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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 treatment benefits 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 the proposed CRC is to generate the knowledge base for the systematic utilization of patients’ expectation in order to optimize therapeutic strategies and thereby improve health outcomes. To achieve this goal, we will characterize the psychological and neurobiological mechanisms underlying positive and negative expectations and their impact on treatment outcomes, and how expectation effects interact with actual (e.g., pharmacological) treatment effects. We will initially focus on the pain and affective system, as experimental and clinical evidence indicate substantial and clinically relevant effects of expectation on patient-reported treatment outcomes in both normal and pathological forms of pain and affective processing. Using a highly interdisciplinary and translational approach and guided by a unified theoretical framework, we will conduct basic experimental studies in animals, 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. The research program is designed around the long-term perspective of the CRC, in which the focus of the three funding periods will gradually shift from characterizing the mechanisms underlying treatment expectation to applying gained insights in clinical applications. During the first funding period, we will focus on the psychological and neurobiological mechanisms and interindividual differences in the effects of expectation on health outcomes in healthy volunteers and patients. To ensure rapid transfer into the clinical context, mechanistic studies will be complemented by small-scale translational clinical proof-of-concept studies testing approaches to modulate treatment expectation in patient groups with chronic pain or depression. In the second funding period, we will then focus on the dynamics of expectation. In particular, we will investigate how expectation is revised and updated based on patients’ treatment experience. We also aim to go 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 (e.g., autoimmune or cardiovascular diseases). Finally, this will allow us to systematically utilize expectation in a context-, patient-, and disease-specific manner in the third funding period. An additional important spin-off during this final funding period will be the optimization of clinical trial designs with the aim to improve drug discovery and development.
DFG Programme CRC/Transregios

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Applicant Institution Universität Duisburg-Essen
 
 

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