How can we optimize the expectations of patients in order to increase the success of therapies? Prof. Dr. Johannes Laferton is investigating this question. He also works with teams from our CRC—and is therefore very welcome as a new associate member of our research network. In this interview, he explains his current projects.
Expectations are an essential mechanism of placebo and nocebo effects and thus a widely documented influencing factor for the success of medical treatments. Prof. Dr. Johannes Laferton, professor of medical psychology and psychological psychotherapist at the HMU Health and Medical University Potsdam since 2020, has long been researching how to optimize patient expectations.
In June 2025, Laferton initiated a joint, highly acclaimed article with Prof. Meike Shedden Mora and Prof. Winfried Rief from SFB 289 “Treatment Expectation” for the Journal of the American Medical Association (JAMA). As part of the series “JAMA Insights – Communicating Medicine,” the three researchers explain four evidence-based communication strategies that practitioners can use to specifically promote positive expectation effects.
Prof. Laferton is a new associate member of SFB 289. His research has several points of contact with existing SFB 289 projects, such as projects A09 and A15 on antidepressant treatments and A13 on hip surgery.
Expectation optimization as a research focus: Prof. Johannes Laferton on his current research priorities
How do patients' expectations influence the success of antidepressant treatments or the recovery process after knee surgery? How do therapies in turn affect expectations? And how can practitioners strengthen positive expectations in order to increase the chances of success of therapies? Johannes Laferton is conducting research at the HMU Health and Medical University Potsdam, exploring the tension between these questions.
Professor Laferton, where does your interest in the complex field of “expectation optimization” come from?
For me, one of the central questions is how we as therapists can help patients develop more positive expectations. I previously worked on the PSY-Heart study with Prof. Winfried Rief in Marburg. There, we were able to demonstrate that simple psychological interventions can optimize expectations in patients prior to heart surgery, thereby further increasing the success of treatment. Back in 2017, this was already a good example of the significant impact that addressing individual treatment expectations can have on patients.
You won a poster award at SIPS in Krakow for your project “Dynamics of patient expectations in antidepressant treatment.” What is the key aspect?
In the past, expectations in the context of antidepressant treatment were almost exclusively surveyed in randomized controlled studies. Often, expectations were only asked about once, at the beginning or end of treatment. As a result, it is still difficult today to determine, first, the exact interaction between antidepressant treatment and expectations and, second, the exact interaction between antidepressant treatment and expectations.
The aim of our new study is to repeatedly record aspects of antidepressant treatment such as symptom change, side effects, interaction with practitioners, and treatment expectations over the course of treatment, thereby gaining a more precise understanding of their mutual dynamics.
Do you have a hypothesis?
Hypothesis 1 is: There is a correlation between changing expectations and the progression of depressive symptoms and side effects in the context of antidepressant treatment. Hypothesis 2 is: There is a correlation between the progression of depressive symptoms and side effects and changing expectations in the context of antidepressant treatment. And hypothesis 3 is: Positive therapist-patient interaction is related to expectations and the course of depressive symptoms and side effects in the context of antidepressant treatment.
That sounds complicated. Is this a chicken-and-egg question?
Yes, essentially. Are there changes in expectations from day to day, and are these changes related to therapeutic improvements or symptom worsening? Or are they related to communication between therapists and patients? There is still very little research on this interaction in normal routine care for antidepressant treatment. We use a mobile phone app for this purpose, in which patients answer questions about their expectations, depressive symptoms, and side effects every evening in two to three minutes. Around 100 patients are involved in this study.
What consequences could your findings have?
If we can better understand the precise relationship between expectations, treatment success, and side effects in antidepressant treatment, it would help us to use interventions for expectation optimization in a more targeted manner. Either by suggesting specific communication strategies for expectation optimization to the treating physician or by attempting to address patients' expectations directly, for example via digital health applications.
In a new project that is currently getting started, you are examining different patient groups prior to knee replacement surgery. What exactly do you aim to find out?
We want to know how different techniques can be used to optimize treatment expectations for knee replacement surgery. Before any therapy, patients consider: Is this the right therapy for me, how will it work for me, will I have side effects, how quickly will I get better? This applies to mental health issues as well as primarily physical complaints.
Knee replacement surgery is one of the most common surgical procedures worldwide. Many patients feel significantly better after the operation, but 10 to 20 percent of those who undergo surgery are not satisfied with the results or continue to experience chronic pain even after the operation. Previous studies have shown that patients' expectations prior to knee surgery are related to the success of the operation: people with positive expectations also have better surgical outcomes.
Our question now is: Can these expectations be specifically addressed before knee surgery in order to further improve the outcome of the surgery? To this end, we first want to test suitable communication strategies. In a feasibility study, patients who are scheduled for knee surgery will receive our workbook “My Surgery Coach,” which provides them with information to help them develop realistic, positive expectations about the surgery and their life afterward. In addition, following each of the three chapters in the workbook, we will conduct a 30-minute conversation via (video) call to develop personalized, realistic and positive expectations together with the patients. We expect results in 2026. If patients find expectation optimization helpful, we want to conduct a larger study to investigate whether it can also further improve surgical outcomes.
Link to the JAMA publication:
Laferton JAC, Rief W, Shedden-Mora M. Improving Patients’ Treatment Expectations. JAMA. Published online June 04, 2025. doi:10.1001/jama.2025.6261
https://jamanetwork.com/journals/jama/article-abstract/2834861
You can find out more details in the podcast with Prof. Johannes Laferton:
JAMA Podcast Clinical Reviews – Prof. Laferton in conversation
https://jamanetwork.com/journals/jama/pages/jama-clinical-reviews