Breaking Free of Societal Expectations: Part Two

The expectations we face daily affect everything we do-how we think and act. It affects our future.

In my first blog post (Breaking Free of Societal Expectations: Part One) I talked about how the expectations of today’s world can make it feel impossible to be the real, true you. It can sometimes feel impossible to choose your own path in life due to conforming to societal norms. Then, I had a discussion with a mental health professional in another post which shed some light on society’s harmful effects of mental health stigma.

In this post-part two- I am going to talk about expectations again, but in a diferent way. Unfortunately, we can confidently say that the environment we live in today endorses stigmatized behavior which leads to negative judgements of others with mental illnesses. When advocates everywhere say lets “break the stigma of mental health” it can seem like a vague stance to take that encompasses a lot of different aspects. There are many interpretations of this and ways to help #breakthestigma. I want to touch on a specific point of view that involves expectations.

When people hear the words “mental illness” they immediately think negatively. They EXPECT to see a helpless person and tend to judge them based on this. These expectations about people who struggle with mental illness are wrong. Mental illness is a spectrum and way more complicated than that. There are so many different diagnoses and they vary in severity. Everyone’s is unique to them. Some diagnoses come and go too. Some people who have a mental health diagnosis may have had a past experience to cause it. Others say its the anatomy they were born with or a chemical imbalance. Regardless, the negative expectations many people have surrounding mental health affects recovery and treatment outcomes.

In a scholarly article titled “The role of expectations in mental disorders and their treatment” by Winfried Rief and Julia Anna Glombiewski, this concept is delved into more deeply. This article touches on positive and negative expectations and their affects on treatment plan success. It also details how some mental health disorders are actually “expectation disorders” by definition. Lastly, this article brings insight to the challenge currently faced today by professionals of investigating the role of expectations and transferring this knowledge into clinical psychiatric practice.

What are expectations? “Expectations are defined as cognitions which are future-directed and focused on the incidence or non-incidence of a specific event or experience.” As far as treating mental disorders, this relates to modifying patient’s expectations without disregarding past experiences.

The example this article uses to explain this is: “…temporary ear noises are no problem for most people as long as the person expects them to vanish promptly…but the same experience can be diffcult to bear if the person expects them to last forever.” So, it may not be the actual negative effects that causes someone to develop a mental health disorder, but the negative expectations one has of the future. All of this is greatly influenced by social norms and what is expected to be felt as well. Approaching mental health focusing on “expectations” can help break the stigma and diminish negative affects it has on outcomes.

Think about it-if you expect yourself to fail you will most likely not perform at your best. But, if you expect yourself to succeed you will be more confident and have a better chance at a positive outcome. Your mind is so powerful and having positive outlooks or expectations can make a huge difference in the end. Investigating expectations and their presence among society can help determine better treatment plans and why some outcomes fail with one person versus another. Understanding the role of expectations in everyday life will help mental health sufferers understand themselves and how they can succeed. Positive and negative attitudes about the future affect mental health outcomes and treatment success, and it can also CAUSE the mental health disorders (expectation disorders).

“EXPECTATION DISORDERS” What does this mean? This article presents anixety disorders (phobias, panic disorder, and genralized anxiety disorder), obsessive-complusive disorder and post-traumatic stress disorder in this category. Anxiety disorders particularly fall under this. “In these cases, patients expect adverse consequences when being exposed to specific stimuli, situations, or experiences…and in obsessive-complusive disorder the patient expects dreadful consequences if complusive behaviors are prohibited.” Let’s use social anxiety as another example. Many times people who experience social anxiety are thinking more about what will happen or what they expect will happen, not what was or is in the moment. Like having negative expectations about saying the wrong thing at the wrong time or embarasing one’s self. When in reality, those negative expectations are only making the anxiety that is present flourish.

There are other disorders that do not fall under the “expectation disorder” category but involve the same concepts in a different way, like depression. “Individuals suffering from depression show more depression-specific negative expectations.” For example, if you are feeling sad, depressed, or down it can be hard to think happy thoughts. Sometimes your mind immediately reverts to the negative and this causes you to fall deeper into the depression. Eventually you start ruminating and believing the negative expectations you are thinking, harming your treatment outcomes and success.

These are just a few examples. Whether you are a mental health professional or suffer from a diagnosis yourself, incorporating how expectations affect the way a patient (or you) think will lead to greater treatment success. This article describes it well. It states that “optimizing treatment expectations can result in improved outcome and prevention of treatment side effects, while the induction of negative expectations can abolish the effects of highly effective medications.”

Expectations are one of the most powerful predictors of outcome.” Based on this, they suggest rearranging treatmet therapies to better focus on the change of expectations. For example, “interventions must maximally modify illness-specific expectations, and positive outcome expectations should be sufficiently established before treatment starts. There are treatment plans based on this out there, although it is not well known to everyone. This is the first time I am learning about this myself.

What is EFPI? EFPI means Expectation-focused psychological interventions. “EFPI places a strong focus on analyzing and summarizing disorder specific expectations of the patient, developing tests to check the credibility of the expectations, and re-evaluating expectations by comparing pre-existing expectations with the experience during exposure.”

Regardless of treatment plans, this is so important for all people! It is important to understand your patient in this way, or understand your own expectations before diving into treatment. The expectations you have about yourself and your outcome success can greatly affect how interventions play out day to day. Your own negative expectations can also lead to (percieved) self-stigma and cause internalizing of these negative thoughts, leading to poorer treatment outcomes.

So, when we say “breaking the stigma of mental health” addressing expectations of yourself and others can help! Being aware of and understanding society’s expectations is the first step to changing them from negative to positive. Changing people’s expectations surrunding mental health to positive thoughts can help break the stigma and lead to many more successful outcomes. We must work together to stop endorsing stigmatized thinking which leads to negative thoughts and negative outomes. Remeber: positive thoughts and positive expectations about people and your future can change mindsets and be so powerful in today’s world!

RESOURCE: Article from the offical journal of the world psychiatric association (World Psychiatry). “The role of expectations in mental disorders and their treatment.” 2017. Winfried Rief and Julia Anna Glombiewski. Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg.

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