Winfr select

Winfried Rief
Professor of Clinical Psychology and Psychotherapy, and head of the Clinic for Psychological Interventions. Philipps University of Marburg, Germany. 

Why changing dysfunctional expectations in clinical practice is challenging

During the last decade, psychological and neurobiological mechanisms that are involved in the development of placebo and nocebo responses have been identified. While clinical trials used to reduce placebo mechanisms, clinical practice should try to make use of them for the benefit of the patient. Expectation and learning mechanisms are the major psychological factors contributing to placebo and nocebo effects. Examples will be presented how optimizing patients’ expectations leads to improved outcome in different clinical conditions. However, to better understand the persistence of dysfunctional expectations in patients, we need a model for understanding mediators of expectation change in the case of expectation violation. We introduce the concept of “cognitive immunization” to understand expectation persistence, and we will present examples how dysfunctional expectations can be changed in patients, even if they have a tendency for persistence of negative expectations.

Finally, implications for optimizing psychological interventions in general will be highlighted, and first examples confirm the clinical potential of successfully applying our model of expectation change.



Winfried Rief, Professor of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany. Head of the Clinic for Psychological Interventions. License for psychotherapy and supervision. Dr. Rief worked for many years in hospital settings (e.g., Roseneck Hospital for Psychosomatic Medicine, Prien a. Ch.). He is specialized in placebo- and nocebo effects, perception and coping with somatic symptoms, optimization of clinical studies and interventions. He was guest professor at Harvard Medical School, Boston (2004/2005), University of Auckland Medical School (2002), and University of California San Diego (2009/2010). Additionally, he was nominated for the expert committee of WHO/APA for the revision of the classification of mental disorders according to DSM-5, and he is co-chairing the WHO working group on chronic pain diagnoses in ICD-11. Dr. Rief is elected coordinator for grant applications to the German Research Foundation and he is spokesperson of the DFG-research unit on placebo and nocebo mechanisms. His publication record summarizes more than 450 articles, in particular in the field of behavioral medicine and somatoform disorders. He received the Distinguished Researchers award in Behavioral Medicine in 2014.