More optimistic treatment expectations are associated with better outcomes through stronger group cohesion, but not dyadic alliance: results from a naturalistic day clinic study in complex depression

These findings provide preliminary support for an indirect association of treatment expectations with outcome through group cohesion in depression. However, the results should be interpreted with caution due to several methodological constraints. Future research should replicate these findings in larger samples, with prospective cohesion measurements, and examine temporal dynamics. Clinically, these findings highlight the potential relevance of explicitly addressing treatment expectations and group cohesion.