Understanding Women With Endometriosis and Their Treatment Expectations: Baseline Results of a Clinical Cohort Study

Understanding Women With Endometriosis and Their Treatment Expectations: Baseline Results of a Clinical Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Women With Endometriosis and Their Treatment Expectations: Baseline Results of a Clinical Cohort Study Navin Joußen, Ann-Katrin Meyrose, Nina Hirsing, Olaf Buchweitz, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4303538/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction . Endometriosis is still somewhat unknown to the general public, often overlooked and not treated satisfactorily. 20-30% of affected women report persistent pain disability even after successful surgical removal of endometriotic tissue via laparoscopy. Medical factors can not explain this symptom persistence. Therefore, psychological factors, such as treatment expectations, might play a role for treatment outcomes of endometriosis and women’s quality of life. This study aimed to characterise women with endometriosis, describe their treatment expectations before laparoscopy, and identify predictors of treatment expectations. Method . This study characterizes a clinical cohort of N = 393 women with endometriosis treated in a specialized endometriosis centre in Germany. Treatment expectations were assessed using the Treatment Expectation Questionnaire and the Generic Rating Scale for Treatment Expectations. Medical characteristics were evaluated with a self-conducted case report form. Analysis . Descriptive and multiple linear regression analyses with ten different treatment expectations as the dependent variable were conducted. Results . The mean endometriosis-related pain disability score was 30.77 ± 13.28, and the mean somatic symptom severity score was 15.61 ± 5.07. 40.2% ( n = 158) of the participants had a high likelihood of having major depression, and 39.9% ( n = 157) were highly likely to have a general anxiety disorder. Treatment expectations concerning the laparoscopy of participants were rather positive. Multiple linear regressions show that endometriosis-related pain disability and state anxiety predict treatment expectations of women with endometriosis. Medical characteristics were not significantly associated with treatment expectations. Conclusion . Affected women are highly physically and psychologically burdened, mostly over several years. Patients with higher pain disability and anxiety are especially prone to negative treatment expectations. Trial Registration Number: ID NCT05019612 (ClinicalTrials.gov), registration date August 25 th . expectancy gynaecology laparoscopy quality of life treatment Figures Figure 1 Introduction Endometriosis is a chronic disease defined as endometrium-like tissues outside the uterus ( 1 ). It affects 6–10% of pre-menopausal women ( 2 ) and 2–4% of post-menopausal women ( 3 ). The average time between the first complaints and surgical diagnosis is 6.7 years ( 4 ), both adversely affecting women's quality of life ( 5 , 6 ). Women with endometriosis show significantly lower physical health and higher levels of depression and anxiety than unaffected women ( 2 , 7 ). Nevertheless, endometriosis is still widely unrecognised and not treated satisfactorily ( 5 ). About 20–30% of treated women still report endometriosis-related complaints and disability after successful laparoscopic surgery (i.e., removing all affected tissue) ( 8 ). These symptoms cannot be explained by laparoscopy or endometriosis recurrence ( 8 ). Therefore, psychological factors, such as expectations, may affect responses to treatment in women with endometriosis. Treatment expectations predict various medical conditions and treatment outcomes ( 9 , 10 ). In the field of gynaecology, this applies to complex diseases such as menopausal hot flushes ( 11 ) and breast cancer ( 12 ). Focusing on psychological factors can lead to more effective treatment outcomes and, in turn, improved quality of life ( 9 ). However, treatment expectations can be influenced by different factors. Treatment expectations can be influenced by treatment information ( 13 ), prior treatment experiences ( 14 – 16 ), pain levels ( 17 ), depression, and anxiety ( 15 , 18 , 19 ). Since endometriosis is related to high pain levels ( 20 ), pain catastrophising ( 8 , 21 ), somatic symptom impairment, and higher levels of depression and anxiety ( 2 ), these factors might also predict negative treatment expectations of women with endometriosis. Furthermore, a longer duration of experiencing endometriosis-related symptoms might result in pain chronification and, in turn, be associated with negative expectations toward treatment. In contrast, the latest medical endometriosis staging system (revised American Society for Reproductive Medicine Score; rASRM) is unrelated to subjective symptom severity ( 22 ) and, therefore, should also be unrelated to patients' treatment expectations. To summarise, exploring individual factors may help to understand the treatment expectations of women with endometriosis and affect the efficacy of future treatments. To our knowledge, this is the first study to examine treatment expectations and related individual factors in women with diagnosed endometriosis. Firstly, this study aims to better understand and characterise women with endometriosis; secondly, to describe treatment expectations; and thirdly, to identify predictors of treatment expectations. We hypothesise that: 1. Prior treatment experiences with endometriosis laparoscopy are associated with treatment expectations. 2. Higher endometriosis-related pain disability is associated with more negative treatment expectations. 3. Higher pain catastrophisation is associated with more negative treatment expectations. 4. Higher somatic symptom impairment is associated with more negative treatment expectations. 5. Higher state depression is associated with more negative treatment expectations. 6. Higher state anxiety is associated with more negative treatment expectations. 7. Higher age and symptom duration are associated with more negative treatment expectations. 8. The endometriosis stage is not associated with treatment expectations. Methods and Analyses Study Design Data were derived from the preoperative baseline assessment (T 0 ) and an additional surgery case report from the ROXWELL study. The ROXWELL study is a mixed-method clinical observational study involving patients with indications for laparoscopy. For further details regarding the study, see the study protocol Hirsing et al. (2023) or the preregistration at ClinicalTrials.gov (ID NCT05019612), registration date August 25th . Participants The target sample consisted of women with a clinical indication for laparoscopy according to endometriosis-related symptoms with or without an unmet wish to have children. A total of N = 393 eligible women were included in the final sample. Recruitment Women were recruited in a specialised centre of surgical endoscopy and endometriosis in Hamburg, Germany. All women with an appointment for endometriosis laparoscopy and sufficient German language skills were informed about the study by the receptionists of the outpatient clinic or by study psychologists. Interested women received the baseline assessment link (T 0 ) via e-mail. Patients filled in the survey between the 25th of August 2021 and the 27th of June 2023. In- and Exclusion Criteria Participants had to fulfil the following inclusion criteria for study participation: ( 1 ) being at least 18 years old, ( 2 ) endometriosis-related symptoms with or without an unmet wish to have children, ( 3 ) good speaking and comprehension of the German language, ( 4 ) female biological sex, ( 5 ) given informed consent for study participation, ( 6 ) an indication for laparoscopy, and ( 7 ) visually diagnosed endometriosis by surgeons. Exclusion criteria were: ( 1 ) incomplete excision of endometrial tissue and ( 2 ) maligne result when endometrial tissue was examined. The exclusion criteria were evaluated post-hoc. Procedure After patients provided contact data and written informed consent were obtained online, the baseline assessment (T 0 ) was conducted online several weeks or days before laparoscopy. The baseline assessment (T 0 ) included questions about current endometriosis-related symptoms, -disability, prior treatment experiences, and treatment expectations. It lasted approximately 15–20 minutes. After laparoscopy, surgeons documented endometriosis-related medical characteristics and relevant information about surgery within a self-conducted case report form (CRF) and exclusion criteria were checked by the study team. The Psychotherapeutenkammer Hamburg, Germany, ethics committee gave ethical approval (ROXWELL-2021-HH) for the study. The study is preregistered at ClinicalTrials.gov (ID NCT05019612). Informed consent and exemption from confidentiality were obtained from all participants. Measures Primary Outcome Measure Treatment expectations about laparoscopy were assessed by the Treatment Expectation Questionnaire, TEX-Q ( 23 , 24 ), and the Generic Rating Scale for Treatment Expectations, GEEE expect ( 25 ). The TEX-Q assesses patients' self-reported treatment expectations towards laparoscopy and consists of 15 items on an 11-point Likert scale ( 0 to 10 ) covering six dimensions (treatment benefit, positive impact, adverse events, negative impact, process, and behavioural control). Mean scores were computed for all dimensions and the total score, ranging from 0 to 10. Higher scores indicate more positive treatment expectations on the subscales of treatment benefit, positive impact, process, and behavioural control. Higher scores indicate more negative expectations on the subscales of adverse events and negative impact. These two subscales were inverted for the total score, meaning a higher total score indicates more positive expectations. Cronbach's α was .71 to .92 for the total score ( 24 ). In our study, Cronbach's α was .81. The GEEE expect assesses treatment expectations towards laparoscopy and expected complaints. It contains three items, i.e. expected improvement, expected worsening and expected complaints, on an 11-point Likert scale ( 0 = no improvement/worsening to 10 = greatest improvement/worsening imaginable; 0 = no complaints to 10 = greatest complaints imaginable ). Higher scores for the first item indicate more positive treatment expectations. Higher scores for the second and third items indicate more negative treatment expectations. Predictors Prior experiences with endometriosis laparoscopy were assessed using the Generic Rating Scale for Previous Treatment Experiences, GEEE pre ( 25 ). We used the first item of the GEEE pre to differentiate between the following two categories: no prior experiences with endometriosis laparoscopy vs. prior experiences with endometriosis laparoscopy. Endometriosis-related pain disability was assessed by the German version of the Pain Disability Index, PDI ( 26 , 27 ). The PDI assesses the self-reported pain disability and was adapted to endometriosis-related symptoms for this study. It contains seven items on an 11-point Likert scale (0 = no disability to 10 = total disability). The total score ranges from 0 to 70. Higher sum scores indicate a higher disability due to pain. Good reliability has been proven, ranging from Cronbach's α = .83 to .90 ( 26 ). In our study, Cronbach's α was .84. Pain catastrophisation was assessed by the subscale catastrophisation of the Coping Strategies Questionnaire, CSQ paincat ( 28 ). CSQ paincat comprises six items with seven response options ( 0 = never do that to 6 = always do that ). The total sum score ranges from 0 to 36. Higher sum scores indicate a higher level of pain catastrophisation. Cronbach’s α was .97 ( 28 ). In our study, Cronbach's α was .87. Somatic symptom impairment was assessed by the Patient Health Questionnaire, PHQ-15 ( 29 ). The PHQ-15 consists of 15 physical symptoms with three response options (0 = not at all to 2 = bothered a lot). The total sum score ranges from 0 to 30. Higher sum scores indicate a higher level of impairment. Cronbach's α was .80 for the total score ( 29 ). In our study, Cronbach's α was .78. State depression was assessed by two items of the Patient Health Questionnaire for Depression (PHQ-2) ( 30 ) on a four-point Likert scale (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day) . The total score ranged from 0 to 6. Higher sum scores indicate a higher level of state depression. Cronbach's α was .79 for the total score ( 31 ). In our study, Cronbach's α was .78. A cut-off score of 3 or greater indicates a good sensitivity and specificity to detect a major depressive disorder ( 32 ). State anxiety was assessed by two items of the Generalized Anxiety Disorder Scale (GAD-2) on a four-point Likert scale (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day) . The total score ranged from 0 to 6. Higher sum scores indicate a higher level of state anxiety. Cronbach's α was .81 for the total score ( 31 ). In our study, Cronbach's α was .78. A cut-off score of 3 or greater indicates a good sensitivity and specificity to detect a generalized anxiety disorder ( 33 ). The endometriosis stage was assessed by the revised American Society for Reproductive Medicine Score (rASRM) (Canis et al., 1997). The rASRM is a scoring system for endometriosis lesions using points corresponding to the size of the lesions in different areas ( 35 ). The resulting points are classified into four grades of severity ( 1 to 5 points = stage I "minimal", 6 to 15 points = stage II "mild", 16 to 40 points = stage III "moderate", > 40 points = stage IV "severe" ). Statistical Analysis We described our sample by analysing frequencies, means, standard deviations and ranges of relevant sociodemographic, medical, and psychological variables. We used frequencies, means, standard deviations, ranges, kurtosis, skewness, and quartiles for both measuring instruments (TEX-Q and GEEE expect ) to describe expectations toward laparoscopy. To investigate bivariate associations, we calculated Pearson's correlation coefficients. We followed Cohen (( 36 )) to evaluate the strength of bivariate associations: a correlation of r ≥ .10 indicates a small, r ≥ .30 a moderate, and r ≥ .50 a strong relationship. Multiple linear regression analyses were used to examine the relationship between treatment expectations and predictors. Multiple linear regression models were tested for each of the ten dependent variables by entering all independent variables simultaneously. Improvement in model fit due to adding all predictor variables was assessed based on the adjusted R 2 value, F -statistic, and the degrees of freedom in parentheses. To evaluate the variables of interest, regression coefficients ( ß ) with corresponding 95% confidence intervals ( CI ), standard errors ( SE ), and p -values were calculated. All analyses were conducted using IBM SPSS Statistics Version 27. The significance level was determined as p < .05 for all analyses. Results Sample Characteristics Of 1448 scheduled laparoscopies (since August 2021), 875 women were interested in the study, of which 699 completed the baseline survey (T 0 ). Due to some women not having an endometriosis diagnosis, the decision against laparoscopic surgery and other dropout reasons, the final sample consisted of 393 participants (see Fig. 1 ). Characteristics of the investigated sample and the distributions of the six predictors are presented in Table 1 . Participants were 18 to 51 years old ( M = 29.74, SD = 6.52). About one-sixth had a migrant background, i.e. women whose one or both parents were not born in Germany. Almost every tenth woman was incapable of working. In the present study, patients showed four times higher pain disability scores ( M = 30.77, SD = 13.28 vs. M = 6.9, SD = 11.1, N = 1,368 ( 37 )) and three times higher somatic impairment scores ( M = 15.61, SD = 5.07 vs. M = 6.31, SD = 4.06, N = 4,815 ( 38 )) than the general population. Pain catastrophising scores were M = 18.33 on average ( SD = 7.81). Furthermore, participants showed higher state depression ( M = 2.52, SD = 1.40) and state anxiety scores ( M = 2.36, SD = 1.64) than healthy subjects ( 7 , 39 ). Almost half of the women showed signs of major depression (40.2%) and/or an anxiety disorder (39.9%). Overall, more than every fourth woman simultaneously showed signs of major depression and a general anxiety disorder (27.0%). The duration of symptoms ranged from 0 to 486 months ( M = 84.85, SD = 83.97), respectively M = 7.1 ( SD = 7.0) years. Every fifth woman stated prior experiences with laparoscopy (19.8%). Table 1 presents more information on the characteristics of the sample under analysis and descriptive statistics. Treatment expectations concerning the laparoscopy of participants were, in general, rather positive. However, TEX-Q mean scores were lower than in the validation sample ( M = 6.70, SD = 1.24 vs. M = 7.34, SD = 1.20, N = 251 ( 24 )) and distributed slightly left-skewed (skewness: -0.23). The positive dimension of the GEEE (i.e. expected improvement) was rated with higher values ( M = 7.08, SD = 2.04) and distributed left-skewed (skewness: -0.88). Negative dimensions of the GEEE (i.e. expected worsening and expected complaints) were rated with lower values ( M = 1.12 and 3.83, SD = 1.68 and 2.33) and distributed right-skewed (skewness: 1.84 and 0.31). Distributions of all measurement instruments and items assessing treatment expectations are presented in Table 2 . Table 1 Sample characteristics at baseline (T 0 ). Women with endometriosis ( N = 392) n % M SD Observed range Potential range Gender (female vs. non-binary) 388 98.7 Age (in years) 29.74 6.51 18–51 18–99 Migrant background 61 15.5 Unable to work 36 9.2 Pain disability (PDI) 30.77 13.28 0–69 0–70 Pain catastrophisation (CSQ) 18.33 7.81 0–36 0–36 Somatic symptom impairment (PHQ-15) 15.61 5.07 3–27 0–30 State depression (PHQ-2) 2.52 1.40 0–6 0–6 High likelihood of major depression (PHQ-2 ≥ 3) 158 40.2 3–6 3–6 State anxiety (GAD-2) 2.36 1.64 0–6 0–6 High likelihood of general anxiety disorder (GAD-2 ≥ 3) 157 39.9 3–6 3–6 High likelihood of major depresson and general anxiety disorder (PHQ-2 + GAD-2 ≥ 3) 106 27.0 Prior experiences with laparoscopy 78 19.8 Duration of symptoms (in months) 84.85 83.97 0-486 ≥ 0 Deep infiltrating endometriosis 78 19.8 rASRM (stage of endometriosis) minimal 250 63.6 mild 88 22.4 moderate 38 9.7 severe 7 1.8 Recommendation of further hormone therapy 279 71.0 Note. CSQ = catastrophisation subscale of the Coping Strategies Questionnaire; GAD-2 = Generalized Anxiety Disorder Scale; PDI = Pain Disability Index; PHQ-2 = Patient Health Questionnaire for Depression; PHQ-15 = Patient Health Questionnaire; rASRM = revised American Society for Reproductive Medicine Score. Table 2 Treatment expectation scales. Subscale M SD Observed range Skewness ( SE ) Kurtosis ( SE ) Percentiles 25 50 75 TEX-Q total score 6.70 1.24 2.4–10 -0.226 (.12) .226 (.25) 5.87 6.73 7.53 Treatment benefit 6.77 2.15 1–10 -0.745 (.12) 0.544 6.00 7.33 8.33 Positive impact 6.36 2.56 0–10 -0.725 (.12) 0.035 5.00 7.00 8.33 Adverse events 2.83 1.96 0–9 0.349 (.12) -0.262 2.33 3.33 5.00 Negative impact 2.19 2.40 0–10 0.849 (.12) -0.016 0.50 2.00 4.00 Process 6.55 2.33 0–10 -0.359 (.12) -0.053 5.50 7.00 8.00 Behavioural control 6.03 2.60 0–10 -0.277 (.12) -0.445 4.50 6.00 7.50 GEEE expect _improvement 7.08 2.04 0–10 -0.879 (.12) 0.843 (.25) 6.00 7.00 8.00 GEEE expect _worsening 1.12 1.68 0–9 1.838 (.12) 3.385 (.25) 0.00 0.00 2.00 GEEE expect _complaints 3.83 2.33 0–10 0.312 (.12) -0.516 (.25) 2.00 4.00 5.00 Note. The mean TEX-Q total score was computed after inverting TEX-Q_7 to TEX-Q_11. Higher scores indicate more positive treatment expectations. GEEE expect = Generic Rating Scale for Treatment Expectations; TEX-Q = Treatment Expectation Questionnaire. Bivariate Associations A correlation matrix of bivariate associations between the outcome measures and predictors is presented in Table 3 . All bivariate associations between individual items measuring treatment expectations are presented in Supplementary Table 1. Women with higher scores of anxiety reported significantly lower overall treatment expectations measured by the TEX-Q total score, r = − .149, p = .003. Treatment expectations regarding treatment benefit were not significantly associated with any predictors. Women with higher scores of pain disability, pain catastrophising, and somatic symptom impairment reported significantly higher positive impact expectations, r = .230, p < .005, r = .204, p < .005, and r = .175, p < .005. Women with higher scores of pain disability, pain catastrophizing, somatic symptom impairment, depression, and anxiety reported significantly higher treatment expectations regarding adverse events (i.e. negative expectations regarding treatment), r = .190, p < .00), r = .152, p < .005, r = .165, p < .005, r = .148, p < .005, and r = .184, p < .005. Women with higher scores of pain disability and somatic symptom impairment reported significantly higher treatment expectations regarding negative impact (i.e. negative expectations regarding treatment), r = .161, p < .005 and r = .134, p = .008. Women with higher scores of anxiety and a longer duration of symptoms reported significantly lower treatment process expectations (i.e. a less straightforward process), r = − .152, p < .005 and r = − .107, p = .034. Women with higher scores of somatic symptom impairment reported significantly higher treatment expectations regarding behavioural control (i.e. being able to influence treatment success), r = .141, p = .005. Treatment improvement expectations measured with the G-EEE were not significantly associated with any predictors. Women with higher scores of pain catastrophizing reported significantly higher treatment worsening expectations (i.e. negative expectations regarding treatment), r = .116, p = .021. Women with higher scores of pain disability, somatic symptom impairment, and depression reported significantly higher treatment complaint expectations (i.e. negative expectations regarding treatment), r = .171, p < .005, r = .144, p < .005, r = .107, p = .035. All significant bivariate associations were small. Prior experiences with laparoscopy were not significantly associated with any of the outcome variables. Regarding medical information, neither the rASRM-score nor having deeply infiltrated endometriosis were significantly associated with any of the outcome variables. Prediction of treatment expectations Seven of the ten multiple linear regression analyses found a significant regression equation. There was a significant model fit for total treatment expectations (TEX-Q_total: F(8,384) = 2.72, p = .006, R 2 = .034), positive impact (TEX-Q_positiveimpact: F(8,384) = 5.48, p < .001, R 2 = .084), adverse events (TEX-Q_adverseevents: F(8,384) = 3.56, p < .001, R 2 = .046), negative impact (TEX-Q_negativeimpact: F(8,384) = 1.96, p = .048, R 2 = .020), process (TEX-Q_process: F(8,384) = 2.34, p = .019, R 2 = .027), behavioural control (TEX-Q_behaviouralcontrol: F(8,384) = 2.21, p = .026, R 2 = .024), and impairment (F(8,384) = 2.73, p = .006, R 2 = .034). The expected treatment benefit (TEX-Q_treatmentbenefit), improvement (GEEE expect _improvement), and worsening (GEEE expect _worsening) had no significant model fit. Women with prior experiences expected significantly fewer complaints due to treatment (GEEE expect _complaints: B = − .102, p = .045) than women without prior experiences with endometriosis laparoscopy. Women with a higher disability due to pain had significantly higher treatment expectations regarding positive impact (B = 1.37, p = .027), expected significantly more adverse events due to treatment (B = .132, p = .036), had significantly higher treatment expectations regarding negative impact (B = .165, p = .010), and expected more complaints due to the treatment (GEEE expect _complaints: B = .143, p = .025). Patients with a higher level of pain catastrophising had significantly higher total treatment expectations (B = .131, p = .044) and expected higher positive impact due to the treatment (B = .197, p = .002). Participants with a higher level of physical impairment expected significantly higher behavioural control (B = .188, p = .002). Women with a higher level of state depression did not significantly differentiate in terms of their treatment expectations from those who had lower levels of state depression. Women with a higher level of state anxiety had significantly lower total treatment expectations (B = − .190, p = .005), lower expectations regarding positive impact due to the treatment (B = − .155, p = .019), and lower expectations regarding the treatment process (B = − .192, p = .005). Women with a higher level of state anxiety expected significantly more adverse events due to treatment (B = .141, p = .036). Patients of older age reported significantly higher total treatment expectations (B = .119, p = .029) and expected significantly higher positive impact due to the treatment (B = .118, p = .025). Participants with a longer duration of endometriosis-related symptoms had significantly lower total treatment expectations (B = − .119, p = .023), and had significantly lower expectations regarding the treatment process (B = − .140, p = .008). All significant and non-significant regression equations and model coefficients can be found in Tables 4 and 5 . Table 4 Multiple linear regression analyses of the total TEX-Q score and subscales. TEX-Q total score TEX-Q treatment benefit TEX-Q Positive impact TEX-Q Adverse events TEX-Q Negative impact TEX-Q Process TEX-Q Behavioural control Stand. Beta p -value Stand. Beta p -value Stand. Beta p -value Stand. Beta p -value Stand. Beta p -value Stand. Beta p -value Stand. Beta p -value (Constant) Treatment Experience − .002 .964 − .002 .962 − .043 .384 − .079 .118 .017 .734 − .009 .863 − .014 .777 Pain disability (PDI) − .030 .634 − .029 .654 .137 .027 .132 .036 .165 .010 − .009 .890 .042 .510 Pain catastrophising (CSQ) .131 .044 .074 .259 .197 .002 .005 .941 − .083 .206 .073 .263 .015 .823 Somatic symptom impairment (PHQ-15) .073 .231 .059 .341 .101 .089 .064 .293 .088 .153 .060 .324 .188 .002 State depression (PHQ-2) − .040 .572 − .076 .288 − .025 .717 − .026 .706 − .071 .318 − .020 .780 − .117 .098 State anxiety (GAD-2) − .190 .005 − .073 .289 − .155 .019 .141 .036 .082 .229 − .192 .005 − .044 .521 Age (in years) .119 .029 .117 .034 .118 .025 − .025 .642 − .010 .849 .054 .324 .079 .146 Duration of symptoms (in months) − .119 .023 − .127 .07 − .094 .066 .024 .645 .053 .315 − .140 .008 .003 .956 Modell fit Adjusted R 2 SE of the Estimate F Change df1/ df2 Sig. Change in F .034 1.23 2.72 8 / 384 .006 .012 1.84 1.59 8 / 384 .126 .084 2.19 5.48 8 / 384 .001 .046 1.85 3.56 8 / 384 .001 .020 2.29 1.98 8 / 384 .048 .027 1.82 2.34 8 / 384 .019 .024 2.35 2.21 8 / 384 .026 Note. Significant p -values are in bold. CSQ = Sum score of the catastrophisation subscale of the Coping Strategies Questionnaire; GAD-2 = Sum score of the Generalized Anxiety Disorder Scale; PDI = Sum score of the Pain Disability Index; PHQ-2 = Sum score of the Patient Health Questionnaire for Depression; PHQ-15 = Sum score of the Patient Health Questionnaire; TEX-Q = Treatment Expectations Questionnaire. Table 5 Multiple linear regression analyses of the three GEEE expect items. GEEE expect _improvement GEEE expect _worsening GEEE expect _complaints Stand. Beta p -value Stand. Beta p -value Stand. Beta p -value (Constant) Treatment Experience .029 .577 .059 .251 − .102 .045 Pain disability (PDI) − .005 .936 .024 .705 .143 .025 Pain catastrophising (CSQ) .100 .127 .076 .250 − .057 .377 Somatic symptom impairment (PHQ-15) .102 .099 .029 .638 .088 .148 State depression (PHQ-2) − .061 .391 .007 .918 .039 .578 State anxiety (GAD-2) − .082 .233 .012 .867 .009 .898 Age (in years) .088 .109 − .007 .899 .050 .354 Duration of symptoms (in months) − .106 .045 .054 .313 .059 .260 Modell fit Adjusted R 2 SE of the Estimate F Change df1/ df2 Sig. Change in F . 0.13 2.03 1.63 8 / 384 .114 .001 1.67 1.06 8 / 384 .388 .034 2.29 2.73 8 / 384 .006 Note. Significant p -values are in bold. CSQ = Sum score of the catastrophisation subscale of the Coping Strategies Questionnaire; GAD-2 = Sum score of the Generalized Anxiety Disorder Scale; GEEE expect = Generic Rating Scale for Treatment Expectations; PDI = Sum score of the Pain Disability Index; PHQ-2 = Sum score of the Patient Health Questionnaire for Depression; PHQ-15 = Sum score of the Patient Health Questionnaire. Discussion Overall, our results emphasise the complexity of endometriosis and associated problems. The present study has two key findings: First, endometriosis-related pain disability and state anxiety are the strongest predictors of treatment expectations of women with endometriosis. Second, our study indicated that women with endometriosis are more physically and psychologically burdened than healthy subjects and are highly likely to develop major depression and general anxiety disorder. Discussing Research Results Partly consistent with our first hypothesis, prior treatment experiences signifcantly predicted less negative expectations regarding complaints due to treatment. However, contrary to our remaining hypotheses, there were no further associations between treatment experiences and treatment expectations. These results do not align with the existing literature ( 40 ). For example, Newton and Cunningham (2012) stated in their article that previous experiences in a specific and related setting impact patients’ expectations of the treatment process and outcome. However, there might be one primary reason our results did not completely support these findings. Our sample included only 78 patients with prior treatment experiences, and we did not differentiate with respect to the valence of previous treatment experiences. Partly consistent with our second hypothesis, higher endometriosis-related pain disability significantly predicted more negative treatment expectations regarding adverse events, negative impact due to treatment, and impairment due to treatment. Findings suggest that patients with higher pain levels are more prone to negative expectations regarding treatment. These results align with the existing literature ( 41 ). Ballou et al. (2018) suggested that baseline pain severity negatively impacts women with irritable bowel syndrome expectations. However, contrary to our second hypothesis, higher endometriosis-related pain disability also predicted more positive treatment expectations regarding positive impact due to treatment. This finding aligns with a study examining placebo effects in patients with neuropathic pain ( 17 ), where baseline pain level was the strongest predictor of a greater placebo response. Bivariate associations between endometriosis-related pain disability and different treatment expectations align with multiple linear regression analyses' results, showing ambiguous findings with small effect sizes. Those findings underline the complexity of the disease, especially with its subjective symptoms such as pain. Pain levels might predict positive treatment expectations in one woman and negative treatment expectations in another. We suggest future studies to validate our findings and better understand pain's impact on expectations in women with endometriosis. Partly consistent with our third hypothesis, higher state anxiety significantly predicted less positive treatment expectations regarding overall treatment expectations, positive impact due to treatment, and satisfaction with the treatment. Additionally, higher state anxiety predicted more negative treatment expectations regarding adverse events. Findings suggest that patients with higher state anxiety are less prone to develop positive treatment expectations and more prone to develop negative treatment expectations. These results align with the current literature ( 42 ). Corsi and Colloca (2017) stated that anxiety positively correlated with the nocebo response and, on the other hand, negatively with the placebo response. Bivariate associations between state anxiety and different treatment expectations align with our multiple linear regression analyses' results and the literature: Higher state anxiety was positively correlated with more negative treatment expectations and with less positive treatment expectations. Strengths and Limitations The following strengths of the present work should be highlighted: The present study followed a naturalistic and observational approach. The sample size of 392 patients was large. Furthermore, treatment expectations were examined multidimensionally via different subscales of the TEX-Q and GEEE expect . This approach allowed us to differentiate between positive and negative treatment expectations. Finally, the present study is the first to describe treatment expectations of women with diagnosed endometriosis and the factors that affect those expectations. Nevertheless, the following limitations should be considered: Firstly, we did not differentiate between the value of prior treatment experiences and could, therefore, not compare treatment expectations of patients who had negative treatment experiences with the ones who had positive treatment experiences. The small subsample size of 78 patients with prior treatment experiences did not allow for logical contributions into different groups that differentiated between the values of previous treatment experiences. We suggest that future research includes a higher sample size of patients with prior treatment experiences and differentiates between the value of those experiences. Secondly, there might be a sample bias in our study. Patients with negative preoperative experiences and expectations with and toward laparoscopy might not want an appointment for laparoscopy and, therefore, were not included in our sample. This sample bias might explain generally positive treatment expectations in our sample and should be considered when interpreting the results. Finally, present analyses are based on cross-sectional data and did not allow for examining causal relationships. Future Directions Our study results clarify treatment expectations of women with endometriosis and how they are impacted, especially of women at higher risk for developing negative treatment expectations. Understanding patients' treatment expectations and how they are affected seems promising in optimising the treatment of endometriosis. Therefore, a medical briefing about the effects of treatment expectations on treatment outcomes in clinical care with different standardised questions about patients' treatment expectations should be considered. Additionally, patients at higher risk for nocebo effects, for example, due to higher endometriosis-related pain disability or state anxiety, might significantly benefit from psychological interventions before laparoscopic surgery. For instance, in heart surgery, patients who received a brief psychological pre-surgery intervention to optimise outcome expectations (EXPECT) showed significant improvements in the treatment outcome ( 43 ). We suggest two key aspects to be considered in future research. Firstly, we propose further research identifying treatment expectations of women with endometriosis and how they are impacted. Treatment expectations are multidimensional and often not fully portrayed by a universal questionnaire. Understanding patients' treatment expectations is crucial for optimising the treatment of endometriosis and options for implementing psychological interventions. Secondly, to further investigate the influence of treatment expectations and other psychological factors on patients' short- and long-term symptom course after laparoscopy, especially for those who are highly physically and psychologically burdened. Our baseline results set the first step toward better understanding women with endometriosis and their treatment expectations. The running ROXWELL-study will consider these results. Furthermore, future study results will show whether women's preoperative and postoperative treatment expectations are met or if they change over time. Conclusion Study results emphasise the importance of understanding women with endometriosis and identifying their treatment expectations to optimise treatment outcomes. Our findings highlight that women with higher pain disability and anxiety are especially prone to negative treatment expectations. These women might benefit from an adapted medical briefing before laparoscopy, psychoeducation, and clinical support to prevent negative treatment outcomes. Declarations Declaration of Interest: The authors have declared that no competing interests exist. Ethical Approval: Ethical approval was obtained from the Psychotherapeutenkammer Hamburg, Germany (ROXWELL-2021-HH). The trial is preregistered at ClinicalTrials.gov (ID NCT05019612). Consent to participate: Informed consent and exemption from confidentiality were obtained from all participants. Consent for publication: Not applicable. Data Availability: The data supporting this study's findings are openly available in PsychArchives at https://doi.org/10.23668/psycharchives.14428. The medical characteristics of the included individuals have been removed to ensure confidentiality. Funding Statement: This work was funded by the internal research funding (IFF2020, 27/05/2020; grant to Prof. Dr. Yvonne Nestoriuc and Dr. Ann-Katrin Meyrose) of the Helmut-Schmidt-University/ University of the Federal Armed Forces Hamburg. Acknowledgements: We thank all patients who participated in this study for their time and involvement. We thank the staff of the Frauenklinik an der Elbe and all psychology students who worked on the ROXWELL study for their support in the recruitment process. Author Contribution: NJ, AKM, YN, NH, and OB contributed to the study's conception and design. NJ, NH, and OB collected data. NJ, AKM, and YN formulated the research questions and mainly interpreted the results. NJ analysed the data and wrote the manuscript. AKM, OB, and YN provided resources and supervision. All authors contributed to the manuscript revision and read and approved the submitted version. References Zondervan KT, Becker CM, Missmer SA, Endometriosis. New England Journal of Medicine [Internet]. 2020 Mar 26 [cited 2022 Jun 15];382(13):1244–56. https://doi.org/10.1056/NEJMra1810764 . La Rosa VL, Barra F, Chiofalo B, Platania A, Di Guardo F, Conway F et al. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. Journal of Psychosomatic Obstetrics & Gynecology [Internet]. 2020 Apr 2 [cited 2021 Nov 5];41(2):93–7. https://www.tandfonline.com/doi/full/ 10.1080/0167482X.2019.1659775 . Giannella L, Marconi C, Di Giuseppe J, Delli Carpini G, Fichera M, Grelloni C, et al. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers (Basel). 2021;13(16):4026. Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco Nardone F, de Cicco Nardone C et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertility and Sterility [Internet]. 2011 Aug 1 [cited 2021 Nov 5];96(2):366–373.e8. https://www.sciencedirect.com/science/article/pii/S0015028211008764 . Mechsner S. Endometriosis, an Ongoing Pain—Step-by-Step Treatment. Journal of Clinical Medicine [Internet]. 2022 Jan [cited 2022 Jun 15];11(2):467. https://www.mdpi.com/2077-0383/11/2/467 . Thiel P, Burke M, Bridge-Cook P, Leonardi M. The placebo and nocebo effects in the treatment of endometriosis: a commentary [Internet]. Preprints; 2021 Feb [cited 2022 Jan 12]. https://www.authorea.com/users/396926/articles/510001-the-placebo-and-nocebo-effects-in-the-treatment-of-endometriosis-a-commentary?commit=aa96cc3bc50cf512eff7e7997d0c00a8eca20418 . Gallagher JS, DiVasta AD, Vitonis AF, Sarda V, Laufer MR, Missmer SA. The impact of endometriosis on quality of life in adolescents. Journal of Adolescent Health [Internet]. 2018 Dec [cited 2021 Nov 5];63(6):766–72. https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2018-60660-009⟨=de&site=ehost-live&scope=site Carey ET, Martin CE, Siedhoff MT, Bair ED, As-Sanie S. Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis. International Journal of Gynecology & Obstetrics [Internet]. 2014 Feb 1 [cited 2022 Jun 15];124(2):169–73. https://www.sciencedirect.com/science/article/pii/S0020729213005766 . Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JAC, Broadbent E et al. Patients’ Expectations Predict Surgery Outcomes: A Meta-Analysis. IntJ Behav Med [Internet]. 2016 Feb 1 [cited 2022 Jun 6];23(1):49–62. https://doi.org/10.1007/s12529-015-9500-4 . Kube T, Glombiewski JA, Rief W. Using Different Expectation Mechanisms to Optimize Treatment of Patients With Medical Conditions: A Systematic Review. Psychosomatic Medicine [Internet]. 2018 Aug [cited 2022 Jan 11];80(6):535–43. https://journals.lww.com/psychosomaticmedicine/Abstract/2018/07000/Using_Different_Expectation_Mechanisms_to_Optimize.6.aspx . Pan Y, Meister R, Löwe B, Kaptchuk TJ, Buhling KJ, Nestoriuc Y. Open-label placebos for menopausal hot flushes: a randomized controlled trial. Sci Rep [Internet]. 2020 Nov 18 [cited 2022 Jul 15];10(1):20090. https://www.nature.com/articles/s41598-020-77255-z . Shedden-Mora MC, Pan Y, Heisig SR, von Blanckenburg P, Rief W, Witzel I et al. Optimizing Expectations About Endocrine Treatment for Breast Cancer: Results of the Randomized Controlled PSY-BREAST Trial. Clinical Psychology in Europe [Internet]. 2020 Mar 31 [cited 2022 Jun 21];2(1):1–20. https://cpe.psychopen.eu/index.php/cpe/article/view/2695 . Rief W, Sperl MFJ, Braun-Koch K, Khosrowtaj Z, Kirchner L, Schäfer L et al. Using expectation violation models to improve the outcome of psychological treatments. Clinical Psychology Review [Internet]. 2022 Dec 1 [cited 2024 Feb 28];98:102212. https://www.sciencedirect.com/science/article/pii/S0272735822000976 . Colloca L. The Placebo Effect in Pain Therapies. Annu Rev Pharmacol Toxicol [Internet]. 2019 Jan 6 [cited 2022 Jun 27];59:191–211. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402571/ . Kirsch I. Placebo Effect in the Treatment of Depression and Anxiety. Frontiers in Psychiatry [Internet]. 2019 [cited 2022 Jun 27];10. https://www.frontiersin.org/article/ 10.3389/fpsyt.2019.00407 . Petrie KJ, Rief W. Psychobiological Mechanisms of Placebo and Nocebo Effects: Pathways to Improve Treatments and Reduce Side Effects. Annual Review of Psychology [Internet]. 2019 [cited 2022 Jan 12];70(1):599–625. https://doi.org/10.1146/annurev-psych-010418-102907 . Irizarry MC, Webb DJ, Ali Z, Chizh BA, Gold M, Kinrade FJ et al. Predictors of Placebo Response in Pooled Lamotrigine Neuropathic Pain Clinical Trials. The Clinical Journal of Pain [Internet]. 2009 Aug [cited 2023 Jun 7];25(6):469. https://journals.lww.com/clinicalpain/FullText/2009/07000/Predictors_of_Placebo_Response_in_Pooled.3.aspx?casa_token=uIkOHDPjsykAAAAA:EHROZv6x22Qh8s_z8UWYMOnhRXAiJk6u732dI1xYJWg_PVOg32pqsEuqqZAje_pQ13eisJ62oMPdyMkmLAa0mz3zMfM . Kube T, Glombiewski JA. How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment. Cogn Ther Res [Internet]. 2021 Jun 1 [cited 2022 Feb 16];45(3):517–28. https://doi.org/10.1007/s10608-020-10191-4 . Polich G, Iaccarino MA, Kaptchuk TJ, Morales-Quezada L, Zafonte R. Placebo Effects in Traumatic Brain Injury. Journal of Neurotrauma [Internet]. 2018 Jun [cited 2022 Jun 27];35(11):1205–12. https://www.liebertpub.com/doi/abs/ 10.1089/neu.2017.5506 . Chiantera V, Abesadze E, Mechsner S. How to Understand the Complexity of Endometriosis-Related Pain [Internet]. 2017 [cited 2023 Jun 7]. https://journals.sagepub.com/doi/full/10.5301/je.5000271 . Facchin F, Barbara G, Saita E, Mosconi P, Roberto A, Fedele L et al. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. Journal of Psychosomatic Obstetrics & Gynecology [Internet]. 2015 Oct 2 [cited 2023 Jun 7];36(4):135–41. https://doi.org/10.3109/0167482X.2015.1074173 . Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P et al. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis. Geburtshilfe Frauenheilkd [Internet]. 2014 Dec [cited 2022 Jun 21];74(12):1104–18. http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1383187 . Albert U, Carmassi C, Cosci F, De Cori D, Di Nicola M, Ferrari S, et al. Role and clinical implications of atypical antipsychotics in anxiety disorders, obsessive-compulsive disorder, trauma-related, and somatic symptom disorders: A systematized review. Int Clin Psychopharmacol. 2016;31(5):249–58. Shedden-Mora MC, Alberts J, Petrie KJ, Laferton JAC, von Blanckenburg P, Kohlmann S et al. The Treatment Expectation Questionnaire (TEX-Q): Validation of a generic multidimensional scale measuring patients’ treatment expectations. PLOS ONE [Internet]. 2023 Jan 23 [cited 2023 Aug 10];18(1):e0280472. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0280472 . Rief W, Nestoriuc Y, Mueller EM, Hermann C, Schmidt K, Bingel U. Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE). 2021 Mar 23 [cited 2022 Feb 23]; https://www.psycharchives.org/en/item/a0bc93a2-9e03-4bba-97b0-8f478b2a39ca . Dillmann U, Nilges P, Saile H, Gerbershagen HU. PDI - Pain Disability Index - deutsche Fassung. 2011 [cited 2022 Jun 14]; https://www.psycharchives.org/handle/20.500.12034/337.2 . Tait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain [Internet]. 1990 Feb 1 [cited 2022 Jun 14];40(2):171–82. https://www.sciencedirect.com/science/article/pii/030439599090068O . Verra ML, Angst F, Lehmann S, Aeschlimann A, Translation. Cross-Cultural Adaptation, Reliability, and Validity of the German Version of the Coping Strategies Questionnaire (CSQ-D). The Journal of Pain [Internet]. 2006 May 1 [cited 2023 Jun 7];7(5):327–36. https://www.sciencedirect.com/science/article/pii/S1526590005010357 . Gierk B, Kohlmann S, Toussaint A, Wahl I, Brünahl CA, Murray AM et al. Assessing somatic symptom burden: A psychometric comparison of the Patient Health Questionnaire—15 (PHQ-15) and the Somatic Symptom Scale—8 (SSS-8). Journal of Psychosomatic Research [Internet]. 2015 Apr 1 [cited 2023 Feb 16];78(4):352–5. https://www.sciencedirect.com/science/article/pii/S0022399914003869 . Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research [Internet]. 2005 Feb 1 [cited 2023 Jun 7];58(2):163–71. https://www.sciencedirect.com/science/article/pii/S0022399904006361 . Staples LG, Dear BF, Gandy M, Fogliati V, Fogliati R, Karin E et al. Psychometric properties and clinical utility of brief measures of depression, anxiety, and general distress: The PHQ-2, GAD-2, and K-6. General Hospital Psychiatry [Internet]. 2019 Jan 1 [cited 2023 Jun 7];56:13–8. https://www.sciencedirect.com/science/article/pii/S0163834318303712 . Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care [Internet]. 2003 [cited 2024 Jan 24];41(11):1284–92. https://www.jstor.org/stable/3768417 . Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection. Ann Intern Med [Internet]. 2007 Mar 6 [cited 2024 Jan 24];146(5):317–25. https://www.acpjournals.org/doi/abs/ 10.7326/0003-4819-146-5-200703060-00004 . Canis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS et al. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility [Internet]. 1997 May [cited 2022 Jul 22];67(5):817–21. http://www.scopus.com/inward/record.url?scp=0030999032&partnerID=8YFLogxK Haas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstetricia et Gynecologica Scandinavica [Internet]. 2013 [cited 2022 Jun 30];92(1):3–7. https://onlinelibrary.wiley.com/doi/abs/ 10.1111/aogs.12026 . Cohen J. The effect size. Statistical Power Analysis for the Behavioral Sciences [Internet]. 1988 [cited 2022 Jun 19];77–83. https://cir.nii.ac.jp/crid/1572261550809239040 . Mewes R, Rief W, Stenzel N, Glaesmer H, Martin A, Brähler E. What is normal disability? An investigation of disability in the general population. Pain [Internet]. 2009 Mar 1 [cited 2022 Jul 23];142(1):36–41. https://www.sciencedirect.com/science/article/pii/S0304395908007045 . Hinz A, Ernst J, Glaesmer H, Brähler E, Rauscher FG, Petrowski K, et al. Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15). J Psychosom Res. 2017;96:27–31. Laganà AS, La Rosa VL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B et al. Anxiety and depression in patients with endometriosis: impact and management challenges. International Journal of Women’s Health [Internet]. 2017 Dec 31 [cited 2023 Aug 15];9:323–30. https://www.tandfonline.com/doi/abs/ 10.2147/IJWH.S119729 . Newton JT, Cunningham SJ. Great expectations: What do Patients Expect and how can Expectations be Managed? J Orthod [Internet]. 2013 Jun 1 [cited 2022 Jan 11];40(2):112–7. https://journals.sagepub.com/doi/abs/10.1179/1465313312Y.0000000038 . Ballou S, Beath A, Kaptchuk TJ, Hirsch W, Sommers T, Nee J et al. Factors Associated With Response to Placebo in Patients With Irritable Bowel Syndrome and Constipation. Clinical Gastroenterology and Hepatology [Internet]. 2018 Nov 1 [cited 2022 Jun 25];16(11):1738–1744.e1. https://www.sciencedirect.com/science/article/pii/S1542356518303458 . Corsi N, Colloca L, Placebo, Effects N. The Advantage of Measuring Expectations and Psychological Factors. Frontiers in Psychology [Internet]. 2017 [cited 2023 Aug 16];8. https://www.frontiersin.org/articles/ 10.3389/fpsyg.2017.00308 . Rief W, Shedden-Mora MC, Laferton JAC, Auer C, Petrie KJ, Salzmann S et al. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Medicine [Internet]. 2017 Jan 10 [cited 2023 Nov 7];15(1):4. https://doi.org/10.1186/s12916-016-0767-3 . Tables Table 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table3.docx SupplementaryTable1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 14 Jul, 2025 Reviews received at journal 05 Apr, 2025 Reviewers agreed at journal 30 Mar, 2025 Reviews received at journal 06 Aug, 2024 Reviewers agreed at journal 31 Jul, 2024 Reviewers invited by journal 23 Apr, 2024 Submission checks completed at journal 23 Apr, 2024 Editor assigned by journal 23 Apr, 2024 First submitted to journal 22 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4303538","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295659374,"identity":"f03faf6f-a041-4ce2-9fa7-0a112086cc6c","order_by":0,"name":"Navin 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Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis is a chronic disease defined as endometrium-like tissues outside the uterus (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). It affects 6\u0026ndash;10% of pre-menopausal women (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) and 2\u0026ndash;4% of post-menopausal women (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e). The average time between the first complaints and surgical diagnosis is 6.7 years (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e), both adversely affecting women\u0026apos;s quality of life (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e). Women with endometriosis show significantly lower physical health and higher levels of depression and anxiety than unaffected women (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). Nevertheless, endometriosis is still widely unrecognised and not treated satisfactorily (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). About 20\u0026ndash;30% of treated women still report endometriosis-related complaints and disability after successful laparoscopic surgery (i.e., removing all affected tissue) (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). These symptoms cannot be explained by laparoscopy or endometriosis recurrence (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). Therefore, psychological factors, such as expectations, may affect responses to treatment in women with endometriosis.\u003c/p\u003e\n\u003cp\u003eTreatment expectations predict various medical conditions and treatment outcomes (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). In the field of gynaecology, this applies to complex diseases such as menopausal hot flushes (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e) and breast cancer (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e). Focusing on psychological factors can lead to more effective treatment outcomes and, in turn, improved quality of life (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e). However, treatment expectations can be influenced by different factors.\u003c/p\u003e\n\u003cp\u003eTreatment expectations can be influenced by treatment information (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e), prior treatment experiences (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e), pain levels (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e), depression, and anxiety (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). Since endometriosis is related to high pain levels (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e), pain catastrophising (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e), somatic symptom impairment, and higher levels of depression and anxiety (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e), these factors might also predict negative treatment expectations of women with endometriosis. Furthermore, a longer duration of experiencing endometriosis-related symptoms might result in pain chronification and, in turn, be associated with negative expectations toward treatment. In contrast, the latest medical endometriosis staging system (revised American Society for Reproductive Medicine Score; rASRM) is unrelated to subjective symptom severity (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e) and, therefore, should also be unrelated to patients\u0026apos; treatment expectations. To summarise, exploring individual factors may help to understand the treatment expectations of women with endometriosis and affect the efficacy of future treatments.\u003c/p\u003e\n\u003cp\u003eTo our knowledge, this is the first study to examine treatment expectations and related individual factors in women with diagnosed endometriosis. Firstly, this study aims to better understand and characterise women with endometriosis; secondly, to describe treatment expectations; and thirdly, to identify predictors of treatment expectations. We hypothesise that:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e1. Prior treatment experiences with endometriosis laparoscopy are associated with treatment expectations.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e2. Higher endometriosis-related pain disability is associated with more negative treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e3. Higher pain catastrophisation is associated with more negative treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e4. Higher somatic symptom impairment is associated with more negative treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e5. Higher state depression is associated with more negative treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e6. Higher state anxiety is associated with more negative treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e7. Higher age and symptom duration are associated with more negative treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e8. The endometriosis stage is not associated with treatment expectations.\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e"},{"header":"Methods and Analyses","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eData were derived from the preoperative baseline assessment (T\u003csub\u003e0\u003c/sub\u003e) and an additional surgery case report from the ROXWELL study. The ROXWELL study is a mixed-method clinical observational study involving patients with indications for laparoscopy. For further details regarding the study, see the study protocol Hirsing et al. (2023) or the preregistration at ClinicalTrials.gov (ID NCT05019612), registration date August 25th .\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe target sample consisted of women with a clinical indication for laparoscopy according to endometriosis-related symptoms with or without an unmet wish to have children. A total of \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;393 eligible women were included in the final sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eRecruitment\u003c/h2\u003e \u003cp\u003eWomen were recruited in a specialised centre of surgical endoscopy and endometriosis in Hamburg, Germany. All women with an appointment for endometriosis laparoscopy and sufficient German language skills were informed about the study by the receptionists of the outpatient clinic or by study psychologists. Interested women received the baseline assessment link (T\u003csub\u003e0\u003c/sub\u003e) via e-mail. Patients filled in the survey between the 25th of August 2021 and the 27th of June 2023.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eIn- and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eParticipants had to fulfil the following inclusion criteria for study participation: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) being at least 18 years old, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) endometriosis-related symptoms with or without an unmet wish to have children, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) good speaking and comprehension of the German language, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) female biological sex, (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) given informed consent for study participation, (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) an indication for laparoscopy, and (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) visually diagnosed endometriosis by surgeons. Exclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) incomplete excision of endometrial tissue and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) maligne result when endometrial tissue was examined. The exclusion criteria were evaluated post-hoc.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eAfter patients provided contact data and written informed consent were obtained online, the baseline assessment (T\u003csub\u003e0\u003c/sub\u003e) was conducted online several weeks or days before laparoscopy. The baseline assessment (T\u003csub\u003e0\u003c/sub\u003e) included questions about current endometriosis-related symptoms, -disability, prior treatment experiences, and treatment expectations. It lasted approximately 15\u0026ndash;20 minutes. After laparoscopy, surgeons documented endometriosis-related medical characteristics and relevant information about surgery within a self-conducted case report form (CRF) and exclusion criteria were checked by the study team.\u003c/p\u003e \u003cp\u003eThe \u003cem\u003ePsychotherapeutenkammer\u003c/em\u003e Hamburg, Germany, ethics committee gave ethical approval (ROXWELL-2021-HH) for the study. The study is preregistered at ClinicalTrials.gov (ID NCT05019612). Informed consent and exemption from confidentiality were obtained from all participants.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section4\"\u003e \u003ch2\u003ePrimary Outcome Measure\u003c/h2\u003e \u003cp\u003e \u003cem\u003eTreatment expectations\u003c/em\u003e about laparoscopy were assessed by the Treatment Expectation Questionnaire, TEX-Q (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and the Generic Rating Scale for Treatment Expectations, GEEE\u003csub\u003eexpect\u003c/sub\u003e (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The TEX-Q assesses patients' self-reported treatment expectations towards laparoscopy and consists of 15 items on an 11-point Likert scale (\u003cem\u003e0 to 10\u003c/em\u003e) covering six dimensions (treatment benefit, positive impact, adverse events, negative impact, process, and behavioural control). Mean scores were computed for all dimensions and the total score, ranging from 0 to 10. Higher scores indicate more positive treatment expectations on the subscales of treatment benefit, positive impact, process, and behavioural control. Higher scores indicate more negative expectations on the subscales of adverse events and negative impact. These two subscales were inverted for the total score, meaning a higher total score indicates more positive expectations. Cronbach's α was .71 to .92 for the total score (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In our study, Cronbach's α was .81. The GEEE\u003csub\u003eexpect\u003c/sub\u003e assesses treatment expectations towards laparoscopy and expected complaints. It contains three items, i.e. expected improvement, expected worsening and expected complaints, on an 11-point Likert scale (\u003cem\u003e0\u0026thinsp;=\u0026thinsp;no improvement/worsening to 10\u0026thinsp;=\u0026thinsp;greatest improvement/worsening imaginable; 0\u0026thinsp;=\u0026thinsp;no complaints to 10\u0026thinsp;=\u0026thinsp;greatest complaints imaginable\u003c/em\u003e). Higher scores for the first item indicate more positive treatment expectations. Higher scores for the second and third items indicate more negative treatment expectations.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePredictors\u003c/h2\u003e \u003cp\u003e \u003cem\u003ePrior experiences\u003c/em\u003e with endometriosis laparoscopy were assessed using the Generic Rating Scale for Previous Treatment Experiences, GEEE\u003csub\u003epre\u003c/sub\u003e (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). We used the first item of the GEEE\u003csub\u003epre\u003c/sub\u003e to differentiate between the following two categories: \u003cem\u003eno prior experiences with endometriosis laparoscopy vs. prior experiences with endometriosis laparoscopy.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eEndometriosis-related pain disability\u003c/em\u003e was assessed by the German version of the Pain Disability Index, PDI (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The PDI assesses the self-reported pain disability and was adapted to endometriosis-related symptoms for this study. It contains seven items on an 11-point Likert scale \u003cem\u003e(0\u0026thinsp;=\u0026thinsp;no disability to 10\u0026thinsp;=\u0026thinsp;total disability).\u003c/em\u003e The total score ranges from 0 to 70. Higher sum scores indicate a higher disability due to pain. Good reliability has been proven, ranging from Cronbach's α\u0026thinsp;=\u0026thinsp;.83 to .90 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In our study, Cronbach's α was .84.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePain catastrophisation\u003c/em\u003e was assessed by the subscale \u003cem\u003ecatastrophisation\u003c/em\u003e of the Coping Strategies Questionnaire, CSQ\u003csub\u003epaincat\u003c/sub\u003e (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). CSQ\u003csub\u003epaincat\u003c/sub\u003e comprises six items with seven response options (\u003cem\u003e0\u0026thinsp;=\u0026thinsp;never do that to 6\u0026thinsp;=\u0026thinsp;always do that\u003c/em\u003e). The total sum score ranges from 0 to 36. Higher sum scores indicate a higher level of pain catastrophisation. Cronbach\u0026rsquo;s α was .97 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In our study, Cronbach's α was .87.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSomatic symptom impairment\u003c/em\u003e was assessed by the Patient Health Questionnaire, PHQ-15 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The PHQ-15 consists of 15 physical symptoms with three response options \u003cem\u003e(0\u0026thinsp;=\u0026thinsp;not at all to 2\u0026thinsp;=\u0026thinsp;bothered a lot).\u003c/em\u003e The total sum score ranges from 0 to 30. Higher sum scores indicate a higher level of impairment. Cronbach's α was .80 for the total score (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In our study, Cronbach's α was .78.\u003c/p\u003e \u003cp\u003e \u003cem\u003eState depression\u003c/em\u003e was assessed by two items of the Patient Health Questionnaire for Depression (PHQ-2) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) on a four-point Likert scale \u003cem\u003e(0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the days, 3\u0026thinsp;=\u0026thinsp;nearly every day)\u003c/em\u003e. The total score ranged from 0 to 6. Higher sum scores indicate a higher level of state depression. Cronbach's α was .79 for the total score (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In our study, Cronbach's α was .78. A cut-off score of 3 or greater indicates a good sensitivity and specificity to detect a major depressive disorder (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eState anxiety\u003c/em\u003e was assessed by two items of the Generalized Anxiety Disorder Scale (GAD-2) on a four-point Likert scale \u003cem\u003e(0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the days, 3\u0026thinsp;=\u0026thinsp;nearly every day)\u003c/em\u003e. The total score ranged from 0 to 6. Higher sum scores indicate a higher level of state anxiety. Cronbach's α was .81 for the total score (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In our study, Cronbach's α was .78. A cut-off score of 3 or greater indicates a good sensitivity and specificity to detect a generalized anxiety disorder (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe endometriosis stage\u003c/em\u003e was assessed by the revised American Society for Reproductive Medicine Score (rASRM) (Canis et al., 1997). The rASRM is a scoring system for endometriosis lesions using points corresponding to the size of the lesions in different areas (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The resulting points are classified into four grades of severity (\u003cem\u003e1 to 5 points\u0026thinsp;=\u0026thinsp;stage I \"minimal\", 6 to 15 points\u0026thinsp;=\u0026thinsp;stage II \"mild\", 16 to 40 points\u0026thinsp;=\u0026thinsp;stage III \"moderate\", \u0026gt; 40 points\u0026thinsp;=\u0026thinsp;stage IV \"severe\"\u003c/em\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eWe described our sample by analysing frequencies, means, standard deviations and ranges of relevant sociodemographic, medical, and psychological variables. We used frequencies, means, standard deviations, ranges, kurtosis, skewness, and quartiles for both measuring instruments (TEX-Q and GEEE\u003csub\u003eexpect\u003c/sub\u003e) to describe expectations toward laparoscopy. To investigate bivariate associations, we calculated Pearson's correlation coefficients. We followed Cohen ((\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)) to evaluate the strength of bivariate associations: a correlation of \u003cem\u003er\u0026thinsp;\u0026ge;\u003c/em\u003e\u0026thinsp;.10 indicates a small, \u003cem\u003er\u0026thinsp;\u0026ge;\u003c/em\u003e\u0026thinsp;.30 a moderate, and \u003cem\u003er\u0026thinsp;\u0026ge;\u003c/em\u003e\u0026thinsp;.50 a strong relationship.\u003c/p\u003e \u003cp\u003eMultiple linear regression analyses were used to examine the relationship between treatment expectations and predictors. Multiple linear regression models were tested for each of the ten dependent variables by entering all independent variables simultaneously. Improvement in model fit due to adding all predictor variables was assessed based on the adjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e value, \u003cem\u003eF\u003c/em\u003e-statistic, and the degrees of freedom in parentheses. To evaluate the variables of interest, regression coefficients (\u003cem\u003e\u0026szlig;\u003c/em\u003e) with corresponding 95% confidence intervals (\u003cem\u003eCI\u003c/em\u003e), standard errors (\u003cem\u003eSE\u003c/em\u003e), and \u003cem\u003ep\u003c/em\u003e-values were calculated. All analyses were conducted using IBM SPSS Statistics Version 27. The significance level was determined as \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05 for all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Characteristics\u003c/h2\u003e\n \u003cp\u003eOf 1448 scheduled laparoscopies (since August 2021), 875 women were interested in the study, of which 699 completed the baseline survey (T\u003csub\u003e0\u003c/sub\u003e). Due to some women not having an endometriosis diagnosis, the decision against laparoscopic surgery and other dropout reasons, the final sample consisted of 393 participants (see Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eCharacteristics of the investigated sample and the distributions of the six predictors are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants were 18 to 51 years old (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;29.74, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.52). About one-sixth had a migrant background, i.e. women whose one or both parents were not born in Germany. Almost every tenth woman was incapable of working. In the present study, patients showed four times higher pain disability scores (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30.77, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13.28 vs. \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.9, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11.1, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1,368 (\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e)) and three times higher somatic impairment scores (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15.61, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.07 vs. \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.31, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.06, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4,815 (\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e)) than the general population. Pain catastrophising scores were \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18.33 on average (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.81). Furthermore, participants showed higher state depression (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.52, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.40) and state anxiety scores (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.36, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.64) than healthy subjects (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e). Almost half of the women showed signs of major depression (40.2%) and/or an anxiety disorder (39.9%). Overall, more than every fourth woman simultaneously showed signs of major depression and a general anxiety disorder (27.0%). The duration of symptoms ranged from 0 to 486 months (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;84.85, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;83.97), respectively \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.1 (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.0) years. Every fifth woman stated prior experiences with laparoscopy (19.8%). Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents more information on the characteristics of the sample under analysis and descriptive statistics.\u003c/p\u003e\n \u003cp\u003eTreatment expectations concerning the laparoscopy of participants were, in general, rather positive. However, TEX-Q mean scores were lower than in the validation sample (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.70, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.24 vs. \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.34, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.20, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;251 (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e)) and distributed slightly left-skewed (skewness: -0.23). The positive dimension of the GEEE (i.e. expected improvement) was rated with higher values (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.08, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.04) and distributed left-skewed (skewness: -0.88). Negative dimensions of the GEEE (i.e. expected worsening and expected complaints) were rated with lower values (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.12 and 3.83, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.68 and 2.33) and distributed right-skewed (skewness: 1.84 and 0.31). Distributions of all measurement instruments and items assessing treatment expectations are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eSample characteristics at baseline (T\u003c/em\u003e\u003csub\u003e\u003cem\u003e0\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eWomen with endometriosis (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;392)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObserved range\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePotential range\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender (female vs. non-binary)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMigrant background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain disability (PDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain catastrophisation (CSQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomatic symptom impairment (PHQ-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState depression (PHQ-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh likelihood of major depression (PHQ-2\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState anxiety (GAD-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh likelihood of general anxiety disorder (GAD-2\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u0026ndash;6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh likelihood of major depresson and general anxiety disorder (PHQ-2\u0026thinsp;+\u0026thinsp;GAD-2\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrior experiences with laparoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of symptoms (in months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0-486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeep infiltrating endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003erASRM (stage of endometriosis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eminimal\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emild\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003emoderate\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003esevere\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecommendation of further hormone therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote.\u003c/em\u003e CSQ\u0026thinsp;=\u0026thinsp;catastrophisation subscale of the Coping Strategies Questionnaire; GAD-2\u0026thinsp;=\u0026thinsp;Generalized Anxiety Disorder Scale; PDI\u0026thinsp;=\u0026thinsp;Pain Disability Index; PHQ-2\u0026thinsp;=\u0026thinsp;Patient Health Questionnaire for Depression; PHQ-15\u0026thinsp;=\u0026thinsp;Patient Health Questionnaire; rASRM\u0026thinsp;=\u0026thinsp;revised American Society for Reproductive Medicine Score.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eTreatment expectation scales.\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSubscale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eObserved range\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSkewness (\u003cem\u003eSE\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eKurtosis (\u003cem\u003eSE\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePercentiles\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTEX-Q total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.226 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.226 (.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eTreatment benefit\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.745 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePositive impact\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.725 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAdverse events\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.349 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eNegative impact\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.849 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eProcess\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.359 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBehavioural control\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.277 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGEEE\u003c/em\u003e\u003csub\u003e\u003cem\u003eexpect\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e_improvement\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.879 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.843 (.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGEEE\u003c/em\u003e\u003csub\u003e\u003cem\u003eexpect\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e_worsening\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.838 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.385 (.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGEEE\u003c/em\u003e\u003csub\u003e\u003cem\u003eexpect\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e_complaints\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.312 (.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.516 (.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u003cem\u003eNote.\u003c/em\u003e The mean TEX-Q total score was computed after inverting TEX-Q_7 to TEX-Q_11. Higher scores indicate more positive treatment expectations. GEEE\u003csub\u003eexpect\u003c/sub\u003e = Generic Rating Scale for Treatment Expectations; TEX-Q\u0026thinsp;=\u0026thinsp;Treatment Expectation Questionnaire.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eBivariate Associations\u003c/h2\u003e\n \u003cp\u003eA correlation matrix of bivariate associations between the outcome measures and predictors is presented in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. All bivariate associations between individual items measuring treatment expectations are presented in Supplementary Table\u0026nbsp;1.\u003c/p\u003e\n \u003cp\u003eWomen with higher scores of anxiety reported significantly lower overall treatment expectations measured by the TEX-Q total score, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.149, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003. Treatment expectations regarding treatment benefit were not significantly associated with any predictors. Women with higher scores of pain disability, pain catastrophising, and somatic symptom impairment reported significantly higher positive impact expectations, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.230, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.204, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, and \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.175, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005. Women with higher scores of pain disability, pain catastrophizing, somatic symptom impairment, depression, and anxiety reported significantly higher treatment expectations regarding adverse events (i.e. negative expectations regarding treatment), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.190, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.00), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.152, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.165, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.148, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, and \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.184, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005. Women with higher scores of pain disability and somatic symptom impairment reported significantly higher treatment expectations regarding negative impact (i.e. negative expectations regarding treatment), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.161, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005 and \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.134, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008. Women with higher scores of anxiety and a longer duration of symptoms reported significantly lower treatment process expectations (i.e. a less straightforward process), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.152, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005 and \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.107, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.034. Women with higher scores of somatic symptom impairment reported significantly higher treatment expectations regarding behavioural control (i.e. being able to influence treatment success), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.141, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005.\u003c/p\u003e\n \u003cp\u003eTreatment improvement expectations measured with the G-EEE were not significantly associated with any predictors. Women with higher scores of pain catastrophizing reported significantly higher treatment worsening expectations (i.e. negative expectations regarding treatment), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.116, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.021. Women with higher scores of pain disability, somatic symptom impairment, and depression reported significantly higher treatment complaint expectations (i.e. negative expectations regarding treatment), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.171, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.144, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.005, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.107, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.035. All significant bivariate associations were small.\u003c/p\u003e\n \u003cp\u003ePrior experiences with laparoscopy were not significantly associated with any of the outcome variables. Regarding medical information, neither the rASRM-score nor having deeply infiltrated endometriosis were significantly associated with any of the outcome variables.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003ePrediction of treatment expectations\u003c/h2\u003e\n \u003cp\u003eSeven of the ten multiple linear regression analyses found a significant regression equation. There was a significant model fit for total treatment expectations (TEX-Q_total: F(8,384)\u0026thinsp;=\u0026thinsp;2.72, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.034), positive impact (TEX-Q_positiveimpact: F(8,384)\u0026thinsp;=\u0026thinsp;5.48, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.084), adverse events (TEX-Q_adverseevents: F(8,384)\u0026thinsp;=\u0026thinsp;3.56, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.046), negative impact (TEX-Q_negativeimpact: F(8,384)\u0026thinsp;=\u0026thinsp;1.96, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.048, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.020), process (TEX-Q_process: F(8,384)\u0026thinsp;=\u0026thinsp;2.34, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.019, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.027), behavioural control (TEX-Q_behaviouralcontrol: F(8,384)\u0026thinsp;=\u0026thinsp;2.21, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.026, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.024), and impairment (F(8,384)\u0026thinsp;=\u0026thinsp;2.73, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.034). The expected treatment benefit (TEX-Q_treatmentbenefit), improvement (GEEE\u003csub\u003eexpect\u003c/sub\u003e_improvement), and worsening (GEEE\u003csub\u003eexpect\u003c/sub\u003e_worsening) had no significant model fit.\u003c/p\u003e\n \u003cp\u003eWomen with prior experiences expected significantly fewer complaints due to treatment (GEEE\u003csub\u003eexpect\u003c/sub\u003e_complaints: B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.102, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.045) than women without prior experiences with endometriosis laparoscopy. Women with a higher disability due to pain had significantly higher treatment expectations regarding positive impact (B\u0026thinsp;=\u0026thinsp;1.37, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.027), expected significantly more adverse events due to treatment (B\u0026thinsp;=\u0026thinsp;.132, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.036), had significantly higher treatment expectations regarding negative impact (B\u0026thinsp;=\u0026thinsp;.165, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.010), and expected more complaints due to the treatment (GEEE\u003csub\u003eexpect\u003c/sub\u003e_complaints: B\u0026thinsp;=\u0026thinsp;.143, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.025). Patients with a higher level of pain catastrophising had significantly higher total treatment expectations (B\u0026thinsp;=\u0026thinsp;.131, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.044) and expected higher positive impact due to the treatment (B\u0026thinsp;=\u0026thinsp;.197, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002). Participants with a higher level of physical impairment expected significantly higher behavioural control (B\u0026thinsp;=\u0026thinsp;.188, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002). Women with a higher level of state depression did not significantly differentiate in terms of their treatment expectations from those who had lower levels of state depression. Women with a higher level of state anxiety had significantly lower total treatment expectations (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.190, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005), lower expectations regarding positive impact due to the treatment (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.155, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.019), and lower expectations regarding the treatment process (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.192, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005). Women with a higher level of state anxiety expected significantly more adverse events due to treatment (B\u0026thinsp;=\u0026thinsp;.141, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.036). Patients of older age reported significantly higher total treatment expectations (B\u0026thinsp;=\u0026thinsp;.119, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.029) and expected significantly higher positive impact due to the treatment (B\u0026thinsp;=\u0026thinsp;.118, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.025). Participants with a longer duration of endometriosis-related symptoms had significantly lower total treatment expectations (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.119, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.023), and had significantly lower expectations regarding the treatment process (B\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.140, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008). All significant and non-significant regression equations and model coefficients can be found in Tables \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eMultiple linear regression analyses of the total TEX-Q score and subscales.\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q total score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q treatment benefit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q Positive impact\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q Adverse events\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q Negative impact\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q Process\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTEX-Q Behavioural control\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.962\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.777\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain disability (PDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.634\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain catastrophising (CSQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.044\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomatic symptom impairment (PHQ-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState depression (PHQ-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState anxiety (GAD-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.036\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of symptoms (in months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.07\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eModell fit\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSE of the Estimate\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e Change\u003c/p\u003e\n \u003cp\u003edf1/ df2\u003c/p\u003e\n \u003cp\u003eSig. Change in \u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003cp\u003e2.72\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.084\u003c/p\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003cp\u003e5.48\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.020\u003c/p\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003cp\u003e2.34\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003cp\u003e2.35\u003c/p\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e Significant \u003cem\u003ep\u003c/em\u003e-values are in bold. CSQ\u0026thinsp;=\u0026thinsp;Sum score of the catastrophisation subscale of the Coping Strategies Questionnaire; GAD-2\u0026thinsp;=\u0026thinsp;Sum score of the Generalized Anxiety Disorder Scale; PDI\u0026thinsp;=\u0026thinsp;Sum score of the Pain Disability Index; PHQ-2\u0026thinsp;=\u0026thinsp;Sum score of the Patient Health Questionnaire for Depression; PHQ-15\u0026thinsp;=\u0026thinsp;Sum score of the Patient Health Questionnaire; TEX-Q\u0026thinsp;=\u0026thinsp;Treatment Expectations Questionnaire.\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eMultiple linear regression analyses of the three GEEE\u003c/em\u003e\u003csub\u003e\u003cem\u003eexpect\u003c/em\u003e\u003c/sub\u003e \u003cem\u003eitems.\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGEEE\u003csub\u003eexpect\u003c/sub\u003e_improvement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGEEE\u003csub\u003eexpect\u003c/sub\u003e_worsening\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGEEE\u003csub\u003eexpect\u003c/sub\u003e_complaints\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStand. Beta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain disability (PDI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain catastrophising (CSQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSomatic symptom impairment (PHQ-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState depression (PHQ-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.578\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState anxiety (GAD-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.898\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (in years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of symptoms (in months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eModell fit\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eSE of the Estimate\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e Change\u003c/p\u003e\n \u003cp\u003edf1/ df2\u003c/p\u003e\n \u003cp\u003eSig. Change in \u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.\u003c/p\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003cp\u003e8 / 384\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e Significant \u003cem\u003ep\u003c/em\u003e-values are in bold. CSQ\u0026thinsp;=\u0026thinsp;Sum score of the catastrophisation subscale of the Coping Strategies Questionnaire; GAD-2\u0026thinsp;=\u0026thinsp;Sum score of the Generalized Anxiety Disorder Scale; GEEE\u003csub\u003eexpect\u003c/sub\u003e = Generic Rating Scale for Treatment Expectations; PDI\u0026thinsp;=\u0026thinsp;Sum score of the Pain Disability Index; PHQ-2\u0026thinsp;=\u0026thinsp;Sum score of the Patient Health Questionnaire for Depression; PHQ-15\u0026thinsp;=\u0026thinsp;Sum score of the Patient Health Questionnaire.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOverall, our results emphasise the complexity of endometriosis and associated problems. The present study has two key findings: First, endometriosis-related pain disability and state anxiety are the strongest predictors of treatment expectations of women with endometriosis. Second, our study indicated that women with endometriosis are more physically and psychologically burdened than healthy subjects and are highly likely to develop major depression and general anxiety disorder.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eDiscussing Research Results\u003c/h2\u003e \u003cp\u003ePartly consistent with our first hypothesis, prior treatment experiences signifcantly predicted less negative expectations regarding complaints due to treatment. However, contrary to our remaining hypotheses, there were no further associations between treatment experiences and treatment expectations. These results do not align with the existing literature (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). For example, Newton and Cunningham (2012) stated in their article that previous experiences in a specific and related setting impact patients\u0026rsquo; expectations of the treatment process and outcome. However, there might be one primary reason our results did not completely support these findings. Our sample included only 78 patients with prior treatment experiences, and we did not differentiate with respect to the valence of previous treatment experiences.\u003c/p\u003e \u003cp\u003ePartly consistent with our second hypothesis, higher endometriosis-related pain disability significantly predicted more negative treatment expectations regarding adverse events, negative impact due to treatment, and impairment due to treatment. Findings suggest that patients with higher pain levels are more prone to negative expectations regarding treatment. These results align with the existing literature (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Ballou et al. (2018) suggested that baseline pain severity negatively impacts women with irritable bowel syndrome expectations. However, contrary to our second hypothesis, higher endometriosis-related pain disability also predicted more positive treatment expectations regarding positive impact due to treatment. This finding aligns with a study examining placebo effects in patients with neuropathic pain (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), where baseline pain level was the strongest predictor of a greater placebo response. Bivariate associations between endometriosis-related pain disability and different treatment expectations align with multiple linear regression analyses' results, showing ambiguous findings with small effect sizes. Those findings underline the complexity of the disease, especially with its subjective symptoms such as pain. Pain levels might predict positive treatment expectations in one woman and negative treatment expectations in another. We suggest future studies to validate our findings and better understand pain's impact on expectations in women with endometriosis.\u003c/p\u003e \u003cp\u003ePartly consistent with our third hypothesis, higher state anxiety significantly predicted less positive treatment expectations regarding overall treatment expectations, positive impact due to treatment, and satisfaction with the treatment. Additionally, higher state anxiety predicted more negative treatment expectations regarding adverse events. Findings suggest that patients with higher state anxiety are less prone to develop positive treatment expectations and more prone to develop negative treatment expectations. These results align with the current literature (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Corsi and Colloca (2017) stated that anxiety positively correlated with the nocebo response and, on the other hand, negatively with the placebo response. Bivariate associations between state anxiety and different treatment expectations align with our multiple linear regression analyses' results and the literature: Higher state anxiety was positively correlated with more negative treatment expectations and with less positive treatment expectations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe following strengths of the present work should be highlighted: The present study followed a naturalistic and observational approach. The sample size of 392 patients was large. Furthermore, treatment expectations were examined multidimensionally via different subscales of the TEX-Q and GEEE\u003csub\u003eexpect\u003c/sub\u003e. This approach allowed us to differentiate between positive and negative treatment expectations. Finally, the present study is the first to describe treatment expectations of women with diagnosed endometriosis and the factors that affect those expectations.\u003c/p\u003e \u003cp\u003eNevertheless, the following limitations should be considered: Firstly, we did not differentiate between the value of prior treatment experiences and could, therefore, not compare treatment expectations of patients who had negative treatment experiences with the ones who had positive treatment experiences. The small subsample size of 78 patients with prior treatment experiences did not allow for logical contributions into different groups that differentiated between the values of previous treatment experiences. We suggest that future research includes a higher sample size of patients with prior treatment experiences and differentiates between the value of those experiences. Secondly, there might be a sample bias in our study. Patients with negative preoperative experiences and expectations with and toward laparoscopy might not want an appointment for laparoscopy and, therefore, were not included in our sample. This sample bias might explain generally positive treatment expectations in our sample and should be considered when interpreting the results. Finally, present analyses are based on cross-sectional data and did not allow for examining causal relationships.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFuture Directions\u003c/h2\u003e \u003cp\u003eOur study results clarify treatment expectations of women with endometriosis and how they are impacted, especially of women at higher risk for developing negative treatment expectations. Understanding patients' treatment expectations and how they are affected seems promising in optimising the treatment of endometriosis. Therefore, a medical briefing about the effects of treatment expectations on treatment outcomes in clinical care with different standardised questions about patients' treatment expectations should be considered. Additionally, patients at higher risk for nocebo effects, for example, due to higher endometriosis-related pain disability or state anxiety, might significantly benefit from psychological interventions before laparoscopic surgery. For instance, in heart surgery, patients who received a brief psychological pre-surgery intervention to optimise outcome expectations (EXPECT) showed significant improvements in the treatment outcome (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe suggest two key aspects to be considered in future research. Firstly, we propose further research identifying treatment expectations of women with endometriosis and how they are impacted. Treatment expectations are multidimensional and often not fully portrayed by a universal questionnaire. Understanding patients' treatment expectations is crucial for optimising the treatment of endometriosis and options for implementing psychological interventions. Secondly, to further investigate the influence of treatment expectations and other psychological factors on patients' short- and long-term symptom course after laparoscopy, especially for those who are highly physically and psychologically burdened.\u003c/p\u003e \u003cp\u003eOur baseline results set the first step toward better understanding women with endometriosis and their treatment expectations. The running ROXWELL-study will consider these results. Furthermore, future study results will show whether women's preoperative and postoperative treatment expectations are met or if they change over time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eStudy results emphasise the importance of understanding women with endometriosis and identifying their treatment expectations to optimise treatment outcomes. Our findings highlight that women with higher pain disability and anxiety are especially prone to negative treatment expectations. These women might benefit from an adapted medical briefing before laparoscopy, psychoeducation, and clinical support to prevent negative treatment outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of Interest:\u0026nbsp;\u003c/strong\u003eThe authors have declared that no competing interests exist.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Psychotherapeutenkammer Hamburg, Germany (ROXWELL-2021-HH). The trial is preregistered at ClinicalTrials.gov (ID NCT05019612).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eInformed consent and\u0026nbsp;exemption from confidentiality\u0026nbsp;were obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe data supporting this study\u0026apos;s findings are openly available in PsychArchives at https://doi.org/10.23668/psycharchives.14428. The medical characteristics of the included individuals have been removed to ensure confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eThis work was funded by the internal research funding (IFF2020, 27/05/2020; grant to Prof. Dr. Yvonne Nestoriuc and Dr. Ann-Katrin Meyrose) of the Helmut-Schmidt-University/ University of the Federal Armed Forces Hamburg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eWe thank all patients who participated in this study for their time and involvement. We thank the staff of the \u003cem\u003eFrauenklinik an der Elbe\u003c/em\u003e and all psychology students who worked on the ROXWELL study for their support in the recruitment process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u0026nbsp;\u003c/strong\u003eNJ, AKM, YN, NH, and OB contributed to the study\u0026apos;s conception and design. NJ, NH, and OB collected data. NJ, AKM, and YN formulated the research questions and mainly interpreted the results. NJ analysed the data and wrote the manuscript. AKM, OB, and YN provided resources and supervision. All authors contributed to the manuscript revision and read and approved the submitted version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZondervan KT, Becker CM, Missmer SA, Endometriosis. New England Journal of Medicine [Internet]. 2020 Mar 26 [cited 2022 Jun 15];382(13):1244\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1056/NEJMra1810764\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1810764\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLa Rosa VL, Barra F, Chiofalo B, Platania A, Di Guardo F, Conway F et al. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. Journal of Psychosomatic Obstetrics \u0026amp; Gynecology [Internet]. 2020 Apr 2 [cited 2021 Nov 5];41(2):93\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tandfonline.com/doi/full/\u003c/span\u003e\u003cspan address=\"https://www.tandfonline.com/doi/full/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/0167482X.2019.1659775\u003c/span\u003e\u003cspan address=\"10.1080/0167482X.2019.1659775\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiannella L, Marconi C, Di Giuseppe J, Delli Carpini G, Fichera M, Grelloni C, et al. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers (Basel). 2021;13(16):4026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNnoaham KE, Hummelshoj L, Webster P, d\u0026rsquo;Hooghe T, de Cicco Nardone F, de Cicco Nardone C et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertility and Sterility [Internet]. 2011 Aug 1 [cited 2021 Nov 5];96(2):366\u0026ndash;373.e8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0015028211008764\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0015028211008764\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMechsner S. Endometriosis, an Ongoing Pain\u0026mdash;Step-by-Step Treatment. Journal of Clinical Medicine [Internet]. 2022 Jan [cited 2022 Jun 15];11(2):467. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2077-0383/11/2/467\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2077-0383/11/2/467\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThiel P, Burke M, Bridge-Cook P, Leonardi M. The placebo and nocebo effects in the treatment of endometriosis: a commentary [Internet]. Preprints; 2021 Feb [cited 2022 Jan 12]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.authorea.com/users/396926/articles/510001-the-placebo-and-nocebo-effects-in-the-treatment-of-endometriosis-a-commentary?commit=aa96cc3bc50cf512eff7e7997d0c00a8eca20418\u003c/span\u003e\u003cspan address=\"https://www.authorea.com/users/396926/articles/510001-the-placebo-and-nocebo-effects-in-the-treatment-of-endometriosis-a-commentary?commit=aa96cc3bc50cf512eff7e7997d0c00a8eca20418\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallagher JS, DiVasta AD, Vitonis AF, Sarda V, Laufer MR, Missmer SA. The impact of endometriosis on quality of life in adolescents. Journal of Adolescent Health [Internet]. 2018 Dec [cited 2021 Nov 5];63(6):766\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://search.ebscohost.com/login.aspx?direct=true\u0026amp;db=psyh\u0026amp;AN=2018-60660-009⟨=de\u0026amp;site=ehost-live\u0026amp;scope=site\u003c/span\u003e\u003cspan address=\"https://search.ebscohost.com/login.aspx?direct=true\u0026amp;db=psyh\u0026amp;AN=2018-60660-009⟨=de\u0026amp;site=ehost-live\u0026amp;scope=site\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarey ET, Martin CE, Siedhoff MT, Bair ED, As-Sanie S. Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis. International Journal of Gynecology \u0026amp; Obstetrics [Internet]. 2014 Feb 1 [cited 2022 Jun 15];124(2):169\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0020729213005766\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0020729213005766\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAuer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JAC, Broadbent E et al. Patients\u0026rsquo; Expectations Predict Surgery Outcomes: A Meta-Analysis. IntJ Behav Med [Internet]. 2016 Feb 1 [cited 2022 Jun 6];23(1):49\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s12529-015-9500-4\u003c/span\u003e\u003cspan address=\"10.1007/s12529-015-9500-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKube T, Glombiewski JA, Rief W. Using Different Expectation Mechanisms to Optimize Treatment of Patients With Medical Conditions: A Systematic Review. Psychosomatic Medicine [Internet]. 2018 Aug [cited 2022 Jan 11];80(6):535\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/psychosomaticmedicine/Abstract/2018/07000/Using_Different_Expectation_Mechanisms_to_Optimize.6.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/psychosomaticmedicine/Abstract/2018/07000/Using_Different_Expectation_Mechanisms_to_Optimize.6.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan Y, Meister R, L\u0026ouml;we B, Kaptchuk TJ, Buhling KJ, Nestoriuc Y. Open-label placebos for menopausal hot flushes: a randomized controlled trial. Sci Rep [Internet]. 2020 Nov 18 [cited 2022 Jul 15];10(1):20090. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nature.com/articles/s41598-020-77255-z\u003c/span\u003e\u003cspan address=\"https://www.nature.com/articles/s41598-020-77255-z\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShedden-Mora MC, Pan Y, Heisig SR, von Blanckenburg P, Rief W, Witzel I et al. Optimizing Expectations About Endocrine Treatment for Breast Cancer: Results of the Randomized Controlled PSY-BREAST Trial. Clinical Psychology in Europe [Internet]. 2020 Mar 31 [cited 2022 Jun 21];2(1):1\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cpe.psychopen.eu/index.php/cpe/article/view/2695\u003c/span\u003e\u003cspan address=\"https://cpe.psychopen.eu/index.php/cpe/article/view/2695\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRief W, Sperl MFJ, Braun-Koch K, Khosrowtaj Z, Kirchner L, Sch\u0026auml;fer L et al. Using expectation violation models to improve the outcome of psychological treatments. Clinical Psychology Review [Internet]. 2022 Dec 1 [cited 2024 Feb 28];98:102212. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0272735822000976\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0272735822000976\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColloca L. The Placebo Effect in Pain Therapies. Annu Rev Pharmacol Toxicol [Internet]. 2019 Jan 6 [cited 2022 Jun 27];59:191\u0026ndash;211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402571/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402571/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirsch I. Placebo Effect in the Treatment of Depression and Anxiety. Frontiers in Psychiatry [Internet]. 2019 [cited 2022 Jun 27];10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/article/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/article/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyt.2019.00407\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2019.00407\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetrie KJ, Rief W. Psychobiological Mechanisms of Placebo and Nocebo Effects: Pathways to Improve Treatments and Reduce Side Effects. Annual Review of Psychology [Internet]. 2019 [cited 2022 Jan 12];70(1):599\u0026ndash;625. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1146/annurev-psych-010418-102907\u003c/span\u003e\u003cspan address=\"10.1146/annurev-psych-010418-102907\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrizarry MC, Webb DJ, Ali Z, Chizh BA, Gold M, Kinrade FJ et al. Predictors of Placebo Response in Pooled Lamotrigine Neuropathic Pain Clinical Trials. The Clinical Journal of Pain [Internet]. 2009 Aug [cited 2023 Jun 7];25(6):469. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/clinicalpain/FullText/2009/07000/Predictors_of_Placebo_Response_in_Pooled.3.aspx?casa_token=uIkOHDPjsykAAAAA:EHROZv6x22Qh8s_z8UWYMOnhRXAiJk6u732dI1xYJWg_PVOg32pqsEuqqZAje_pQ13eisJ62oMPdyMkmLAa0mz3zMfM\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/clinicalpain/FullText/2009/07000/Predictors_of_Placebo_Response_in_Pooled.3.aspx?casa_token=uIkOHDPjsykAAAAA:EHROZv6x22Qh8s_z8UWYMOnhRXAiJk6u732dI1xYJWg_PVOg32pqsEuqqZAje_pQ13eisJ62oMPdyMkmLAa0mz3zMfM\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKube T, Glombiewski JA. How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment. Cogn Ther Res [Internet]. 2021 Jun 1 [cited 2022 Feb 16];45(3):517\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10608-020-10191-4\u003c/span\u003e\u003cspan address=\"10.1007/s10608-020-10191-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolich G, Iaccarino MA, Kaptchuk TJ, Morales-Quezada L, Zafonte R. Placebo Effects in Traumatic Brain Injury. Journal of Neurotrauma [Internet]. 2018 Jun [cited 2022 Jun 27];35(11):1205\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.liebertpub.com/doi/abs/\u003c/span\u003e\u003cspan address=\"https://www.liebertpub.com/doi/abs/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/neu.2017.5506\u003c/span\u003e\u003cspan address=\"10.1089/neu.2017.5506\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiantera V, Abesadze E, Mechsner S. How to Understand the Complexity of Endometriosis-Related Pain [Internet]. 2017 [cited 2023 Jun 7]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/full/10.5301/je.5000271\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/full/10.5301/je.5000271\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFacchin F, Barbara G, Saita E, Mosconi P, Roberto A, Fedele L et al. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. Journal of Psychosomatic Obstetrics \u0026amp; Gynecology [Internet]. 2015 Oct 2 [cited 2023 Jun 7];36(4):135\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/0167482X.2015.1074173\u003c/span\u003e\u003cspan address=\"10.3109/0167482X.2015.1074173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P et al. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis. Geburtshilfe Frauenheilkd [Internet]. 2014 Dec [cited 2022 Jun 21];74(12):1104\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1383187\u003c/span\u003e\u003cspan address=\"http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1383187\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbert U, Carmassi C, Cosci F, De Cori D, Di Nicola M, Ferrari S, et al. Role and clinical implications of atypical antipsychotics in anxiety disorders, obsessive-compulsive disorder, trauma-related, and somatic symptom disorders: A systematized review. Int Clin Psychopharmacol. 2016;31(5):249\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShedden-Mora MC, Alberts J, Petrie KJ, Laferton JAC, von Blanckenburg P, Kohlmann S et al. The Treatment Expectation Questionnaire (TEX-Q): Validation of a generic multidimensional scale measuring patients\u0026rsquo; treatment expectations. PLOS ONE [Internet]. 2023 Jan 23 [cited 2023 Aug 10];18(1):e0280472. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0280472\u003c/span\u003e\u003cspan address=\"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0280472\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRief W, Nestoriuc Y, Mueller EM, Hermann C, Schmidt K, Bingel U. Generic rating scale for previous treatment experiences, treatment expectations, and treatment effects (GEEE). 2021 Mar 23 [cited 2022 Feb 23]; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.psycharchives.org/en/item/a0bc93a2-9e03-4bba-97b0-8f478b2a39ca\u003c/span\u003e\u003cspan address=\"https://www.psycharchives.org/en/item/a0bc93a2-9e03-4bba-97b0-8f478b2a39ca\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDillmann U, Nilges P, Saile H, Gerbershagen HU. PDI - Pain Disability Index - deutsche Fassung. 2011 [cited 2022 Jun 14]; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.psycharchives.org/handle/20.500.12034/337.2\u003c/span\u003e\u003cspan address=\"https://www.psycharchives.org/handle/20.500.12034/337.2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain [Internet]. 1990 Feb 1 [cited 2022 Jun 14];40(2):171\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/030439599090068O\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/030439599090068O\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerra ML, Angst F, Lehmann S, Aeschlimann A, Translation. Cross-Cultural Adaptation, Reliability, and Validity of the German Version of the Coping Strategies Questionnaire (CSQ-D). The Journal of Pain [Internet]. 2006 May 1 [cited 2023 Jun 7];7(5):327\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S1526590005010357\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S1526590005010357\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGierk B, Kohlmann S, Toussaint A, Wahl I, Br\u0026uuml;nahl CA, Murray AM et al. Assessing somatic symptom burden: A psychometric comparison of the Patient Health Questionnaire\u0026mdash;15 (PHQ-15) and the Somatic Symptom Scale\u0026mdash;8 (SSS-8). Journal of Psychosomatic Research [Internet]. 2015 Apr 1 [cited 2023 Feb 16];78(4):352\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0022399914003869\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0022399914003869\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026ouml;we B, Kroenke K, Gr\u0026auml;fe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research [Internet]. 2005 Feb 1 [cited 2023 Jun 7];58(2):163\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0022399904006361\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0022399904006361\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStaples LG, Dear BF, Gandy M, Fogliati V, Fogliati R, Karin E et al. Psychometric properties and clinical utility of brief measures of depression, anxiety, and general distress: The PHQ-2, GAD-2, and K-6. General Hospital Psychiatry [Internet]. 2019 Jan 1 [cited 2023 Jun 7];56:13\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0163834318303712\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0163834318303712\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care [Internet]. 2003 [cited 2024 Jan 24];41(11):1284\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jstor.org/stable/3768417\u003c/span\u003e\u003cspan address=\"https://www.jstor.org/stable/3768417\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JBW, Monahan PO, L\u0026ouml;we B. Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection. Ann Intern Med [Internet]. 2007 Mar 6 [cited 2024 Jan 24];146(5):317\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acpjournals.org/doi/abs/\u003c/span\u003e\u003cspan address=\"https://www.acpjournals.org/doi/abs/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/0003-4819-146-5-200703060-00004\u003c/span\u003e\u003cspan address=\"10.7326/0003-4819-146-5-200703060-00004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS et al. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility [Internet]. 1997 May [cited 2022 Jul 22];67(5):817\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.scopus.com/inward/record.url?scp=0030999032\u0026amp;partnerID=8YFLogxK\u003c/span\u003e\u003cspan address=\"http://www.scopus.com/inward/record.url?scp=0030999032\u0026amp;partnerID=8YFLogxK\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaas D, Shebl O, Shamiyeh A, Oppelt P. The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses. Acta Obstetricia et Gynecologica Scandinavica [Internet]. 2013 [cited 2022 Jun 30];92(1):3\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://onlinelibrary.wiley.com/doi/abs/\u003c/span\u003e\u003cspan address=\"https://onlinelibrary.wiley.com/doi/abs/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/aogs.12026\u003c/span\u003e\u003cspan address=\"10.1111/aogs.12026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen J. The effect size. Statistical Power Analysis for the Behavioral Sciences [Internet]. 1988 [cited 2022 Jun 19];77\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cir.nii.ac.jp/crid/1572261550809239040\u003c/span\u003e\u003cspan address=\"https://cir.nii.ac.jp/crid/1572261550809239040\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMewes R, Rief W, Stenzel N, Glaesmer H, Martin A, Br\u0026auml;hler E. What is normal disability? An investigation of disability in the general population. Pain [Internet]. 2009 Mar 1 [cited 2022 Jul 23];142(1):36\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0304395908007045\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0304395908007045\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHinz A, Ernst J, Glaesmer H, Br\u0026auml;hler E, Rauscher FG, Petrowski K, et al. Frequency of somatic symptoms in the general population: Normative values for the Patient Health Questionnaire-15 (PHQ-15). J Psychosom Res. 2017;96:27\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagan\u0026agrave; AS, La Rosa VL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B et al. Anxiety and depression in patients with endometriosis: impact and management challenges. International Journal of Women\u0026rsquo;s Health [Internet]. 2017 Dec 31 [cited 2023 Aug 15];9:323\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.tandfonline.com/doi/abs/\u003c/span\u003e\u003cspan address=\"https://www.tandfonline.com/doi/abs/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IJWH.S119729\u003c/span\u003e\u003cspan address=\"10.2147/IJWH.S119729\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewton JT, Cunningham SJ. Great expectations: What do Patients Expect and how can Expectations be Managed? J Orthod [Internet]. 2013 Jun 1 [cited 2022 Jan 11];40(2):112\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/abs/10.1179/1465313312Y.0000000038\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/abs/10.1179/1465313312Y.0000000038\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBallou S, Beath A, Kaptchuk TJ, Hirsch W, Sommers T, Nee J et al. Factors Associated With Response to Placebo in Patients With Irritable Bowel Syndrome and Constipation. Clinical Gastroenterology and Hepatology [Internet]. 2018 Nov 1 [cited 2022 Jun 25];16(11):1738\u0026ndash;1744.e1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S1542356518303458\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S1542356518303458\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorsi N, Colloca L, Placebo, Effects N. The Advantage of Measuring Expectations and Psychological Factors. Frontiers in Psychology [Internet]. 2017 [cited 2023 Aug 16];8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2017.00308\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2017.00308\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRief W, Shedden-Mora MC, Laferton JAC, Auer C, Petrie KJ, Salzmann S et al. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Medicine [Internet]. 2017 Jan 10 [cited 2023 Nov 7];15(1):4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12916-016-0767-3\u003c/span\u003e\u003cspan address=\"10.1186/s12916-016-0767-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"expectancy, gynaecology, laparoscopy, quality of life, treatment","lastPublishedDoi":"10.21203/rs.3.rs-4303538/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4303538/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e. Endometriosis is still somewhat unknown to the general public, often overlooked and not treated satisfactorily. 20-30% of affected women report persistent pain disability even after successful surgical removal of endometriotic tissue via laparoscopy. Medical factors can not explain this symptom persistence. Therefore, psychological factors, such as treatment expectations, might play a role for treatment outcomes of endometriosis and women’s quality of life. This study aimed to characterise women with endometriosis, describe their treatment expectations before laparoscopy, and identify predictors of treatment expectations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e. This study characterizes a clinical cohort of \u003cem\u003eN\u003c/em\u003e = 393 women with endometriosis treated in a specialized endometriosis centre in Germany. Treatment expectations were assessed using the Treatment Expectation Questionnaire and the Generic Rating Scale for Treatment Expectations. Medical characteristics were evaluated with a self-conducted case report form.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e. Descriptive and multiple linear regression analyses with ten different treatment expectations as the dependent variable were conducted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. The mean endometriosis-related pain disability score was 30.77 ± 13.28, and the mean somatic symptom severity score was 15.61 ± 5.07. 40.2% (\u003cem\u003en\u003c/em\u003e = 158) of the participants had a high likelihood of having major depression, and 39.9% (\u003cem\u003en \u003c/em\u003e= 157) were highly likely to have a general anxiety disorder. Treatment expectations concerning the laparoscopy of participants were rather positive. Multiple linear regressions show that endometriosis-related pain disability and state anxiety predict treatment expectations of women with endometriosis. Medical characteristics were not significantly associated with treatment expectations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e. Affected women are highly physically and psychologically burdened, mostly over several years. \u0026nbsp;Patients with higher pain disability and anxiety are especially prone to negative treatment expectations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration Number: \u003c/strong\u003eID NCT05019612 (ClinicalTrials.gov), registration date August 25\u003csup\u003eth\u003c/sup\u003e.\u003c/p\u003e","manuscriptTitle":"Understanding Women With Endometriosis and Their Treatment Expectations: Baseline Results of a Clinical Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-30 20:47:02","doi":"10.21203/rs.3.rs-4303538/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-14T11:33:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-05T15:45:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-03-31T02:59:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-06T08:21:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294962279532797677032533662755219836936","date":"2024-07-31T05:52:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-24T03:00:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-23T23:43:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-23T23:43:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-04-22T06:18:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63270dc6-f86f-4da5-9d76-9d5cb5139103","owner":[],"postedDate":"April 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-22T02:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-30 20:47:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4303538","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4303538","identity":"rs-4303538","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}