Revealing subgroup-specific mechanisms of change via moderated mediation: A meditation intervention example.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of consulting and clinical psychology Pub Date : 2024-01-01 Epub Date: 2023-09-28 DOI:10.1037/ccp0000842

Christian A Webb, Matthew J Hirshberg, Oscar Gonzalez, Richard J Davidson, Simon B Goldberg

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引用次数: 0

Abstract

Objective: Effective psychosocial interventions exist for numerous mental health conditions. However, despite decades of research, limited progress has been made in clarifying the mechanisms that account for their beneficial effects. We know that many treatments work, but we know relatively little about why they work. Mechanisms of change may be obscured due to prior research collapsing across heterogeneous subgroups of patients with differing underlying mechanisms of response. Studies identifying baseline individual characteristics that predict differential response (i.e., moderation) may inform research on why (i.e., mediation) a particular subgroup has better outcomes to an intervention via tests of moderated mediation.

Method: In a recent randomized controlled trial comparing a 4-week meditation app with a control condition in school system employees (N = 662), we previously developed a "Personalized Advantage Index" (PAI) using baseline characteristics, which identified a subgroup of individuals who derived relatively greater benefit from meditation training. Here, we tested whether the effect of mindfulness acquisition in mediating group differences in outcome was moderated by PAI scores.

Results: A significant index of moderated mediation (IMM = 1.22, 95% CI [0.30, 2.33]) revealed that the effect of mindfulness acquisition in mediating group differences in outcome was only significant among those individuals with PAI scores predicting relatively greater benefit from the meditation app.

Conclusions: Subgroups of individuals may differ meaningfully in the mechanisms that mediate their response to an intervention. Considering subgroup-specific mediators may accelerate progress on clarifying mechanisms of change underlying psychosocial interventions and may help inform which specific interventions are most beneficial for whom. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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通过适度中介揭示特定亚组的变化机制：一个冥想干预的例子。

目的：针对多种心理健康状况，存在有效的心理社会干预措施。然而，尽管进行了几十年的研究，但在阐明其有益影响的机制方面进展有限。我们知道很多治疗方法都有效，但我们对它们为什么有效知之甚少。由于先前的研究在具有不同潜在反应机制的异质亚组患者中崩溃，变化机制可能会被掩盖。确定预测差异反应（即适度）的基线个体特征的研究可以通过适度中介测试为研究为什么（即中介）特定亚组对干预有更好的结果提供信息。方法：在最近的一项随机对照试验中，我们将为期4周的冥想应用程序与学校系统员工的对照条件进行了比较（N=662），我们之前使用基线特征开发了一个“个性化优势指数”（PAI），该指数确定了一组从冥想训练中获得相对更大益处的个体。在这里，我们测试了正念习得在调解组间结果差异中的作用是否受到PAI评分的调节。结果：一项显著的适度中介指数（IMM=1.22，95%CI[0.30，2.33]）显示，正念习得在中介组结果差异中的作用仅在PAI评分预测冥想应用程序相对更大益处的个体中显著。结论：个体的亚组在调节他们对干预的反应的机制上可能存在显著差异。考虑特定于亚组的中介可能会加速阐明心理社会干预措施背后的变化机制，并可能有助于告知哪些特定干预措施对谁最有利。（PsycInfo数据库记录（c）2023 APA，保留所有权利）。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.