope and expec-
tancy literature and on our previous studies (Montgomery et al., 2003;
David et al., 2004) we expect that the higher the discrepancy between re-
sponse hope and response expectancy regarding a positive nonvolitional
outcome (i.e., relaxation), the higher the distress in stressful situation (i.e.,
exam); the higher the discrepancy between response hope and response
expectancy regarding a negative nonvolitional outcome (i.e., anxiety), the
lower the distress in stressful situation (i.e., exam).

Method

| Participants: One hundred and five undergraduate students from Ye-


shiva University, USA, 18 years of age or above (m=2.72; sd =8.25), com-
pleted measures of distress and of the predictive variables. Participants
were recruited from psychology classes. Written informed consent has been
obtained during a class session.

| Measures: Participants completed the following measures:


Predictor Variables

| Response expectancies and response hopes: Participants’ response


hopes and response expectancies were assessed with face valid visual ana-
logue scales (VAS) for two nonvolitional outcomes: (1) relaxed and (2) anx-
ious. Expectancy items were consistent with previously published method-
ology (Montgomery & Bovbjerg, 2000, 2001; Montgomery et al., 1998). Spe-
cifically, participants were asked to indicate how relaxed (or anxious) they
thought/expected they would feel (right before the exam). Analogously, for
each item they were also asked how relaxed (or anxious) they ‘‘hoped’’ to
feel (right before the exam).

Outcome Variables

| Exam Distress: The Profile of Mood States-Short Version (Shacham,


1984; DiLorenzo, Bovbjerg, Montgomery, Jacobsen, & Valdimarsdottir,
1999) was be used to assess exam-related distress. This measure has 37
items and includes six subscales. It assesses six affective dimensions (i.e.,
tension-anxiety, depression-dejection; anger-hostility; vigor-activity; fa-
tigue-inertia; confusion-bewilderment) and provides a total distress score
(POMS-SV), which was used as the measure of distress in the present study.
6 | DANIEL DAVID, PH.D.; GUY H. MONTGOMERY, PH.D.; TERRY DILORENZO, PH.D.

| Procedure:
Participants completed several assessments:
1. Time One/Baseline: Predictor measures were given to participants
to take home and return to research personnel at the beginning of
the semester.
2. Time Two: On the day of the midterm, prior to the exam, students
completed the POMS-SV.

Results

An alpha level of .05 was used for all statistical tests. Univariate analyses
showed that the data were suitable for further analyses, presented as fol-
lows.
In order to compute the discrepancy between response hopes and re-
sponse expectancies we subtracted the score of response expectancies from
the score of response hopes; we call this score discrepancy score.

POMS Response Response Discrepancy


Exam Expectancy for Expectancy for Score for
Anxiety Relaxation Anxiety
Response
Expectancy for .35
Anxiety
Response
Expectancy for -.30 -.57
Relaxation
Discrepancy
Score for -.24 -.72 .57
Anxiety
Discrepancy
Score for .19 .44 -.77 -.53
Relaxation

Table 1. The correlational analyses between response expectancies,


response hopes, discrepancy scores (i.e., response hope minus response
expectancy) and distress measured at both baseline and prior to the exam.
Note: All results (N=105) are significant (all p’s < .05).

Table 1 presents the correlational analyses between response expectan-


cies, discrepancy score and distress measured prior to the exam. Because
(1) we did not make specific predictions based on response hope but on the
discrepancy between response hope and response expectancy and because
(2) the response hope for relaxation and anxiety did not show a normal dis-
RESPONSE EXPECTANCY VERSUS RESPONSE HOPE… | 7

tribution, response hopes were not introduced in these linear correlational


analyses.

Conclusions and discussion

As expected, response expectancies were related to the nonvolitional


outcomes. While response expectancies for relaxation were inversely re-
lated to distress measured prior to the exam, response expectancies for
anxiety were positively related to distress measured just prior to the exam.
As predicted, the higher the discrepancy between response hope and re-
sponse expectancy regarding a positive nonvolitional outcome (i.e., relaxa-
tion), the higher the distress in a stressful situation (i.e., exam); also as pre-
dicted, the higher the discrepancy between response hope and response
expectancy regarding a negative nonvolitional outcome (i.e., anxiety), the
lower the distress in a stressful situation (i.e., exam).
These conclusions might have interesting implications. From a theoreti-
cal point of view they put forth the possible implications of the discrepancy
between response expectancies and response hopes as mechanism in-
volved in distress and the production of other nonvolitional outcomes.
From a clinical point of view they suggest that in order to reduce distress
one might have to: (1) reduce the response expectancies for distress while
increasing the response expectancy for relaxation, and (2) reduce the dis-
crepancy score for relaxation (e.g., by reducing hope for relaxation) while
increasing the discrepancy score for distress (e.g., by increasing hope for
distress). While the first strategy is already well represented in psychological
theory (e.g., response expectancy theory, Kirsch, 1999) and practice (e.g., ra-
tional-emotive & cognitive-behavioral therapies, Ellis, 1994) many might
find the second strategy implausible, and therefore might view it as a false
positive in our study. However, based on previous reviews of the literature,
we clearly predicted the outcome; therefore, the probability of type one er-
ror is reduced. Moreover, some new developments in rational-emotive &
cognitive-behavioral therapies are congruent with our proposal. Thus,
David Barlow’s exposure treatment package for panic disorder (Barlow,
2003) is based on the idea that trying to relax people is an error because it
communicates to clients that anxiety is dangerous; and it isn't. Following
this line of reasoning, Barlow often asks patients to drink allot of caffeine
while riding a chairlift or walking over a bridge, hoping to get anxious. How-
ever, future studies should investigate the implications of our conclusions
8 | DANIEL DAVID, PH.D.; GUY H. MONTGOMERY, PH.D.; TERRY DILORENZO, PH.D.

for real clinical practice.


The present study is not without limitations. First, though prospective
with regard to the prediction of distress, the study is correlational. Future
experimental studies should determine whether changes in response expec-
tancies and response hopes, following the guidelines suggested above, can
induce changes in distress or other nonvolitional outcomes. Second, it is
unknown whether the present results would generalize beyond student po-
pulations; these results should be replicated in more diverse, larger, and
clinical samples. Third, in order to argue for a specific predictive value of
response expectancy and discrepancy scores, other variables previously re-
lated to distress should be considered (e.g., trait anxiety, irrational beliefs)
simultaneously.
In summary, the present study supports the direct contributions of re-
sponse expectancies and of the discrepancy between response hope and re-
sponse expectancy to students’ distress levels prior to an exam. We think
that the results are interesting enough to deserve future studies, which
should further explore the clinical and the theoretical implications of these
findings.
RESPONSE EXPECTANCY VERSUS RESPONSE HOPE… | 9

References

ANDRYKOWSKI, M. A., & GREGG, M. E. (1992). The role of psychological vari-


ables in post-chemotherapy nausea: Anxiety and expectation. Psychoso-
matic Medicine, 54, 48-58.
BARLOW, D.H. (2003). The nature and development of anxiety and its disor-
ders: Triple Vulnerability Theory. Eye on PsiChi
DAVID, D., MONTGOMERY, G., et al. (2004). Discrimination between hopes and
expectancies for nonvolitional outcomes. Psychological phenomenon or
artefact? Personality and Individual Differences, 36, 1945-1952
DAVID, D., SCHNUR, J., & BELLOIU, A. (2002). Another search for the “hot” cog-
nitions: Appraisal, irrational beliefs, attributions, and their relation to
emotion. Journal of Rational-Emotive and Cognitive-Behavior Therapy,
15, 93-131.
DILORENZO, T. A., BOVBJERG, D. H., MONTGOMERY, G. H., VALDIMARSDOTTIR, H.,
& JACOBSEN, P. B.(1999). The application of a shortened version of the
Profile of Mood States in a sample of breast cancer chemotherapy pa-
tients. British Journal of Health Psychology, 4, 315-325.
ELLIS, A. (1994). Reason and emotion in psychotherapy. (Rev. Ed.) Secaucus,
NJ: Birscj Lane
FRANK, J. D. (1973). Persuasion and healing (2nd ed.). Baltimore, MD: Johns
Hopkins University.
KIRSCH, I. (1985). Response expectancy as a determinant of experience and
behavior. American Psychologist, 40, 1189-1202.
KIRSCH, I. (1990). Changing expectations: A key to effective psychotherapy.
Pacific Grove, CA: Brooks/Cole.
KIRSCH, I. (1999). How expectancies shapme experience. (1st ed.). Washing-
ton, DC: American Psychological Association.
KIRSCH, I., & RASADINO, M. J. (1993). Do double-blind studies with informed
consent yield externally valid results? an empircal test. Psychopharma-
cology, 110, 437-442.
LANSKY, D., & WILSON, G. T. (1981). Alcohol, expectations, and sexual arousal
in males: An information processing analysis. Journal of Abnormal Psy-
chology, 90, 35-45.
MALOUFF, J., SCHUTTE, N., FROHARDT, M., DEMING, W., & MANTELLI, D. (1992).
Preventing smoking: Evaluating the potential effectiveness of cigarette
warnings. The Journal of Psychology, 126, 371-383
10 | DANIEL DAVID, PH.D.; GUY H. MONTGOMERY, PH.D.; TERRY DILORENZO, PH.D.

MONTGOMERY, G. H., & BOVBJERG, D. H. (2000). Pre-infusion expectations pre-


dict post-treatment nausea during repeated adjuvant chemotherapy in-
fusions for breast cancer. British Journal of Health Psychology, 5, 105-
119.
MONTGOMERY, G. H., TOMOYASU, N., BOVBJERG, D. H., ANDRYKOWSKI, M. A.,
CURRIE, V. E., JACOBSEN, P. B., & REDD, W. H. (1998). Patients' pretreatment
expectations of chemotherapy-related nausea are an independent pre-
dictor of anticipatory nausea. Annals of Behavioral Medicine, 20, 104-
109.
MONTGOMERY, G. H., & KIRSCH, I. (1996). Mechanisms of placebo analgesia:
An empirical investigation. Psychological Science, 7, 174-176.
MONTGOMERY, G. H., & KIRSCH, I. (1997). Classical conditioning and the pla-
cebo effect. Pain, 72, 107-113.
MONTGOMERY, G. H., TOMOYASU, N., BOVBJERG, D. H., ANDRYKOWSKI, M. A.,
CURRIE, V. E., JACOBSEN, P. B., & REDD, W. H. (1998). Patients' pretreatment
expectations of chemotherapy-related nausea are an independent pre-
dictor of anticipatory nausea. Annals of Behavioral Medicine, 20, 104-
109.
MONTGOMERY, G. H., & BOVBJERG, D. H. (2000). Pre-infusion expectations pre-
dict post-treatment nausea during repeated adjuvant chemotherapy in-
fusions for breast cancer. British Journal of Health Psychology, 5, 105-
119.
MONTGOMERY, G. H., WELTZ, C. R., SELTZ, G., & BOVBJERG, D. H. (2002). Brief
pre-surgery hypnosis reduces distress and pain in excisional breast bi-
opsy patients. International Journal of Clinical and Experimental Hyp-
nosis.
MONTGOMERY, G. H., DAVID, D., DILORENZO, T., ERBLICH, J. (2003). Is hoping
the same as expecting? Discrimination between hopes and response ex-
pectancies for nonvolitional putcomes. Personality and Individual Dif-
ferences.
PRICE, D. D., MILLING, L. S., KIRSCH, I., DUFF, A., MONTGOMERY, G. H., &
NICHOLLS, S. S. (1999). An analysis of factors that contribute to the magni-
tude of placebo analgesia in an experimental paradigm. Pain, 83, 147-
156.
ROSCOE, J. A., HICKOK, J. T., & MORROW, G. R. (2000). Patient expectations as
predictor of chemotherapy-induced nausea. Annals of Behavioral Medi-
cine, 22, 121-126.
ROTTER, J. B. (1954). Social learning and clinical psychology. Englewood
RESPONSE EXPECTANCY VERSUS RESPONSE HOPE… | 11

Cliffs, NJ: Prentice-Hall.


SCHOENBERGER, N. E., KIRSCH, I., GEARAN, P., MONTGOMERY, G. H., & PASTYRNAK,
S. L. (1997). Hypnotic enhancement of a cognitive behavioral treatment
for public speaking anxiety. Behavior Therapy, 28, 127-140.
SHACHAM, N. (1983). A shorted version of the profile of mood states. Journal
of Personality Assessment, 47, 305-306
SMITH, C. A., & LAZARUS, R. S. (1993). Appraisal components, core relational
themes, and the emotions. Cognition and Emotion, 7, 233-269.
SNYDER, C. R., HOZA, B., PELHAM, W. E., RAPOFF, M., WARE, L., DANOVSKY, M.,
HIGHBERGER, L., RUBINSTEIN, H., & STAHL, K. (1997). The Development and
Validation of the Children's Hope Scale. Journal of Pediatric Psychology,
22, 399-421
SNYDER, C. R., SYMPSON, S., YBASCO, F., BORDERS, T., & BABYAK, M. (1996). De-
velopment and validation of the State Hope Scale. Journal of Personality
and Social Psychology, 70, 321-335
SNYDER, C. R., SYMPSON, S. C., MICHAEL, S. T., & CHEAVENS, J. (2001). Optimism
and hope constructs: Variants on a positive expectancy theme. In E. C.
Chang (Ed.), Optimism and pessimism: Implications for theory, re-
search, and practice. (pp. 101-125). Washington, DC: American Psycho-
logical Association.
TOLMAN, E. C., & HONZIK, C. H. (2001). Introduction and removal of reward
and maze performance in rats. University of California Publication in
Psychology, 4, 257-275.

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