Processes of change in digital interventions for depression: A meta-analytic review of cognitive and behavioral mediators

IF 4.2 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy Pub Date : 2025-04-03 DOI:10.1016/j.brat.2025.104735

Matthias Domhardt , Vera Mennel , Florian Angerer , Simon Grund , Axel Mayer , Rebekka Büscher , Lasse B. Sander , Pim Cuijpers , Yannik Terhorst , Harald Baumeister

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引用次数: 0

Abstract

The efficacy of digital interventions for depression has been established. In contrast, only limited knowledge on their change processes is currently available, and precise effect size estimates for mediators are pending. This study aimed to systematically review mediation studies and meta-analytically evaluate indirect effects of cognitive and behavioral mediators in digital interventions for adults with depression. The databases CENTRAL, Embase, MEDLINE, and PsycINFO were systematically searched for eligible randomized controlled trials. Two independent reviewers extracted the data, assigned mediators to eight categories and evaluated the methodological quality of included studies. Two-stage structural equation modeling was applied to synthesize indirect effects for cognitive and behavioral mediators. Overall, 25 studies (8110 participants) were eligible, which investigated 31 cognitive, 29 behavioral and 24 other mediators. Meta-analyses yielded significant indirect effects for combined cognitive mediators (ab = −0.068; 95 %-CI: [-0.093, −0.047]; k = 14 studies) and combined behavioral mediators (ab = −0.037; 95 %-CI: [-0.048, −0.028]; k = 13), but not for the specific cognitive mediators interpretation bias and dysfunctional attitudes. The systematic review revealed that all studies fulfilled at least five out of nine methodological quality criteria for psychotherapy process research, but the risk of bias assessment raised some concerns, particularly in regard to potential deviations from intended interventions. Overall, the findings of this meta-analytic review contribute to the understanding of the mechanisms of change in digital interventions for depression, and can inform the evidence-based advancement of future interventions.

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来源期刊

Behaviour Research and Therapy PSYCHOLOGY, CLINICAL-

CiteScore

7.50

自引率

7.30%

发文量

148

期刊介绍： The major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. This includes laboratory-based experimental studies with healthy, at risk and subclinical individuals that inform clinical application as well as studies with clinically severe samples. The following types of submissions are encouraged: theoretical reviews of mechanisms that contribute to psychopathology and that offer new treatment targets; tests of novel, mechanistically focused psychological interventions, especially ones that include theory-driven or experimentally-derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery. In addition to traditional psychological disorders, the scope of the journal includes behavioural medicine (e.g., chronic pain). The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.