Impact of treatment credibility and expectancy on cognitive behavioral therapy for insomnia outcomes among cancer survivors
Bibliographic record
Abstract
OBJECTIVES: Cognitive Behavioral Therapy for Insomnia (CBT-I) can effectively improve insomnia among cancer survivors. This secondary analysis explored what factors were associated with higher beliefs about credibility and expectancy and examined the impact of perceived treatment credibility and expectancy on outcomes. METHODS: As part of a randomized waitlist-controlled trial, cancer survivors (N = 132) with insomnia received 7 weekly virtual sessions of CBT-I. Credibility and expectancy beliefs were assessed at baseline for insomnia and perceived cognitive impairment (PCI) using the Credibility Expectancy Questionnaire. We examined which factors were associated with greater credibility and expectancy beliefs and whether credibility and expectancy moderated change in symptoms. Semi-structured interviews explored patient perceptions. RESULTS: Only younger age was associated with higher pre-treatment expectations for both insomnia and PCI (p = 0.009; p = 0.008). The magnitude of expectancy for insomnia and cognitive functioning were similar. Neither beliefs about credibility nor expectancy acted as moderators of change in symptoms of insomnia (p = 0.972; p = 0.502) or PCI (p = 0.143; p = 0.283), respectively. Qualitative results suggest credibility and expectancy can be optimized by: 1) promoting an understanding of sleep; 2) setting appropriate pre-treatment beliefs that foster optimism and mitigate skepticism; 3) promoting consistent engagement with treatment; and 4) fostering positive therapeutic relationships. CONCLUSION/IMPLICATIONS: CBT-I is effective regardless of pre-existing beliefs and expectations. While these factors may play a role in the decision to pursue CBT-I, our results suggest that clients are likely to see benefits if they engage in the therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".