The Role of Hope in Recovery During Transdiagnostic Exposure-Based Therapy for Anxiety-, Obsessive-Compulsive and Trauma- and Stressor-Related Disorders.

Hope has been proposed as a nonspecific process that fosters positive change by enhancing motivation and treatment engagement. However, few studies have examined the temporal dynamics of hope across multiple timepoints, limiting our understanding of its potentially iterative response to and influence on cognitive-behavior therapy (CBT) outcomes. For the present study, we examined data from a clinical trial investigating predictors of non-response to exposure-based therapy for anxiety-related disorders. The sample includes the first 100 participants who completed assessments during 12 weeks of treatment. Multilevel modeling was used to examine changes in hope during treatment and whether hope predicted subsequent anxiety severity. Between-person effects showed that individuals who were more hopeful than others on average during treatment experienced lower anxiety severity throughout (β = -0.31, 95% CI [-0.45, -0.17]), controlling for baseline anxiety severity, demographic characteristics, and psychiatric medication use. Within-person effects supported causal primacy for changes in hope in relation to treatment outcome: increased hope (relative to individual average) predicted less anxiety at the subsequent quarter of treatment (β = -0.09, 95% CI [-0.16, -0.03]), though these effects were comparatively weaker than between-person effects. Findings suggest that hope is a prospective predictor of anxiety reduction during exposure-based therapy, supporting its role as a common factor promoting positive treatment outcomes.