Mediators and mechanisms of change in internet- and mobile-based interventions for depression: A systematic review

Domhardt, Matthias; Steubl, Lena; Boettcher, Johanna; Buntrock, Claudia; Karyotaki, Eirini; Ebert, David Daniel; Cuijpers, Pim; Baumeister, Harald

doi:10.1016/j.cpr.2020.101953

Cited by 70 publications

(89 citation statements)

References 139 publications

(208 reference statements)

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“…Next to these efforts toward precision medicine ( Cohen and DeRubeis, 2018 ) and “ precision digital health ” ( Domhardt et al, accepted ), important future directions for forthcoming research are on how to best improve interventions and maximize treatment outcomes. At that, involving the patients` perspective into intervention development ( Geirhos et al, submitted ; Holmes et al, 2018 ; Low and Manias, 2019 ) and disentangling the active ingredients of interventions by means of component and mediation studies ( Domhardt et al, 2020c ) might be key avenues, to increase the potential benefits of digital health interventions for youth with CC and other underserved populations.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

Domhardt

Schröder

Geirhos

et al. 2021

Internet Interventions

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Background Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC. Method Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' g (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy. Results A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy ( g = 0.38; 95% CI, 0.15 to 0.61; I 2 = 0) and combined disease-related outcomes ( g = −0.13; 95% CI, −0.25 to −0.01 ; I 2 = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies. Conclusion The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

Domhardt

Schröder

Geirhos

et al. 2021

Internet Interventions

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“…The rigorous health care services approach of PSYCHOnlineTHERAPY, embedded into standard care with even new billing codes as part of the underlying PNP contract for the new psychotherapeutic service of the Internetand mobile-based intervention modules will ensure the timely implementation of blended therapy into standard care, in case of PSYCHOnlineTHERAPY being effective and cost-effective. Moreover, the elaborated evaluation concept on moderators and mediators including a smart sensing sub-study, will provide deeper insights into the black box psychotherapy, i.e., the active components and the mechanisms of change (32,115) as well as the differential indication question on which type of psychotherapy and specific technique works for whom at what time in the treatment course (9,(116)(117)(118).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Cost-Effectiveness of PSYCHOnlineTHERAPY: Study Protocol of a Multicenter Blended Outpatient Psychotherapy Cluster Randomized Controlled Trial for Patients With Depressive and Anxiety Disorders

et al. 2021

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Introduction: Internet- and mobile-based interventions (IMIs) and their integration into routine psychotherapy (i.e., blended therapy) can offer a means of complementing psychotherapy in a flexible and resource optimized way.Objective: The present study will evaluate the non-inferiority, cost-effectiveness, and safety of two versions of integrated blended psychotherapy for depression and anxiety compared to standard cognitive behavioral therapy (CBT).Methods: A three-armed multicenter cluster-randomized controlled non-inferiority trial will be conducted comparing two implementations of blended psychotherapy (PSYCHOnlineTHERAPYfix/flex) compared to CBT. Seventy-five outpatient psychotherapists with a CBT-license will be randomized in a 1:1:1 ratio. Each of them is asked to include 12 patients on average with depressive or anxiety disorders resulting in a total sample size of N = 900. All patients receive up to a maximum of 16 psychotherapy sessions, either as routine CBT or alternating with Online self-help sessions (fix: 8/8; flex: 0–16). Assessments will be conducted at patient study inclusion (pre-treatment) and 6, 12, 18, and 24 weeks and 12 months post-inclusion. The primary outcome is depression and anxiety severity at 18 weeks post-inclusion (post-treatment) using the Patient Health Questionnaire Anxiety and Depression Scale. Secondary outcomes are depression and anxiety remission, treatment response, health-related quality of life, patient satisfaction, working alliance, psychotherapy adherence, and patient safety. Additionally, several potential moderators and mediators including patient characteristics and attitudes toward the interventions will be examined, complemented by ecological day-to-day digital behavior variables via passive smartphone sensing as part of an integrated smart-sensing sub-study. Data-analysis will be performed on an intention-to-treat basis with additional per-protocol analyses. In addition, cost-effectiveness and cost-utility analyses will be conducted from a societal and a public health care perspective. Additionally, qualitative interviews on acceptance, feasibility, and optimization potential will be conducted and analyzed.Discussion: PSYCHOnlineTHERAPY will provide evidence on blended psychotherapy in one of the largest ever conducted psychotherapy trials. If shown to be non-inferior and cost-effective, PSYCHOnlineTHERAPY has the potential to innovate psychotherapy in the near future by extending the ways of conducting psychotherapy. The rigorous health care services approach will facilitate a timely implementation of blended psychotherapy into standard care.Trial Registration: The trial is registered in the German Clinical Trials Register (DRKS00023973; date of registration: December 28th 2020).

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“…The findings of this qualitative study identified relevant intervention characteristics and potential change mechanisms from the patient perspective, which are to be verified with subsequent analyses within the evaluation of youthCOACH CD ( Domhardt et al, 2019 ; Steubl et al, 2019 ). A better understanding of the putative factors and mechanisms of change in IMI might contribute to the development of empirically-informed interventions for advanced treatment programs yielding more optimal treatment outcomes ( Domhardt et al, 2020b ).…”

Section: Discussionmentioning

confidence: 99%

Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study

Geirhos

Lunkenheimer

Holl

et al. 2021

Internet Interventions

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Objective A user-centered approach is critical for increasing the adherence to and effectiveness of an internet- and mobile-based intervention program. Therefore, potential future intervention users were involved in the development of an internet- and mobile-based cognitive behavioral therapy program (iCBT) for adolescents and young adults (AYA) with chronic medical conditions and comorbid symptoms of anxiety or depression. We aimed to identify challenges and coping strategies of the intended target group, as well as their needs and preferred intervention characteristics for an iCBT program. Methods Twenty AYA (aged 14–20, 60% females) with either type 1 diabetes (55%), juvenile idiopathic arthritis (25%) or cystic fibrosis (20%) were interviewed in condition-specific focus groups (4–11 participants per group) either via videoconferencing or face-to-face. Transcript verbatim data was analyzed using content analysis. Results Frequently reported disease-specific burdens were among others fear of disease progression, non-acceptance of disease and stressful incidents related to and aversions against medical therapy. Most frequently reported coping strategies included, seeking social support and accepting the disease. Recommendations for the content of an iCBT for comorbid symptoms of anxiety and depression comprised: dealing with disease-related fears and getting advice on health-promoting lifestyles. iCBT characteristics considered preferable by participants were: providing individual feedback by a real-person; implementation of a feature to monitor treatment progress; youthful and varied content presentation; time per session not exceeding 1 h; non-involvement of parents. A mobile-based reminder feature was considered useful, and individual tailoring and self-determination of iCBT content was considered desirable. Conclusions The findings highlight important patient perspectives and age-specific recommendations which can help design more optimal iCBT interventions for AYA with chronic medical conditions.

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Mediators and mechanisms of change in internet- and mobile-based interventions for depression: A systematic review

Cited by 70 publications

References 139 publications

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis

Clinical and Cost-Effectiveness of PSYCHOnlineTHERAPY: Study Protocol of a Multicenter Blended Outpatient Psychotherapy Cluster Randomized Controlled Trial for Patients With Depressive and Anxiety Disorders

Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study

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